[SABCS2014]SOFT试验:乳腺癌内分泌治疗及卵巢功能抑制——Nancy E. Davidson访谈

作者:  N.E.Davidson   日期:2014/12/16 19:37:41  浏览量:67804

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Davidson教授:SOFT试验与TEXT试验均研究了激素受体(HR)阳性绝经前乳腺癌的最佳内分泌治疗,对单用他莫昔芬(TAM)与卵巢功能抑制(OFS)联合他莫昔芬(TAM)给药,及单用芳香化酶抑制剂(AI)与卵巢功能抑制(OFS)联合芳香化酶抑制剂(AI)给药的治疗策略进行比较。

  Oncology Frontier: Dr. Davidson, you touched briefly on the SOFT trial in your talk today. Will you give us the take home message of the SOFT trial when it comes to endocrine therapy?

  《肿瘤瞭望》:在今天的会议上您对SOFT试验作了简要介绍。就内分泌治疗而言,SOFT试验揭示了哪些关键信息?

  Dr. Davidson: The SOFT trial in partnership with the TEXT trial, its sister trial, both of those are trials that look at the role of optimal endocrine therapy for premenopausal women with hormone receptor positive breast cancer. They have looked at strategies of tamoxifen alone, ovarian function suppression plus tamoxifen, or ovarian function suppression plus an aromatase inhibitor. In aggregate I think what they show is that women who take the ovarian function suppression with aromatase inhibitor have a slightly better disease free survival than the women who take the other therapies. The beneift is relatively small and side effects seem to be acceptable but they also show that there is a subset of women who do extraordinarilywell with tamoxifen alone. We should not forget that many of these young women can be treated with tamoxifen and without chemotherapy. For the higher risk women though, it might be that the strategy of ovarian function suppression plus aromatase inhibitor would be worth considering.

  Davidson教授:SOFT试验与TEXT试验均研究了激素受体(HR)阳性绝经前乳腺癌的最佳内分泌治疗,对单用他莫昔芬(TAM)与卵巢功能抑制(OFS)联合他莫昔芬(TAM)给药,及单用芳香化酶抑制剂(AI)与卵巢功能抑制(OFS)联合芳香化酶抑制剂(AI)给药的治疗策略进行比较。总的来说,研究显示相比其他治疗组,采取OFS+AI治疗的乳腺癌患者在无病生存率(DFS)方面获益稍多一些,且其副作用在可耐受范围内。同时这些研究也表明,有些乳腺癌患者单用他莫昔芬治疗也有非常好效果。很多年轻乳腺癌患者可以不化疗而单用他莫昔芬治疗。不过对乳腺癌高危患者而言,AI联合OFS治疗还是值得考虑。

  Oncology Frontier:  You also went into a little bit of depth about how to plan the timing of these therapies. Could you talk more about that?

  《肿瘤瞭望》:您在演讲中也谈了内分泌治疗的时间问题。能否请您更详细地谈一下这方面的内容?

  Dr. Davidson: There is a lot of interest right now in the duration of endocrine therapy. For many years we used 5 years of endocrine therapy, tamoxifen, based on randomized trials that showed that it was better than 2 years or 1 year. Recent data have suggested that 10 years of tamoxifen might be better than 5 years of tamoxifen and so we are beginning to think about how to integrate those data. Do all women need 10 years of therapy or can we somehow subset out those who do well with 5 years and do not need to take on the extra time. Tests are being developed to try to set that up. I think right now there is uncertainty but the knowledge that all women should receive at least five years and manywomen might be candidates for 10 years.

 

  Davidson教授:现在人们对内分泌治疗时间比较感兴趣。鉴于随机试验显示5年期TAM的内分泌治疗比1年或2年期的治疗效果要好,因此我们曾很多年采取5年治疗策略。近期数据显示,与五年期治疗相比,为期十年的TAM治疗效果更好。所以我们开始思考应如何整合这些数据。是否所有女性都需要为期十年的治疗?我们能否找出5年治疗已足够而不需要延长内分泌治疗的时间的患者?目前相关研究正在进行中,我认为上述问题的答案还不确定,但是目前认为所有患者都可接受5年治疗,而其中很多患者适合10年内分泌治疗。

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