Aromatase inhibitors for chemoprevention
Aromatase inhibitors for chemoprevention
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DOI：
10.1016/s1521-690x(03)00070-8
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发表时间：
2004-03-01
影响因子：
7.4
通讯作者：
Strasser-Weippl, K
中科院分区：
文献类型：
--
作者：
Goss, PE;Strasser-Weippl, K
临床前、分子和流行病学证据支持雌激素在乳腺癌的发生和促进中的作用。因此，拮抗雌激素被认为是降低风险的一种方法。他莫昔芬在雌激素受体上与雌激素竞争，已在四项III期临床试验中显示可大幅降低肿瘤发生率。芳香酶抑制剂在晚期疾病和新辅助和辅助治疗中的疗效和毒性方面均上级他莫昔芬。依西美坦可能是独特的，因为它的甾体结构可能保护骨和脂质代谢免受雌激素消融。正在进行的III期试验旨在测试抑制剂的疗效，包括IBIS 2试验（将阿那曲唑与安慰剂随机分组）和NCIC CTG MAP 3研究（将阿司美坦与塞来昔布或不与塞来昔布联合使用与安慰剂）。这些研究的疗效和毒性结果以及从中确定的风险情况令人感兴趣。
Pre-clinical, molecular and epidemiological evidence supports a role for estrogen in both the initiation and promotion of breast cancer. Antagonizing estrogen has therefore been proposed as one way of reducing risk. Tamoxifen, which competes with estrogen at the estrogen receptor, has been shown in four phase III clinical trials to reduce tumour occurrence substantially. Aromatase inhibitors are superior to tamoxifen in terms of both efficacy and toxicity in advanced disease and in the neoadjuvant and adjuvant setting. Exemestane may be distinct because its steroidal structure potentially protects bone and lipid metabolism from estrogen ablation. Phase three trials are ongoing to test the efficacy of the inhibitors, including the IBIS 2 trial which randomizes anastrozole against placebo and the NCIC CTG MAP3 study of exemestane with or without celecoxib against placebo. The efficacy and toxicity results of these studies, and the identification of risk profiles from them, are awaited with interest.