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Mechanisms of endocrine resistance in breast cancer
The term "therapy resistance", in many ways, is not a uniform term.First, it is important to distinguish therapy failure from prognostication[1].While, on the one hand, the fact that a tumor recurrence means that some tumor cells must have survived despite the therapy applied, the fact that example lymph node negative tumors have a lower risk of relapse as compared with node positive ones relate to tumor biology, or metastatic propensity, a factor independent of those biological parameters that may cause drug resistance.
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第31届圣·安东尼奥会议乳腺癌内分泌治疗新临床试验解读
乳腺癌内分泌治疗一直是近几年圣安东尼奥会议的热门话题.几乎每一年都有重要的临床试验结果公布,对我们治疗乳腺癌的临床实践和临床思维不断予以修正.今年也不例外,BIG 1-98和TEAM的试验结果再一次弥补了芳香化酶抑制剂(AI)治疗乳腺癌的一些未知领域的空白.下面将其介绍如下.
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2014年美国临床肿瘤学会指南更新:激素受体阳性乳腺癌的辅助内分泌治疗
大多数乳腺癌为激素依赖性肿瘤,ER阳性乳腺癌约占全部乳腺癌的60%~75%,其中约65%为PR阳性。激素受体阳性肿瘤对内分泌药物敏感,内分泌治疗在乳腺癌综合治疗中占有重要地位。美国临床肿瘤学会( American Society of Clinical Oncology, ASCO)曾于2010年更新激素受体阳性女性乳腺癌患者辅助内分泌治疗指南,迄今为止,另有5项他莫昔芬维持治疗的相关研究数据问世。为此,ASCO再度组织多学科专家进行相关文献回顾,更新了针对激素受体阳性乳腺癌的辅助内分泌治疗方案,并以“Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer:American Society of Clinical Oncology clinical practice guideline focused update”为题名,于2014年第5期Journal of Clinical Oncology全文刊登。
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乳腺癌新辅助内分泌治疗进展
自Beatson应用卵巢切除术治疗局部晚期乳腺癌至今,乳腺癌的内分泌治疗已有超过百年的历史[1].联合使用外科、放疗、化疗和内分泌治疗可以显著提高乳腺癌患者的生存率.自20世纪70年代,他莫昔芬已经成为激素受体阳性乳腺癌患者的标准内分泌治疗药物[2, 3],可以降低雌激素受体(estrogen receptor, ER)阳性乳腺癌的年病死率达31%[4].研究证实,第3代芳香化酶抑制剂用于绝经后女性乳腺癌患者的术前内分泌治疗--新辅助内分泌治疗(neoadjuvant endocrine therapy),效果显著优于他莫昔芬,并且能够提高局部晚期乳腺癌的手术切除率,改善巨大肿瘤和不可手术切除乳腺癌的外科治疗效果.尽管新辅助内分泌治疗已经显现出一些优势,但是仍有一些问题尚待解决.
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Objective Less than a decade ago, ER-positive and PgR-positive diagnostic criteria decrease from 10%to 1%. Up to 20%of current immunohistochemical determinations of ER and PgR worldwide may be inaccu-rate. It is necessary to study patients whose tumors are between luminal A (LABC) and triple-negative (TNBC) breast cancer. Methods Survival analysis grouping by the level of positive hormone receptor, CK5/6 and EGFR, and en-docrine therapy was carried out in 206 patients whose tumors were junction zone between LABC and TNBC. Re-sults There were no significant differences between the low-positive (1%-9%) HR group and positive HR (10%-19%) group in overall survival (OS) and disease-free survival (DFS). There was an apparent difference between the nor-mal-like group and basal-like group in OS and DFS, and between the patients with and without endocrine therapy. There were significant differences between death and tumor progression for EGFR and CK5/6, chemotherapy, and endocrine therapy. Conclusions We conclude that EGFR and CK5/6 are better prognostic indicators than the lev-el of positive HR in patients whose tumors are junction zone at the junction zone between LABC and TNBC. En-docrine therapy can be highly beneficial to these patients regardless of the positive HR level.