Third-generation aromatase inhibitors (AIs) anastrozole, letrozole, exemestane, a prerequisite for the application must be post-menopausal or complete inhibition of ovarian function. With regard to the definition of menopause, but there are still some defects in the standard.
NCCN breast cancer guidelines in 2008 on the recommendation of the standard post-menopausal, still continue to use the 2007 version of the definition. Details are as follows:
(1), bilateral ovariectomy;
(2) age ≥ 60 years of age;
(3) If the age of “60 years, and only natural amenorrhea ≥ 12 months and FSH, estrogen levels in the menopausal range, can define the menopause.
For the treatment-related menopause, it is recommended to be repeated to monitor FSH and estrogen levels, and only continued in the post-menopausal levels of these indicators can be defined as menopause. However, FSH and estrogen on detection frequency, detection technology itself does not.
However, in many years of clinical practice, it was discovered that the above-mentioned criteria for defining the basis of treatment menopause, not exact. United Kingdom Royal Marsden Hospital, Cancer Institute, Smith IE, etc. began to AIs reported 33 cases of pre-certified by the biochemical detection of ovarian function suppression patients, AIs in the application process, the 12 patients re-emergence of menstruation, including 1 case of pregnancy before menstruation resumed. Other studies also have applied AIs lead to unintended pregnancies were reported.
AIs application process in view of the above problems arise, the British Royal Marsden Hospital, Cancer Institute of the experts believe that the above-mentioned groups,
(1) if younger than 40 years of age and should not be alone AIs, who wish to use ovarian function subject to both co-castration;
(2) For women over 40 years of age, without conditions, or can not be accurately monitored estradiol test alone AIs should be careful. This group of patients is best to use tamoxifen, such as the wish to use ovarian function subject to both co-castration;
(3) For women over the age of 40, if the conditions can not be accurately monitored or estradiol testing, continuous monitoring should be started from the baseline serum estradiol and gonadotropin levels, and to take effective and accurate method. If estradiol levels> 20pmol / L, gonadotropin normal, recommend choosing tamoxifen, or tamoxifen ovarian function combined castration, or castration AIs combined ovarian function. If the estradiol level <10pmol / L, elevated gonadotropins, select the AIs are appropriate, but the series needed to monitor for 6 months. For the switch to AIs after tamoxifen treatment of patients, it is recommended to monitor for 6 months. If the decline in estradiol levels and maintained at 10pmol / L the following can be considered post-menopausal patients with access to the state, to continue to AIs are appropriate. If the estradiol level remained at 10pmol / L or more, then the AIs can not play a role in ovarian function should be considered co-castration, or to tamoxifen. In addition, amenorrhea after chemotherapy in all patients receiving AIs course of treatment, if there may be symptoms of menstrual bleeding, or hot flashes suddenly disappeared, it should seek medical attention immediately. All patients in the monitoring period shall take adequate contraceptive measures.
We have the practice of clinical application of AIs, but also feel deeply about the definition of standards for post-menopausal after chemotherapy flawed, has been seeking a more scientific means to confirm menopause. Currently seeking more efficient and accurate means of laboratory studies are in progress.