The indicators that currently provide clear guidance for the treatment of breast cancer are estrogen receptor (ER), progesterone receptor (PR) and epidermal growth factor receptor 2 (HER-2, cerbB-2).
Patients with positive ER and/or PR have relatively slow tumor development, relatively good prognosis and suitable for endocrine therapy; those with positive HER-2 immunohistochemistry ++ or fluorescence in situ hybridization (FISH) have relatively fast tumor development, patients are prone to early distant metastasis after surgery, have relatively short survival and poor prognosis, and trastuzumab therapy can significantly improve the survival of these patients; patients with various indicators are suitable for chemotherapy. Patients are suitable for chemotherapy. Yan Min, Department of Breast Medicine, Henan Cancer Hospital
Endocrine therapy for breast cancer
At present, the commonly used endocrine therapy drugs are as follows.
Anti-estrogens: tamoxifen (triamcinolone), toremifene, fulvestrant
Progestins: medroxyprogesterone, megestrol
LH-RH antagonists: Goserelin (Norelide)
Aromatase inhibitors: Anastrozole, Letrozole, Exemestane
Aromatase inhibitors are only indicated for postmenopausal patients. For non-menopausal patients who need aromatase inhibitors, they should be used together with goserelin (Norelide). For patients considering aromatase inhibitor therapy, the determination of menstrual status is critical, so how do you determine if a patient is menopausal?
In the cNCCN guidelines, menopause is defined as follows.
(1) Post bilateral oophorectomy.
(2) Age ≥ 60 years.
(3) Age <60 years with FSH and estradiol at postmenopausal levels.
(4) Patients receiving LH-RH agonists or antagonists in whom menopause cannot be judged.
(5) In premenopausal women undergoing adjuvant chemotherapy, menopause cannot be used as a basis for judging menopause because ovarian function may remain normal or may recover despite the fact that the patient will stop ovulating or have no menstruation after chemotherapy.
(6) In women with chemotherapy-induced menopause, if an aromatase inhibitor is considered as endocrine therapy, ovariectomy or serial monitoring of FSH and/or estradiol levels is required to ensure that the patient is in a postmenopausal state.