ALTERATION OF ENDOCRINE PARAMETERS IN PREMENOPAUSAL WOMEN WITH BREAST-CANCER DURING LONG-TERM ADJUVANT THERAPY WITH TAMOXIFEN AS THE SINGLE AGENT
ALTERATION OF ENDOCRINE PARAMETERS IN PREMENOPAUSAL WOMEN WITH BREAST-CANCER DURING LONG-TERM ADJUVANT THERAPY WITH TAMOXIFEN AS THE SINGLE AGENT
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DOI：
10.1093/jnci/83.20.1488
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发表时间：
1991-10-16
期刊：
影响因子：
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通讯作者：
TORMEY, DC
中科院分区：
文献类型：
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作者：
JORDAN, VC;FRITZ, NF;TORMEY, DC
他莫昔芬用于治疗乳腺癌每个阶段的选定患者。尽管绝经后妇女获得了大部分临床经验，但越来越多的绝经前妇女将在手术后接受5年或更长时间的三苯氧胺辅助治疗。事实上，在高危妇女中使用他莫昔芬预防乳腺癌的提议可能会导致其在育龄期间的延长使用。我们监测了绝经前(41-47岁)I期或II期乳腺癌患者在乳腺癌切除术后4-72个月单用三苯氧胺辅助治疗期间卵巢和脑下垂体循环激素水平的变化。每例患者(共8例)继续月经，并发生排卵。黄体生成素和卵泡刺激素的循环水平(除一名妇女外)保持在正常范围(对照组中12名有规律月经的妇女测定)。雌二醇、雌酮和孕酮的水平增加了一到三倍。催乳素水平下降30%-40%，但性激素结合球蛋白水平不受影响。这些数据表明，绝经前服用他莫昔芬的妇女有潜在的怀孕风险，必须接受屏障避孕的咨询。此外，必须评估他莫昔芬多年来对卵巢刺激的影响，特别是在患有结节阴性疾病的妇女或使用他莫昔芬预防乳腺癌的健康妇女中。
Tamoxifen is used to treat selected patients at each stage of breast cancer. Although most clinical experience has been obtained with postmenopausal women, increasing numbers of premenopausal women will be treated with 5 or more years of adjuvant tamoxifen therapy following surgery. Indeed, the proposed use of tamoxifen to prevent breast cancer in high-risk women could result in its extended use during the childbearing years. We have monitored the changes in circulating hormone levels from the ovary and pituitary gland in premenopausal (41-47 years old) women with stage I or II breast cancer during adjuvant therapy with tamoxifen as the single agent for 4-72 months following a mastectomy. Each patient (total eight) continued to menstruate, and ovulation occurred. Circulating levels of luteinizing hormone and follicle-stimulating hormone (except in one woman) remained in the normal range (determined in 12 regularly menstruating women in a control group). The levels of estradiol, estrone, and progesterone were elevated onefold to threefold. Prolactin levels decreased by 30%-40%, but the levels of sex hormone binding-globulin were unaffected. These data demonstrate that premenopausal women taking tamoxifen are potentially at risk for pregnancy and must be counseled about barrier contraception. Furthermore, the impact of many years of ovarian stimulation by tamoxifen must be evaluated, especially in women with node-negative disease or in healthy women in whom tamoxifen is used to prevent breast cancer.