乳腺癌内分泌治疗新思路和临床实践乳癌的治疗手段乳癌内分泌治疗的发展HormoneTherapyResponseRate(%)inDifferentReceptorStatusSurvivalbyResponseArimidex1mgMAAGTamoxifenfor5YearsvsNoTreatment891011TamoxifenAdjuvantTherapyforEBCER阳性TAM和化疗合用比单用TAM更有效CAF与TAM序贯合用比同时效果更好MAAGSurvivalDataAnastrozole/MA瑞宁得(Arimidex)比MA更有效、更安全PreventionDCIS/NeoadjAnastrozoleisSuperiortoTamoxifeninFirstLineTherapy（0030）*Hazardratio(tam:‘Arimidex’)1.44,lowerCL1.16.Study‘powered’forequivalence.Medianfollow-upof18months.71%progressedAIsisSuperiortoTamoxifenasFirst-lineTherapyforAdvancedBreastCancerPreventionDCIS/NeoadjRationaleforAdjuvantTherapyWithAromataseInhibitors(AIs)TheGoldStandardMilestonesActivated1996Plannedaccrual9366AccrualtodateClosed1999Kaplan–MeierCurvesofDisease-freeSurvivalinITTPopulationKaplan–MeierCurvesofDisease-freeSurvivalinReceptor-positivePopulationPredefinedadverseevents*HotflushesAvsTCvsTAvsCTheATACEarlybreastcancertrialinpostmenopausalpatientsEndometrialsub-protocolresultsDemographicsBaselineUltrasoundAvsTCvsTAvsCATACSummaryConclusionsAnalysisoftheIncidenceofNew(Contralateral)BreastPrimariesWhyuseanAromataseInhibitor?ATAC:incidenceofnew(contralateral)breastprimariesinITTpopulationWomen-yearsoffollow-upperarm3100x2.8=8600Rateofcontralateraltumoursinwomennottreatedwithtamoxifen(women-years)ExpectedcontralateraltumoursObservedontamoxifen46%reductionObservedon‘Arimidex’77%REDUCTIONIBISITamoxifeninpreventionIBISII:PreventionIBISII:DCISNSABPPreventionDCIS/Neoadj绝经前乳癌内分泌治疗卵巢切除加口服依西美坦治疗绝经前乳腺癌骨转移长期缓解Zoladex诺雷得用于绝经前乳腺癌患者的治疗Zoladex与卵巢切除术治疗复发转移乳癌效果比较Zoladex3.6mg用于绝经前进展期乳腺癌II期临床试验KlijnJGM,etal.JClinOncol2001;19:343–53.Overalllogranktest:p=0.0114Zoladex=卵巢切除术Zoladex+TAM>ZoladexArimidex>TAMZoladex+Arimidex诺雷得+瑞宁得诺雷德+瑞宁得治疗绝经前患者ARandomizedTrialofZoladex+TAMvsZoladex+Arimidexinper/perimenopausalpatientswithhormonedependentABCZoladex+TAMvsZoladex+Arimidexinper/perimenopausalABCpatientsZoladex+ArimidexvsZoladex+TAMinpre/perimenopausalABCpatientsZoladex+Arimidexiseffcientandwelltoleratedshouldbecon