Tailored Treatments for Premenopausal Patients with Endocrine Responsive Breast Cancer.

对于50岁以下的激素受体阳性(ER+)乳腺癌患者，化疗、他莫昔芬和卵巢切除的辅助治疗都是有效的，并可减少复发。联合两种疗法比一种疗法更有效，尽管目前还不确定联合三种疗法是否会带来额外的好处。通过手术或放射进行卵巢消融是永久性的，但现在可以通过注射进行可逆的卵巢抑制。三个名为Soft、Text和Perche的国际试验被设计用于对患有ER+乳腺癌的绝经前妇女进行辅助治疗。这些试验考虑了医疗实践中的区域国家差异和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、计划使用他莫昔芬但在化疗后尚未进入更年期的女性中添加卵巢抑制的好处。这项试验还测试了用一种名为西美坦的新药取代他莫昔芬，并联合抑制卵巢功能是否更有效。TEXT是为那些通常接受卵巢抑制加他莫昔芬治疗的女性准备的。文本试验还测试了西美坦替代他莫昔芬的作用。依西美坦是一种芳香酶抑制剂。芳香酶抑制剂可以降低雌激素水平，但只有在卵巢不活跃时才起作用。最近在绝经后妇女中的试验表明芳香酶抑制剂比他莫昔芬更有效，我们的目标是通过将西西美坦与卵巢抑制相结合在年轻女性中复制这一改善。Perche是为化疗的益处不确定的女性提供的，例如，那些淋巴结转移有限或没有扩散的女性。所有女性都接受内分泌治疗和卵巢抑制加他莫昔芬的联合治疗，并随机接受另外的化疗或不化疗，看看结果是否不同。

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.