Endocrine therapy is directly aimed at stimulating factor and development of breast cancer treatment, by inhibiting or reducing the related hormone secretion, reducing its levels for therapeutic purposes, the value of no less than surgery, chemotherapy and radiotherapy, and in many cases it also has other measures can not be replaced, even unparalleled advantage. Endocrine therapy more targeted and selective toxicity tend to be more relaxed, but its therapeutic value in the appropriate patients are enormous, and we are often overlooked in the clinical work it. Thus, doctors and patients should be assured that the use of hormonal therapy, so that more estrogen receptor-positive patients from the chemotherapy side effects, have a healthy, happy every day.
In the treatment of breast cancer there is a misunderstanding that people tend to attach importance to endocrine therapy with chemotherapy and contempt. Chemotherapy that is given the concentration of drug in a certain period of time to kill a certain percentage of residual cancer cells. Chemotherapy side-effects are mainly bone marrow suppression, alopecia, nausea, vomiting, nerve toxicity. Most patients had to endure chemotherapy-induced toxicity, reduced quality of life. And other malignant tumors is different from the incidence of breast cancer development and estrogen levels and metabolic disorders are closely linked. In fact, hormonal therapy is almost adapted to ER-positive cases in each period. Due to adverse reactions during treatment of light on the need for systemic treatment of elderly, infirm, or the coexistence of other diseases, chemotherapy can not tolerate estrogen or progesterone-positive, endocrine therapy is the best indication.
Breast cancer, endocrine therapy is just the environment by affecting the hormones play a therapeutic effect, the drug itself is not a hormone. Can be three levels of treatment: anti-estrogen, pituitary RH-LH analog and aromatase inhibitor. Anti-estrogen therapy can be divided into surgical castration, radiotherapy and drug treatment three kinds of castration. The former two ovaries through surgery or by radiation suppression of ovarian function, removal of adrenal and pituitary, directly or indirectly, to reduce blood levels of estrogen, surgical castration of women’s psychology on the back foot, but also a non-reversible measures, it is now seldom use. In contrast, reversible RH-LH analogues commonly used drugs were nore, nore, enough to effectively suppress ovarian estrogen synthesis, mainly applicable to pre-menopausal patients, in promoting the quality of life today, but would provide a large number of accepted by young patients.
Tamoxifen (TAM) as the core of endocrine therapy of breast cancer drugs on the receptor-positive premenopausal, postmenopausal patients have obvious results. Recent including anastrozole, letrozole, and exemestane, step three-generation aromatase inhibitors (Als) the advent of the gold standard makes the TAM’s position was challenged. With the long-term adjuvant treatment with tamoxifen, when compared to Als better tolerated, side effects low. In recent years, a large number of clinical studies have shown that the international Als curative effect well tolerated and can be used as endocrine therapy for postmenopausal women with early breast cancer, the preferred drugs and postmenopausal women with advanced breast cancer, first-line treatment.
With the aging of the population over age 65 of breast cancer more and more elderly patients, mostly receptor-positive, the efficacy of chemotherapy for these patients is not high, and many of these patients is accompanied by some internal diseases, and chemotherapy, compared endocrine therapy is relatively much safer. Neo-adjuvant chemotherapy in patients up to pathological complete remission, 90% are estrogen receptor-negative patients. Pairs of receptor-positive breast cancer patients, chemotherapy may not be the best treatment.
