Benefits and adverse effects of endocrine therapy
Benefits and adverse effects of endocrine therapy
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DOI：
10.1093/annonc/mdq281
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发表时间：
2010-10-01
影响因子：
50.5
通讯作者：
Giobbie-Hurder, A.
中科院分区：
文献类型：
--
作者：
Colleoni, M.;Giobbie-Hurder, A.
小而无结节受累的内分泌反应性肿瘤(即被归类为PT1 pN0的肿瘤)是一组异质性肿瘤，在大多数病例中复发风险较低。因此，在这类患者中，应仔细考虑辅助性内分泌治疗的成本和收益。治疗决策应考虑到合并症以及其他经典危险因素的存在，如HER2过度表达或广泛的瘤周血管侵犯。他莫昔芬或他莫昔芬联合卵巢功能抑制应被认为是绝经前患者合适的内分泌治疗方法。仅抑制卵巢功能或卵巢消融术也可能被认为在选定的患者中是足够的(例如，在存在共病或患者偏好的情况下，极低风险患者)。芳香酶抑制剂应该成为大多数患有受体阳性乳腺癌的绝经后女性的标准内分泌治疗的一部分，尽管低风险或合并肌肉骨骼或心血管危险因素的患者可能被认为适合单独使用他莫昔芬。对于内分泌反应性肿瘤分类为PT1 pN0的患者，应考虑进行量身定制的内分泌治疗。关注安全性、生活质量和主观副作用的问题应该成为常规讨论。
Endocrine-responsive tumors that are small and without nodal involvement (i.e. tumors classified as pT1 pN0) are a heterogeneous group of tumors that are associated with a low risk of relapse in the majority of the cases. Therefore, the costs and benefits of adjuvant endocrine therapy should be carefully considered within this subgroup of patients. Treatment decisions should take into consideration co-morbidities as well as the presence of other classical risk factors such as HER2 overexpression or extensive peritumoral vascular invasion. Tamoxifen or tamoxifen plus ovarian function suppression should be considered as proper endocrine therapies in premenopausal patients. Ovarian function suppression alone or ovarian ablation might also be considered adequate in selected patients (e.g. very low-risk patients, in the presence of co-morbidities or patient preference). An aromatase inhibitor should form part of standard endocrine therapy for most postmenopausal women with receptor-positive breast cancer, although patients at low risk or with co-morbid musculoskeletal or cardiovascular risk factors may be considered suitable for tamoxifen alone. Tailored endocrine treatments should be considered in patients with endocrine-responsive tumors classified as pT1 pN0. Issues focusing on safety, quality of life and subjective side effects should be routinely discussed.