延长辅助内分泌治疗在激素受体阳性早期乳腺癌治疗中的价值

摘要

Estrogen receptor positive early breast cancer has been associated with a recurrence risk.The MA.17 trial demonstrated improved disease-free survival(DFS)with use of letrozole for 5 years after some years of tamoxifen and an overall survival advantage for this approach in women with node-positive oestrogen receptor-positive cancer at diagnosis.The recently reported MA.17R trial randomized women who had already completed 5 years of aromatase in-hibitor therapy with or without previous tamoxifen to further 5 years of letrozole or placebo.DFS was significantly im-proved in the extended letrozole group.The absolute benefit in terms of reduced distant recurrences in these studies is modest,and tolerability and compliance challenges remain.Extended therapy with either tamoxifen or letrozole should be considered for all and decision based on menopausal status,individual risk,tolerance and magnitude of potential benefit.%雌激素受体(estrogen receptor,ER)阳性早期乳腺癌的复发风险一直存在.MA.17试验证明,在淋巴结阳性、雌激素受体阳性的乳腺癌患者中,常规应用5年来曲唑治疗后继续应用他莫昔芬治疗,其无病生存期(disease-free survival,DFS)和整体生存期(overall survival,OS)都得到了明显改善.MA.17R试验证明,完成5年芳香化酶抑制剂治疗的患者,继续随机应用来曲唑或安慰剂,来曲唑组的DFS明显改善.在这些研究中,延长内分泌治疗能减少远期复发的绝对益处是适度的,然而其耐受性和依从性的挑战依然存在.对于完成5年常规内分泌治疗的患者,最终是选择他莫昔芬还是来曲唑来延长治疗,主要应该考虑患者的绝经状态、淋巴结情况、耐受性和潜在的利益大小这些因素.