Endocrine effects of adjuvant chemotherapy and long-term tamoxifen administration on node-positive patients with breast cancer.
Endocrine effects of adjuvant chemotherapy and long-term tamoxifen administration on node-positive patients with breast cancer.
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辅助化疗和长期服用他莫昔芬对淋巴结阳性乳腺癌患者的内分泌影响。
作者：
V. Jordan;N. F. Fritz;D. Tormey
测定绝经前和绝经后乳腺癌患者在辅助化疗或化疗加他莫昔芬（TAM）期间的卵巢和垂体激素水平。化疗不影响绝经后患者的促性腺激素水平；然而，在治疗方案中加入TAM可部分（约50%）降低黄体生成素（LH）和促卵泡激素的循环水平。只要TAM继续治疗，促性腺激素水平就会降低，然后上升到绝经后的水平。化疗（6-12个月）导致绝经前患者卵巢功能衰竭，雌激素（雌酮加雌二醇）下降，促性腺激素水平上升至绝经后水平。在治疗方案中加入TAM导致卵巢衰竭前（治疗6-9个月）循环雌激素峰值初始升高3倍。一些较年轻的患者（大约40岁）在接受短期化疗（4个月）加TAM治疗后，继续单独使用TAM治疗，恢复了排卵周期。与对照组相比，雌激素、黄体酮和促卵泡激素水平升高。与单独接受化疗的患者相比，辅助化疗加TAM的卵巢功能衰竭患者促性腺激素仅部分升高。TAM在治疗期间维持促性腺激素水平，此时它们上升到绝经后水平。尽管TAM对促性腺激素表现出雌激素样作用，但绝经前或绝经后患者的循环催乳素水平没有雌激素样增加。1例患者在长期他莫昔芬治疗期间出现雌激素受体阳性复发。他莫昔芬及其代谢物的血清水平在复发前一年下降，这与促性腺激素升高有关。这表明患者不遵医嘱。依从性可以直接监测血清TAM水平或通过系列促性腺激素测定。我们认为，TAM的最佳抗肿瘤活性将在低雌激素环境下实现，在血清中持续高水平的药物。我们建议接受长期TAM治疗的患者监测完全卵巢功能衰竭和药物依从性。
Ovarian and pituitary hormones were determined in pre- and postmenopausal breast cancer patients before and at intervals during adjuvant chemotherapy or chemotherapy plus tamoxifen (TAM). Chemotherapy did not affect gonadotrophin levels in postmenopausal patients; however, inclusion of TAM in the regimen produced a partial (approximately 50%) reduction in circulating levels of luteinizing hormone (LH) and follicle-stimulating hormone. Gonadotrophin levels remained reduced as long as TAM therapy continued, at which time they rose to postmenopausal values. Chemotherapy (6-12 months) caused ovarian failure in premenopausal patients with decreases in estrogen (estrone plus estradiol) and rises in gonadotrophin levels to postmenopausal levels. Inclusion of TAM in the regimen caused an initial 3-fold rise in peak circulating estrogen levels before ovarian failure (6-9 months of therapy). Some younger patients (approximately 40 years of age) who had a short course (4 months) of chemotherapy plus TAM followed by continuous TAM therapy alone resumed ovulatory menstrual cycles. Estrogen, progesterone, and follicle-stimulating hormone levels were increased compared with control subjects. Those patients who experienced ovarian failure with adjuvant chemotherapy plus TAM only had a partial rise in gonadotrophins compared with patients receiving chemotherapy alone. TAM maintained the levels of gonadotrophins for as long as therapy was administered, at which time they rose to postmenopausal levels. Although TAM exhibited estrogen-like effects on gonadotrophins there was no estrogen-like increase in circulating prolactin levels in either pre- or postmenopausal patients. One patient experienced an estrogen receptor-positive recurrence during long-term tamoxifen therapy. Serum levels of tamoxifen and metabolites declined in the year prior to the recurrence and this was associated with a rise in gonadotrophins. This indicated noncompliance by the patient. Compliance can be monitored either directly with serum levels of TAM or by serial gonadotrophin determinations. We suggest that the optimal antitumor activity of TAM will be achieved in a low estrogen environment with continuous high levels of the drug in the serum. We recommend that patients undergoing long-term TAM therapy be monitored for complete ovarian failure and drug compliance.
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他莫昔芬辅助治疗患有 II 期乳腺癌的老年女性。
影响因子：
39.2
作者：
Cummings,FJ;Gray,R;Davis,TE;Tormey,DC;Harris,JE;Falkson,G;Arseneau,J
通讯作者：
Arseneau,J
影响因子：
11.2
作者：
C. Osborne;C. Osborne;D. Boldt;G. Clark;J. Trent
通讯作者：
C. Osborne;C. Osborne;D. Boldt;G. Clark;J. Trent
淋巴结阳性乳腺癌女性的术后化疗和化学激素治疗。
DOI：
--
发表时间：
1986
期刊：
NCI monographs : a publication of the National Cancer Institute
影响因子：
--
作者：
Tormey,DC;Gray,R;Taylor4th,SG;Knuiman,M;Olson,JE;Cummings,FJ
通讯作者：
Cummings,FJ
影响因子：
11.2
作者：
C. Osborne;K. Hobbs;G. Clark
通讯作者：
C. Osborne;K. Hobbs;G. Clark
辅助化学激素治疗对乳腺癌患者卵巢和肾上腺功能的影响。
影响因子：
11.2
作者：
Rose,DP;Davis,TE
通讯作者：
Davis,TE