乳腺癌患者内分泌治疗期间的管理.pptVIP

EndocrineTherapy:SwitchingStrategiesSwitchingstrategies:TAM2-3yrsAI2-3yrsTAM2-3yrs1.CoombesRCetal.JClinOnc20062.JakeszRetal.Lancet2005AIExemestaneAnastrozoleTrialIES1ABCSG-8/ARNO952DFSHR0.76*p0.0001HR0.60?p0.0009OSSignificantinER+subset(p=0.05)Notsignificant*58momedianf/u;?28momedianf/u这幅图显示了妇女一生中骨密度（BMD）与年龄的关系。尽管这种关系见于所有妇女，但个体之间的骨密度有很大差异。一般认为，骨量高峰期出现在30－35岁。骨量减少是与骨折危险性升高的多个危险因素之一。在绝经后妇女中，骨折的危险性比一般女性高很多，并且随着年龄的增大而进一步升高。参考文献HoughS.快速和缓慢骨质丢失者.与骨质疏松症治疗的关系.DrugsAging1998;12(Suppl1):1–7.阿那曲唑组骨折发生率的增加可能仅与有效治疗期（5年）有关，而在治疗完成后并无持续增加治疗后的随访期中，阿那曲唑组和三苯氧胺组的骨折发生率相似（IRR[发生率比率]=1.03，差异无显著性）Alendronate阿伦膦酸盐Risendronate－利塞膦酸盐(risendronate）Raloxifene－雷洛昔芬[13]OutcomesofWomenWhoWerePremenopausalatDiagnosisofEarlyStageBreastCancerintheNCICCTGMA17Trial.

GossPE,IngleJN,MartinoS,RobertN,MussH,ShepherdL,PritchardKI,LivingstonRB,DavidsonN,PerezEA,CameronD,WhelanT,PalmerM,TuDMassachusettsGeneralHospitalCancerCenter,Boston,MA;MayoClinic,Rochester,MN;AngelesClinicandResearchInstitute,LosAngeles,CA;InovaFairfaxHospital,FallsChurch,VA;UniversityofNorthCarolina,ChapelHill,NC;NationalCancerInstituteofCanada,Kingston,ON,Canada;UniversityofToronto,Toronto,Canada;UniversityofArizona,Tucson,AZ;UniversityofPittsburghCancerInstitute,Pittsburgh,PA;MayoClinic,Jacksonville,FL;UniversityofLeeds,Leeds,UnitedKingdom;McMasterUniversity,Hamilton,ON,Canada

Background:MA17showedthatadjuvantletrozoleafter5yearsoftamoxifenmarkedlyreducedtheriskofrecurrenceinwomenwithER+earlystagebreastcancerandimprovedoverallsurvivalinwomenpresentingwithnode+vedisease.Mosttrialsofearlyadjuvantaromataseinhibitortherapyrequiredwomentobepostmenopausalatdiagnosisto