Tailored Treatments for Premenopausal Patients with Endocrine Responsive Breast Cancer.

对于50岁以下的雌激素受体阳性（ER+）乳腺癌患者，化疗、他莫昔芬和卵巢消融术等辅助治疗均有效，可减少复发。结合两种治疗比一种更有效，尽管不确定结合三种治疗是否会带来额外的好处。卵巢消融手术或放疗是永久性的，但可逆的卵巢抑制注射现在是可行的。三个名为SOFT， TEXT和PERCHE的国际试验被设计用于绝经前ER+乳腺癌妇女的辅助治疗。这些试验考虑到地区和国家在医疗实践方面的差异以及在这种情况下患者的不同选择。SOFT适用于非常年轻的女性，并测试在接受化疗的女性中添加卵巢抑制的益处，计划使用他莫昔芬，但化疗后没有进入更年期。该试验还测试了用一种名为依西美坦的新药替代他莫昔芬并联合抑制卵巢功能是否更有效。TEXT适用于通常使用卵巢抑制加他莫昔芬治疗的女性。TEXT试验还测试了依西美坦替代他莫昔芬。依西美坦是一种芳香酶抑制剂。芳香酶抑制剂降低雌激素水平，但只有在卵巢不活跃时才有效。最近对绝经后妇女的试验显示芳香酶抑制剂比他莫昔芬更有效，我们的目标是通过将依西美坦与卵巢抑制相结合，在年轻妇女中复制这种改善。PERCHE适用于化疗效果不确定的妇女，例如淋巴结扩散有限或没有扩散的妇女。所有的女性都接受了联合内分泌治疗、卵巢抑制和他莫昔芬，并随机分组接受化疗或不接受化疗，以观察结果是否不同。

For women under 50 years with hormone receptor positive (ER+) breast cancer, adjuvant treatment with chemotherapy, tamoxifen and ovarian ablation are each effective and reduce recurrence. Combining two treatments is more effective than one, although it is uncertain if combining three provides extra benefit. Ovarian ablation by surgery or radiation is permanent, but reversible ovarian suppression by injections is now available. Three international trials called SOFT, TEXT and PERCHE have been designed for adjuvant therapy of premenopausal women with ER+ breast cancer. These trials take into account regional-country variations in medical practice and different patient choices in this setting. SOFT is for very young women and tests the benefit of adding ovarian suppression in a woman who has received chemotherapy, with tamoxifen planned, but who has not gone into menopause after chemotherapy. The trial also tests if substituting a newer drug called exemestane for tamoxifen, combined with ovarian function suppression is more effective. TEXT is for women who would ordinarily be treated with ovarian suppression plus tamoxifen. The TEXT trial also tests substitution of exemestane for tamoxifen. Exemestane is an aromatase inhibitor. Aromatase inhibitors lower oestrogen levels, but only work if the ovaries are inactive. Recent trials in post menopausal women show aromatase inhibitors are more effective than tamoxifen, and we aim to replicate that improvement in younger women by combining exemestane with ovarian suppression. PERCHE is for women in whom the benefit of chemotherapy is uncertain, for example those with limited or no spread to lymph nodes. All women receive combined endocrine treatment with ovarian suppression plus tamoxifen, and are randomised to receive in addition, either chemotherapy or no chemotherapy, to see if results differ.