摘要
内分泌治疗在激素受体阳性乳腺癌中扮演着至关重要的角色,并与患者的绝经状态密切相关。本文旨在深入探讨关于乳腺癌患者绝经状态判断的两个关键问题。第一,针对绝经前患者添加卵巢功能抑制(ovarian function suppression,OFS)治疗后,雌二醇(estradiol,E2)数值仍超标,可能存在“真性”超标和“假性”超标两种情况,氟维司群、阿贝西利、依西美坦及他莫昔芬等内分泌治疗药物可能干扰E2测定结果,需要警惕检测性“假性”超标的可能性。第二,在判断OFS治疗下患者是否已进入生理性绝经状态时,需考虑化疗对绝经状态的影响、围绝经期内分泌变化的复杂性等因素。建议根据患者年龄及内分泌治疗方案,考虑转换治疗并定期监测血清E2和卵泡刺激素(follicle-stimulating hormone,FSH)水平,针对疑难情况可综合抗缪勒管激素(anti-Mullerian hormone,AMH)、抑制素B(inhibin B,INHB)和雄激素等指标进行评估。
Endocrine therapy plays a crucial role in hormone receptor-positive breast cancer and is closely related to the patient’s menopausal status.This manuscript aimed to explore two key questions in assessing menopausal status of breast cancer patients.Firstly,for premenopausal patients receiving ovarian function suppression(OFS)therapy,persistently elevated estradiol(E2)levels post-treatment may be attributed to either“true”or“pseudo”elevation,with caution needed due to potential interference from endocrine therapy drugs such as fulvestrant,abemaciclib,exemestane and tamoxifen.Secondly,when determining whether patients under OFS therapy have reached physiological menopause,factors such as the impact of chemotherapy on menopausal status and the complexity of hormone levels around menopause need to be considered.It is recommended to consider switching treatments based on the patient’s age and original endocrine therapy,and to regularly monitor levels of estradiol and follicle-stimulating hormone(FSH).In challenging cases,a comprehensive evaluation can be conducted by incorporating markers such as anti-Mullerian hormone(AMH),inhibin B(INHB)and androgen.
作者
张剑
ZHANG Jian(Department of Medical Oncology,Fudan University Shanghai Cancer Center,PhaseⅠClinical Trial Center,Fudan University Shanghai Cancer Center,Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200032,China)
出处
《中国癌症杂志》
CAS
CSCD
北大核心
2024年第7期619-627,共9页
China Oncology
关键词
乳腺癌
绝经状态
卵巢功能抑制
临床思考
Breast cancer
Menopausal status
Ovarian function suppression
Clinical considerations
