Objective To determine the investigation progression on exemestane in the treatment of breast cancer. Methods The literatures of recent years on the studies of exemestane were reviewed. Results Exemestane is an effective steroidal aromatase inactivator with superior tolerability, safety and efficacy in the adjuvant, neo-adjuvant and metastatic therapy of breast cancer. Conclusion With the progression of clinical trial with exmestane, exemestane will be regarded as an important drug in comprehensive therapy of breast cancer.
【摘要】 目的 探讨老年性乳腺癌术前内分泌治疗效果及降期后手术优点。 方法 2004年5月－2010年12月19例老年性局部晚期乳腺癌患者，术前给予口服芳香化酶抑制剂（aromatase inhibitors，AI）2～10个月，进行疗效观察，降期后手术及术后同一有效内分泌药物继续治疗并随访，时间1～66个月。 结果 自AI治疗开始至手术时，临床完全缓解2例，部分缓解11例，稳定3例，进展3例；手术14例，另5例由于全身状况差、基础疾病严重不能耐受手术或局部进展而放弃手术，5年总生存率68%，无瘤生存率47%。 结论 术前内分泌治疗疗效可靠，不良反应轻，特别适应老年伴有内科疾病不适应化学疗法的患者，可以增加保乳手术率和手术切除率。【Abstract】 Objective To investigate the clinical value of neo-adjuvant endocrine therapy for locally advanced breast cancer in elderly patients and the advantages of operation after down-staging of breast cancer. Methods From May 2004 to December 2010, 19 patients with locally advanced breast cancer were treated with Aromatase inhibitor (AI) neo-adjuvant endocrine therapy for 2 to 10 months before operation. The clinical efficacy was observed. Operation was performed after down-staging of the cancer. After the operation, patients continued taking the same effective drug and were followed-up for 1 to 66 months. Results From AI treatment to the time of operation, there were 2 cases of clinical complete response, 11 cases of clinical partial response, 3 cases of stable disease, and 3 cases of progressive disease. A total of 14 patients were operated, and 5 other patients could not have the operation for bad body conditions, serious basic-diseases or local progress of the disease. The 5-year overall survival rate was 68%, and the disease-free survival rate was 47%. Conclusion Neo-adjuvant endocrine therapy has a reliable clinical effect and low side-effects. It is especially suitable for elderly patients excluded from chemotherapy because of internal medical diseases. It can also increase the rate of breast-conserving and surgical excision.
Objective To investigate the trend of breast cancer treatment and prognosis in 30 years. Methods Total 1 092 patients with breast cancer treated in the Peking Union Medical College Hospital between 1975 and 2006 were reviewed in six time phases for therapy, metastasis, and survival rate. Six time phases were 1975-1980 years, 1985-1986 years, 1990-1991 years, 1995-1996 years, 2000-2001 years and 2005-2006 years. Results Radical operation was the major treatment (68.9%， 91/132) of breast cancer in 1975-1980 and then became less popular until it was totally abandoned after 2001. The number of modified radical operation begun to rise from 1980 and reached its peak in 1995-1996 (94.9%， 146/154). The number of lumpectomy had been increasing since 2000, and that of chemotherapy had been rising since 1985-1986. But there was no apparent change of the percentage of radiotherapy treatment. In 1975-1980, only 0.8% （1/126） patients received endocrine therapy, but in 1990-1991, the ratio was 66.0% （33/50）. The metastasis and recurrence ratio was declining gradually in the 6 time phases (P＜0.05). The 5-year and 10-year disease free survival rates in the groups of 1990-1991, 1995-1996, 2000-2001, and 2005-2006 were apparently higher than those in two earlier groups of 1975-1980 and 1985-1986 (P＜0.05). Conclusion The conclusions of laboratory experiments and clinical trials on breast cancer are critical for improving prognosis.
Objective To study the risk factors for contralateral breast cancer (CBC) in women after regular treatment of the primary breast cancer. Methods Between January 1997 to December 2002, the clinical data of 340 breast cancer patients at our institution were retrospectively analyzed. In all the patients a detailed analysis was carried out with respect to age, operation type, radiation therapy technique and dose, the use of chemotherapy or hormone therapy, and other clinicopathologic characteristics. The KaplanMeier method was used to estimate the actuarial rate of CBC. The Cox proportional hazard regression model was used to estimate the relative risk factors of CBC. Results Fourteen cases were diagnosed to be CBC, thus overall incidence of CBC was 4.1%. Ten-year CBC incidence (2.7%) was higher than 5-year incidence of CBC (1.4%). Univariate analysis showed that the risk factors of CBC at 5-year and 10-year included: ≤45 years old, medullary carcinoma, family history of breast cancer and being taken without endocrine therapy (P＜0.05), while chemotherapy and radiotherapy were not risk factors of CBC (P＞0.05). Mutivariate analysis showed that ≤ 45 years old and being internal breast radiotherapy were independent risk factors of CBC at 5-year and 10-year (P＜0.05). Conclusions CBC may occur in these primary breast cancer patients with age ≤45 years old, medullary carcinoma, family history of breast cancer. In order to reduce the incidence of CBC, endocrine therapy rather than internal breast radiotherapy should be performed in early breast cancer patients.
ObjectiveTo summarize progression of growth factor receptor (GFR) signaling pathway in endocrineresistant breast cancer. Method Literatures about mechanisms of GFR signaling pathway in the development of endocrineresistant breast cancer were reviewed. ResultsThe crosstalk between GFR and estrogen receptor (ER) signaling pathway had been reported to be involved in the development of endocrine-resistant breast cancer. Interrupting this signaling pathway could overcome endocrine therapy resistance. Many clinical trails had shown that the utilizing endocrine therapy combined with GFR inhibitors could obviously increase the survival rate of patients with breast cancer. ConclusionSeveral agents targeting GFR signaling pathways show a great potential for treatment of patients with breast cancer.
Objective To explore therapeutic effect of endocrine therapy in breast cancer patients with negative hormone receptor (HR–) of primary lesion and positive HR (HR+) of metastatic axillary lymph node lesion. Methods Sixty-seven cases of breast cancer with HR– of primary lesion and HR+ of metastatic axillary lymph node lesion from January 2011 to January 2016 were selected. All the patients were randomly divided into endocrine therapy group (33 cases) and control group (34 cases). The patients were given the oral drug of tamoxifen on the basis of conventional chemotherapy in the endocrine therapy group after the surgery, 10 mg/time, twice daily, 5 years; while the patients in the control group were not given the oral drug of tamoxifen but the other therapy same as the endocrine therapy group. The survivals were compared in both groups. Results There were no significant differences in the age, menstrual condition, tumor diameter, preoperative TNM stage, and so on between the endocrine therapy group and the control group (P>0.05). All the patients were followed up for 12–60 months with a 48.5 months of median time. There were no significant differences in the rates of the local recurrence and metastasis, or death rate due to the recurrence and metastasis in both groups (P>0.05). The progression-free survival and overall survival in the endocrine therapy group were significantly higher than those in the control group (P<0.05). The 5-year cumulative progression-free survival and overall survival in the endocrine therapy group were significantly better than those in the control group (P<0.05). Conclusion Pay attention to molecular classification of primary lesion and metastatic axillary lymph node lesion in patients with breast cancer, and endocrine therapy might be able to improve survival rate of breast cancer patients with primary lesion HR– and metastatic axillary lymph node lesion HR+.