Znaczenie inhibitorów aromatazy w leczeniu chorych na raka piersi Artykuł przeglądowy
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Opublikowane:
wrz 26, 2012
Słowa kluczowe:
inhibitory aromtazy, rak piersi, anastrozol, letrozol, eksemestan
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Abstrakt
Leczenie hormonalne raka piersi ma na celu ograniczenie oddziaływania endogennych estrogenów na komórki nowotworu. Odkrycie receptorów hormonalnych i poznanie ich znaczenia umożliwiło zastosowanie hormonoterapii w celowany sposób. U kobiet po menopauzie estrogeny wytwarzane są z androgenów. Aromataza jest enzymem, który powoduje konwersję androgenów do estronu. Inhibitory aromatazy blokują syntezę estrogenów. Leki z tej grupy wykazywały aktywność w leczeniu uogólnionego raka piersi, leczeniu uzupełniającym i w leczeniu neoadiuwantowym. Inhibitory aromatazy są lekami bezpiecznymi i wygodnymi w podawaniu. U chorych na uogólnionego raka piersi są bardziej aktywne niż tamoksyfen. W leczeniu neoadiuwantowym również wykazywały aktywność większą niż tamoksyfen. W leczeniu uzupełniającym przeprowadzono badania porównujące bezpośrednio tamoksyfen z inhibitorami aromatazy. Badano również leczenie sekwencyjne polegające na podawaniu przez 2–3 lata tamoksyfenu, a następnie inhibitora aromatazy (badano również odwrotną sekwencję). W ramieniu kontrolnym przez 5 lat podawano tamoksyfen. Przeprowadzono również badania nad znaczeniem wydłużonego stosowania inhibitorów aromatazy, w których po 5-letnim leczeniu tamoksyfenem podawano inhibitor aromatazy. Wyniki tych badań i przeprowadzonych na ich podstawie metaanaliz pozwalają na rekomendowanie stosowania inhibitorów aromatazy w leczeniu uzupełniającym.
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Pieńkowski T. Znaczenie inhibitorów aromatazy w leczeniu chorych na raka piersi. OncoReview [Internet]. 26 wrzesień 2012 [cytowane 3 lipiec 2024];2(3(7):173-81. Dostępne na: https://journalsmededu.pl/index.php/OncoReview/article/view/311
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Utwór dostępny jest na licencji Creative Commons Uznanie autorstwa – Użycie niekomercyjne 4.0 Międzynarodowe.
Copyright: © Medical Education sp. z o.o. This is an Open Access article distributed under the terms of the Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Address reprint requests to: Medical Education, Marcin Kuźma (marcin.kuzma@mededu.pl)
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28. Ingle J.N., Goss P.E., Tu D. et al.: Analysis of duration of letrozole extended adjuvant therapy as measured by hazard ratios of disease recurrence over time for patients on NCIC CTG MA. 17. Cancer Treatmet. Res. Treat. 2005; 94(supp. 1): 17a.
29. Goss P., Ingle J., Martino S. et al.: Efficacy of letrozole extended adjuvant therapy according to estrogen receptor and progesterone receptor status of the primary tumor. National Institute of Canada Clinical Trials Group MA.17. J. Clin. Oncol. 2007; 25: 2006-2011.
30. Jakesz R., Greil R., Gnant M. et al.: Extended adjuvant therapy with anastrozole among postmenopausal breast cancer patients: Results from the randomized Austrian Breast and Colorectal Cancer Study Group Trial 6a. J. Natl. Cancer Inst. 2007; 99: 1845-1853.
31. Mamounas E., Jeong J., Wickerham D. et al.: Benefit from exemestane as extended adjuvant therapy after 5 years of adjuvant tamoxifen: intentionto-treat analysis of the National Surgical Adjuvant Breast and Bowel Project B-33 trial. J. Clin. Oncol. 2008; 26: 1965-1971.
32. Burstein H., Prestud A., Seindenfeld J. et al.: American Society of Clinical Oncology Clinical Practice Guideline: Update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. J. Clin. Oncol. 2010; 28(23): 3784-3796.
33. Goldhirsh A., Wood W., Coates A. et al.: Strategies for subtypes-dealing with the diverdity of breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann. Oncol. 2011. DOI: 10.1093/annonc/mdr304.
34. Hiller B., Ingle J., Chlebowski R. et al.: American Society of Clinical Oncology 2003. Uptake on the role of bisphosphonates and bone health issues in women with breast cancer. J. Clin. Oncol. 2003; 21: 4042-4057.
35. Cuppone F.: Do adjuwant aromatase inhibitors increase the cardiovascular risk in postmenopausal women with early breast cancer? Meta-analysis of randomized trials. Cancer 2008; 112: 260-267.
2. Early Breast Cancer Trialist Collaborative Group. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomized trials. Lancet 2005; 365: 1687-1717.
3. Geisler J., Lonning P.: Aromatase inhibition: translation into a successful therapeutic approach. Clinical Cancer Research 2005; 11: 2809-2821.
4. Carlini P., Bria E., Giannarelli D. et al.: New aromatase inhibitors as second-line endocrine therapy in postmenopausal patients with metastatic breast carcinoma: pooled analysis of the randomized trials. Cancer 2005; 104: 1335-1342.
5. Compos S.: Aromatase inhibitors for breast cancer in postmenopausal women. Oncologist 2004; 9: 126-136.
6. Rose C., Vtoraya O., Pluzanska A. et al.: An open randomized trial second line endocrine therapy in adcvanced breast cancer: comparison of the aromataze inhibitors letrozole and anastrozole. Eur. J. Cancer. 2003; 39: 2318-2327.
7. Compos S., Gusastalla J., Subar M. et al.: A comparative study of exemestane versus anastrozole in patients with postmenopausal breast cancer with visceral metastases. Clin. Breast Cancer 2009; 9: 39-44.
8. Llombarrt-Cussak A., Ruiz A., Anton A. et al.: Exemestane versus anastrozole as front-line endocrine therapy in postmenopausal patients with hormone receptor positive advanced breast cancer. Cancer 2012; 118: 241-247.
9. Harper-Wynne C., Coombes R.: Anastrozole shows evidence of activity in postmenopausal patients who responded or stabilized on formestan therapy. Eur. J. Cancer 1999; 35: 744-746.
10. Lonnig P., Bajetta E., Murray R. et al.: Activity of exemestane (Aromasin) in metastatic breast cancer after failure of nonsteroidal inhibitors, a phase II study. J. Clin. Oncol. 2000; 18: 2234-2244.
11. National Comprehensive Cancer Network (wersja 1.2012).
12. Eierman W., Paepke S., Appefelstaedt J. et al.: Preoperative treatment of postmenopausal breast cancer patients with letrozole: a randomized double-blind multicenter study. Ann. Oncol. 2001; 12: 1527-1532.
13. Smith I., Dowsett M., Ebbs S. et al.: Neoadjuvant treatment of postmenopausal breast cancer with anastrozole, tamoxifen or both in combination: the immediate preoperative anastrozole, tamoxifen or combined with tamoxifen (IMPACT) multicenter double-blind randomized trial. J. Clin. Oncol. 2005; 23: 5108-5116.
14. Semiglazov V., Kletsel A., Semiglazov E. et al.: Exemestane (E) vs tamoxifen (T) as neoadjuvant endocrine therapy for postmenopausal women with clinical stage II/III estrogen receptor positive breast cancer. J. Clin. Oncol. 2005; 23: 530 (Abs.).
15. Ellis M., Buzdar A., Unzeitig G. et al.; ASOCOC Z1031: A randomized phase II trial comparing exemestan, letrozol and anastrozol in postmenopausal women with clinical stage II/III estrogen receptor positive breast cancer. J. Clin. Oncol. 2010; 28: LBA13 (Abs.).
16. Semiglasov V., Semiglasov V.V., Dashyan G. et al.: Phase II randomized trial primary endocrine therapy vs chemotherapy in postmenopausal patients with estrogen receptor-positive breast cancer. Cancer 2007; 110: 244-254.
17. Seo J., Kim Y., Kim J. et al.: Meta-analysis of pre-operative aromatase inhibitor versus tamoxifen in postmenopausal woman with receptor positive breast cancer. Cancer Chemother. Pharmacol. 2009; 63: 261-266.
18. Arimidex, Tamoxifen, Alone or in Combination (ATAC) Trialist Group; Forbes J.F., Cuzik J. et al.: Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer 100 month analysis of the ATAC trial. Lancet Oncol. 2008; 9: 45-53.
19. BIG 1-98 Collaborative Group; Mouridsen H., Giobbie-Hurder A. et al.: Letrozole therapy alone or in sequence with tamoxifen in women with breast cancer. N. Engl. J. Med. 2009; 361: 766-776.
20. Gnant M., Minertsch B., Schippinger W. et al.: Endocrine therapy plus zoledronic acid in premenopausal breast cancer. N. Engl. J. Med. 2009; 360(7): 679-691.
21. Jakesz R., Gnant M., Griel R. et al.: Tamoxifen and anastrozole as sequencing strategy in postmenopausal women with hormone-responsive early breast cancer. Updated data from the Austrian breast and colorectal study group trial 8. Breast Cancer Symposium, San Antonio (Tx), 2008, ABS 14.
22. Boccardo F., Rubagotti A., Gugliemini P. et al.: Switching to anastrozole versus continued tamoxifen treatment for early breast cancer: Updated results of the Italian tamoxifen anastrozole (ITA) trial. Ann. Oncol. 2006 Jun; 17(Suppl. 7): vii10-4.
23. Rea D., Hasenburg A., Seynaeve C. et al.: Five years of exemestane as initial therapy compared to 5 years of tamoxifen followed by examestane. The TEAM Trial, a prospective randomized phase III trial in postmenopausal women in hormone-sensitive early breast cancer. San Antonio Breast Cancer Symposium. 2009.
24. Coombes R., Kilburn L., Snowdon C. et al.: Survival and safety of exemestane versus tamoxifen after 2-3 years tamoxifen treatment. (Intergroup Exemestane Study). A randomized controlled trial. Lancet 2007; 369: 559-570.
25. Kaufman M., Jonat W., Hifrich J. et al.: Improved overall survival in postmenopausal women with early breast cancer after anastrozole initiated after treatment with tamoxifen compared with continued tamoxifen. The ARNO 95 study. J. Clin. Oncol. 2007; 25: 2664-2670.
26. Dowset M., Cuzick J., Ingle J. et al.: Meta-analysis of breast cancer outcomes in adjuvant trials of aromatase inhibitors versus tamoxifen. J. Clin. Oncol. 2009; 28: 509-518.
27. Goss P.E., Ingle J.N., Martino S. et al.: Randomized trial of letrozol following tamoxifen as extended adjuvant therapy in receptor-positive breast cancer: updated findings from NCIC CTG MA. 17. J. Natl. Cancer Inst. 2005; 97: 1262-1271.
28. Ingle J.N., Goss P.E., Tu D. et al.: Analysis of duration of letrozole extended adjuvant therapy as measured by hazard ratios of disease recurrence over time for patients on NCIC CTG MA. 17. Cancer Treatmet. Res. Treat. 2005; 94(supp. 1): 17a.
29. Goss P., Ingle J., Martino S. et al.: Efficacy of letrozole extended adjuvant therapy according to estrogen receptor and progesterone receptor status of the primary tumor. National Institute of Canada Clinical Trials Group MA.17. J. Clin. Oncol. 2007; 25: 2006-2011.
30. Jakesz R., Greil R., Gnant M. et al.: Extended adjuvant therapy with anastrozole among postmenopausal breast cancer patients: Results from the randomized Austrian Breast and Colorectal Cancer Study Group Trial 6a. J. Natl. Cancer Inst. 2007; 99: 1845-1853.
31. Mamounas E., Jeong J., Wickerham D. et al.: Benefit from exemestane as extended adjuvant therapy after 5 years of adjuvant tamoxifen: intentionto-treat analysis of the National Surgical Adjuvant Breast and Bowel Project B-33 trial. J. Clin. Oncol. 2008; 26: 1965-1971.
32. Burstein H., Prestud A., Seindenfeld J. et al.: American Society of Clinical Oncology Clinical Practice Guideline: Update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. J. Clin. Oncol. 2010; 28(23): 3784-3796.
33. Goldhirsh A., Wood W., Coates A. et al.: Strategies for subtypes-dealing with the diverdity of breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann. Oncol. 2011. DOI: 10.1093/annonc/mdr304.
34. Hiller B., Ingle J., Chlebowski R. et al.: American Society of Clinical Oncology 2003. Uptake on the role of bisphosphonates and bone health issues in women with breast cancer. J. Clin. Oncol. 2003; 21: 4042-4057.
35. Cuppone F.: Do adjuwant aromatase inhibitors increase the cardiovascular risk in postmenopausal women with early breast cancer? Meta-analysis of randomized trials. Cancer 2008; 112: 260-267.