A 2009 Update on the Treatment of Patients with Hormone Receptor-Positive Breast Cancer
A 2009 Update on the Treatment of Patients with Hormone Receptor-Positive Breast Cancer
复制标题
DOI：
10.3816/cbc.2009.s.001
复制
发表时间：
2009-06-01
影响因子：
3.1
通讯作者：
Palmieri, Carlo
中科院分区：
文献类型：
--
作者：
Cleator, Susan J.;Ahamed, Eliyaz;Palmieri, Carlo
在高达75%的乳腺癌中，雌激素受体（ER）信号传导是肿瘤增殖的关键促进剂，抑制该途径具有明确的治疗效果。抑制ER信号传导的主要临床手段包括选择性ER调节剂，如他莫昔芬，其充当部分受体激动剂;降低雌激素循环水平的措施，包括卵巢消融、促性腺激素释放激素类似物和芳香酶抑制;以及抗雌激素氟维司群对ER的拮抗和下调。这些疗法中的每一种在一定比例的ER阳性乳腺癌中是有效的，但从头和获得性耐药仍然是重要的问题。ER信号传导生物学的新知识将提供对耐药机制的见解，并有助于指导治疗策略的发展，以最大限度地提高反应。本文综述了绝经前和绝经后妇女早期和晚期ER阳性乳腺癌的当代治疗，重点是最近发表或提交的数据。还将讨论对内分泌干预措施的抵抗机制和探索克服它们的策略的试验。
In up to 75% of breast cancers, estrogen receptor (ER) signaling is a key promoter of tumor proliferation, and inhibition of this pathway has clear therapeutic efficacy. The principal clinical means of inhibiting ER signaling comprise selective ER modulators, such as tamoxifen, that act as partial receptor agonists; measures to reduce the circulating level of estrogen, including ovarian ablation, gonadotropin-releasing hormone analogues, and aromatase inhibition; and antagonism and downregulation of ER by the antiestrogen fulvestrant. Each of these therapies is effective in a proportion of ER-positive breast cancers, but de novo and acquired resistance remain significant problems. Emerging knowledge of the biology of ER signaling will provide insights into the mechanisms of resistance and help guide development of therapeutic strategies to maximize response. This review summarizes the contemporary treatment of early-stage and advanced ER-positive breast cancer in premenopausal and postmenopausal women, with an emphasis on recently published or presented data. Mechanisms of resistance to endocrine interventions and trials exploring strategies to overcome them will also be discussed.