Chemoprevention of breast cancer: tamoxifen, raloxifene, and beyond.
Chemoprevention of breast cancer: tamoxifen, raloxifene, and beyond.
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DOI：
10.1097/00045391-200607000-00011
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发表时间：
2006-07-01
影响因子：
4.2
通讯作者：
Stearns, Vered
中科院分区：
文献类型：
--
作者：
Bao, Ting;Prowell, Tatiana;Stearns, Vered
乳腺癌是最常见的癌症，也是美国女性癌症死亡的第二大常见原因。虽然非随机研究报告说，预防性乳房切除术或卵巢切除术可以显着降低乳腺癌的风险，这些方法是不能接受的大多数妇女。化学预防，其定义为通过抑制或逆转致癌过程的药物预防癌症，因此日益成为乳腺癌预防工作的重点。第一代选择性雌激素受体调节剂（SERM）他莫昔芬是美国食品和药物管理局批准的唯一用于预防乳腺癌的药物，可将高危女性患乳腺癌的风险降低50%。雷洛昔芬，第二代SERM，也被证明对乳腺癌预防有效，并在最近完成的一项大型随机试验中与他莫昔芬进行了比较。芳香化酶抑制剂（AIs）用于辅助治疗时可降低对侧乳腺癌的发病率，目前正在进行的一级预防研究中进行评估。此外，一些新的药物，包括抗抑郁药和类维生素A衍生物，根据临床前和流行病学数据，这些药物似乎很有希望，目前正在研究之中。仍然存在一些重要的挑战，包括确定在初级预防环境中使用时的适当剂量和治疗持续时间，以及使用乳腺癌发病率和死亡率的替代终点开发新的研究模型，以允许更快地临床应用有前途的新药物。
Breast cancer is the most common cancer and the second most common cause of cancer death among women in the United States. While nonrandomized studies have reported that prophylactic mastectomy or oophorectomy can significantly reduce the risk of breast cancer, these approaches are unacceptable to the majority of women. Chemoprevention, which is defined as the prevention of cancer by pharmacological agents that inhibit or reverse the process of carcinogenesis, has thus increasingly become the focus of breast cancer prevention efforts. The first-generation selective estrogen receptor modulator (SERM) tamoxifen is the only US Food and Drug Administration- approved drug for breast cancer prevention and reduces the risk of breast cancer by as much as 50% in high-risk women. Raloxifene, a second-generation SERM, also has demonstrated efficacy for breast cancer prevention and is being compared with tamoxifen in a large randomized trial that has recently completed accrual. The aromatase inhibitors (AIs) decrease the incidence of contralateral breast cancer when used in the adjuvant setting and are being evaluated in ongoing primary prevention studies. In addition, a number of novel agents, including antiinflammatory drugs and retinoid derivatives, which appear to be of promise based on preclinical and epidemiological data, are under investigation. Several important challenges remain, including determination of the appropriate dose and duration of treatment when used in the primary prevention setting and development of new research models using surrogate end points for breast cancer incidence and mortality to permit more rapid clinical application of promising new agents.