药物去势在绝经前乳腺癌内分泌治疗中的应用  

Application of Medical Castration in Endocrine Therapy for Premenopausal Breast Carcinoma

作　　者：陈道宝[1] 杨红健[1] 

机构地区：[1]浙江省肿瘤医院,浙江杭州310022

出　　处：《中国肿瘤》2015年第5期413-420,共8页China Cancer

基　　金：浙江省卫计委科研项目(2011RCB010)

摘　　要：乳腺癌发生、发展与雌激素作用密切相关,特别是激素敏感性乳腺癌。促黄体生成素释放激素类似物(LHRHa)在垂体水平阻断卵巢雌激素的合成达到去势效应,并可联合他莫昔芬或芳香化酶抑制剂,降低雌激素的生物利用,达到治疗乳腺癌的目的。临床试验结果显示LHRHa单用等效于CMF化疗,与他莫昔芬单药相似;LHRHa联合他莫昔芬可进一步提高疗效,LHRHa联合依西美坦疗效优于联合他莫昔芬。药物去势的主要副作用为潮热、体重增加,而恶心、呕吐、脱发等副作用明显低于化疗,治疗期间生存质量优于化疗。LHRH类似物在绝经前乳腺癌术后辅助内分泌治疗中尚有诸多未解决的问题,有待更多的临床试验结果为临床实践提供充分的证据。Breast cancer＇s occurrence and development are closely related to estrogen ,especially hormone sensitive breast carcinoma. Luteinizing hormone releasing hormone （LHRH） agonists combined with tamoxifen or aromatase inhibitors, can reduce the activity of estrogen receptor by decreasing its amount or blocking it to achieve the aim of curing breast carinoma. The priority of medical castration has been emphasized on endocrine therapy for premenopausal breast carcinoma. Medical castration with LHRHa alone,has been shown to be as effective as chemotherapy （CMF-- cyclophosphamide ,methotrexate ,fluorouracil-containing regimens） in some patient. The combina- tion of LHRHa and tamoxifen might confer additional benefit, while the latest data showed that LHRHa＇s combined with exemestane significantly reduced the risk of recurrence compared to the combination with tamoxifen. The main adverse effects,including hot flushes,weight gain,were no- ticed in medical castration, while nausea, vomiting, hair loss and other side effects during treatment is significantly lower than that of chemotherapy. Although LHRH agonists has been used for many years in endocrine therapy for premenopausal women with breast cancer,but it remains many un- knowns regarding its optimal use. Ongoing trials could provide sufficient evidence to our clinical practice.

关 键 词：乳腺癌 药物去势 绝经前 LHRH类似物 

分 类 号：R737.9[医药卫生—肿瘤]