In recent years, the endocrine treatment of mammary glands cancer was subjected to a more and more extensive value, relevant mammary glands cancer endocrine treatment of the strategy is also take place deep variety.Therefore, the treatment strategy of the exactitude confidence mammary glands cancer, will contribute to the treatment effect of the endocrine which raises a mammary glands cancer.
Over 100 years, the mammary glands cancer endocrine treatment experienced adrenal glands to cut off, the ovary cut off, male hormone, estrogen, Yun hormone, anti- estrogen, fragrance turn Mao depressant a treatment etc. development process.Currently, although ovary resection(surgical operation emasculation) still Be unique lend support to treatment and relapse to transfer a sufferer behind through the ex- mammary glands cancer Shu of one of the treatment meanses, more and more of the women adopt medicine emasculation to replace surgical operation emasculation, cure the development of new medicine because of risk and endocrine of surgical operation, the adrenal glands cut off and hangs body excision already basic need not.The mammary glands cancer endocrine treatment in past now, mainly mean medicine treatment.The mammary glands cancer in common use endocrine treatment medicine has anti- male hormone, Yun hormone, yellow body born vegetable to release the hormone similar thing(LH － RH similar thing) and fragrance to turn Mao depressant.The endocrine treatment all differs from a chemotherapy at function mechanism's etc., compared with the chemotherapy, the endocrine treatment contains many advantages.
Can surgical operation mammary glands the assistance endocrine of the cancer cure
1.three benzene oxygen the An use strategy and evaluation:Generally think, be subjected to the sufferer of body masculine gender to the estrogen or the Yun hormone, in spite of it the age, menstruation appearance, tumor size, lymphoid knot has already denied to transfer, all deal with is cure by assistance endocrine.Assistance treatment the most in common use medicine is three benzene oxygen An(TAM).Currently, the TAM is already used for curing each mammary glands cancer with another period.
TAM the function in the mammary glands cancer in later period is more important than the function lends support to under medical treatment after the mammary glands cancer Shu.
The analytical result of EBCTCG(the ′ collaborative of the cancer trialist of the early breast group)37000 random clinical trials:Take orally TAM5 yearses can show a Zhao exaltation a sufferer of have no the existence rate(DFS) of disease for 10 years with total existence rate(OS).To lymphoid knot masculine gender and feminine gender sufferer, can make it absolutely relapse a rate to lower 15.2% and 10.9% respectively, the death rate lowers 14.9% and 5.6%, and can make the cancer take place risk to lower generally to the side mammary glands.The curative effect taken orally TAM for 2 years is because of a year, 5 years and the curative effect surpasses for 2 years.
NSABP － 14(the project － of the and bowel of the adjuvant breast of the national surgical 14) experiment further confirmed to take orally TAM to can raise ER masculine gender, lymphoid knot the feminine gender sufferer's curative effect, the 4 years DFS of treatment set and matched control sufferer distinguishes to 83% and 77%.
As for TAM give medicine for time, the EBCTCG has already confirmed that the effect obviously surpasses for 5 years for a year and 2 years, but denies above better for 5 years?In the NSABP － 14 experiment, to have no the disease exist for 5 years of lymphoid knot feminine gender, ER male sufferer, again random is divided in to continue to use TAM or placebo for 5 years, result manifestation, continued to take orally TAM and don't increase curative effect.But still lack lymph to knot a male sufferer to use TAM5 yearses an above clinical trial result currently.Generally think TAM of the best is to connect to use 5 years for time for medicine.
As for the endocrine treatment and the chemotherapy of consociation usage whether will increase curative effect, some international clinical trials have already had explicit conclusion to this.NSABP B － 16 with NSABP B － 20 experiment enunciation, to ER masculine gender of sufferer, the chemotherapy adds a TAM ratio a list to use TAM and can obviously raise OS and DFS.EBCTCG the latest research also expresses that chemotherapy not only can prolong to cut off through the ex- sufferer's existence period, but also to unique through empress the mammary glands cancer is as well valid.If ER masculine gender, add to take TAM then ability further exaltation existence rate.
Chemotherapy and TAM are a preface Guan or is in the meantime to give medicine, pass by, the doctor is different to this opinion.Southwest tumor cooperation set(SWOG) report way a set of mammary glands cancer in the United States large-scale III period prospect random clinical trial result(the intergroup trial of the breast cancer 0100), that research result enunciation, the preface Guan but isn't in the meantime to give the CAF(wreath Lin Mao An, mildewed vegetable and the fluorine Mao Mi Ding) add a TAM treatment, can show the Zhao exaltation mammary glands cancer sufferer DFS.
The preface Guan makes the chemotherapy effect increase 50% for medicine.Give in the meantime medicine set the sufferer of 4 year, DFS and 7 years, the OS Gao after list using a sufferer, preface Guan give the DFS of medicine set at 8 years shows Zhao high at the same time to the medicine set, but it always exists to be subjected to a benefit still not clear, need to continue to carry on long-term with visit.
2.medicine emasculation:Although some clinical trials hint, the ovary excision can raise an existence rate towards extremely being relapse by the high Wei of body masculine gender through the ex- hormone case, , because of the side effect of the surgical operation and to sufferer mental state of influence, abroad more and more of the sufferer choose to use the medicine ovary emasculation.The in common use medicine is a brain to hang the body yellow body born vegetable to release the hormone(LHRH) similar thing Ge to give up a Rui wood, in opposition to the surgical operation and the chemotherapy, its curative effect more good and the toxicity be lower.
The IBCSG(the cancer study of the international breast group) experiments a VIII result hint, to unique through front or round unique menstruation sufferer, if lymphoid knot feminine gender, especially ER feminine gender or weak masculine gender, the curative effect of the chemotherapy is better;Contrary, if lymphoid knot feminine gender, ER feminine gender, the Ge gives up Rui a wood and adds or don'ts add the curative effect likeness of chemotherapy.
3.the fragrance turn Mao depressant:TAM always is mammary glands cancer, the Shu lends support to an endocrine treatment behind of main medicine.In recent years, the new generation fragrance turns Mao depressant such as that song Shi, to song Shi's etc. get into a clinical trial, experiment result to TAM of the position put forward a challenge.The ATAC(arimidex, the combination of the tamoxifen alone or in) experiment to compare that song Shi and TAM used for the curative effect of the mammary glands cancer assistance treatment.At in with visit for 3 years, two sets of sufferers DFS distinguishes to 89.4% and 87.4%;The Stgallen in 2003 international mammary glands cancer meeting report way medium with visit a result for 47 month, the DFS distinguishes to 86.9% and 84.5%.Above result hint, the fragrance turns Mao depressant to probably become the valid medicine of the mammary glands cancer assistance treatment.
Transfer the endocrine of sex mammary glands cancer a treatment
The later period transfers the treatment of sex mammary glands cancer(MBC) more difficult, cure of the main purpose alleviate symptom and prolong the existence period of high quality.Because endocrine medicine usage convenience, the curative effect be accurate and the toxicity be small, past specially suitable for MBC treatment.
Generally accepted currently, if sufferer's age>35 years old, the Shu has no lump existence to expect behind>2 years, bone and soft organization transfer, have no the internal organs of symptom to transfer, ER or PR masculine gender, can the endocrine cures first.
The effect of the endocrine treatment with be subjected to body appearance closely related.ER and PR all is masculine genders, efficient is 30% ～s 40%;Both all is feminine genders, efficient<10%.In addition, the curative effect of the endocrine treatment is still transfer by tumor part with unique through the length of time etc. the influence of factor.It since effect generally and more slow, usually needing to take a medicine then can see after 2~3 months the tumor contract, as a result, if tumor have no obvious progress, there is necessity taking a medicine revaluing curative effect after 16 weeks.Generally think, the curative effect not better than one which unites to use a medicine uses a medicine.
Have to the basis sufferer's menstruation condition choose suitable endocrine medicine.Cut off can choose to use sex Rui a wood(the Ge give up Rui a wood) through the ex- sufferer with bright C Rui wood;Cut off to choose to turn Mao depressant with the fragrance through the future trouble;But all can choose to use TAM and Yun hormone to the sufferer of various age.
Traditional 1, 2 and 3 line medicineses of the endocrine treatment are TAM, Yun hormone and fragrance to turn Mao depressant respectively.Because in recent years of clinical trial result, add of TAM already extensively applied in mammary glands cancer Shu behind lend support to a treatment, so have already consumedly changed this traditional method of using currently, clinical up have already had more and more doctors to turn fragrance to two lines or a glimmer of treatment that the Mao depressant useds for MBC.
According to the west beautiful Tan, that song Shi and come to song Shi is currently to study at most and the most thorough new generation fragrance turn Mao depressant.Many centers random divide a set of clinical trial to express, conduct and actions is two line medicines, its curative effect surpass A ground Yun Tong.
The future direction of the mammary glands cancer endocrine treatment
Endocrine treatment to the mammary glands cancer of the earlier period after the Shu of assistance treatment and have already got to the MBC curative effect widespread affirmation.Reasonable usage endocrine treatment, doubtless will raise curative effect further, reduce side effect, raise a sufferer to live quality.From now on, the mammary glands cancer endocrine research will concentrate again as follows several aspects:(1)Continue to develop a new endocrine treatment medicine, such as development the selectivity estrogen be subjected to a body Jie anti-(SERM), high selectivity fragrance turn Mao depressant, grow hormone to release factor similar thing etc..(2)Study endocrine medicine occasionally the consociation of the endocrine medicine and other anti-cancer medicine an usage.(3)Discuss the consociation usage that the endocrine treatment cures with living creature.(4)Extend existing usage scope, such as mammary glands cancer of chemistry prevention, new assistance endocrine treatment, new of the endocrine medicine used for an assistance a treatment.(5)Thorough research the function mechanism of the endocrine medicine.
Subscribe to:
Post Comments (Atom)
No comments:
Post a Comment