Breast cancer drug treatment (1) androgen: Androgen treatment of breast cancer mechanism of action is not fully clear, it was considered physiological androgen receptor by androgen binding, and thus stimulate cell growth, the amount of testosterone medicinal estrogen receptor can shift from the cytoplasm the nucleus to the cytoplasm to prevent the re-synthesis of estrogen receptors, it was thought to be androgen suppression of the pituitary gonad-promoting hormone, follicle puncture and luteinizing hormone, so that breast atrophy. Bone metastasis is better with male hormones, most of the patient's symptoms have been alleviated, and thus patients with bone metastasis of androgen therapy should be preferred. Of soft tissue and lymph node metastasis rate was 20% of patients, lung, liver and other organs metastases of androgen poor efficacy, the effect of androgen treatment of breast cancer in postmenopausal women, the former is better than the menopause, but males can not be used after ovariectomy hormone therapy, because testosterone can be metabolized into estrogen to stimulate the growth of cancer cells.
Agents commonly used testosterone propionate testosterone are paid, each 50_100mg, 2_3 times / week, available six months; dehydrogenase Koo intoxicated in vinegar 1_2g / day, intramuscular injection. Androgens are available oral dimethyl testicular intoxicated, 50mg, 4 times / day, the side effects of androgen is mainly masculine symptoms, such as hair loss, hoarseness, etc., go away after stopping.
(3) estrogen: physical volume of the cytoplasm of estrogen can increase the estrogen receptor, and treatment when the amount of estrogen receptor can shift from the cytoplasm, the nucleus, the cytoplasm of the lack of estrogen receptor content, which inhibition of DNA synthesis. Also suggested that the endocrine environment may be through changes in the body, and inhibit the growth of cancer cells, estrogen more than 5 years of menopause better, while pre-menopausal women often ineffective, hormone receptor positive effect on the better of skin and soft tissue metastases are more efficient, followed by lung and bone metastases, liver and brain metastasis often yuan effect. Preparations are commonly used acetylene estrogen estradiol 3mg, 3 times / day, common side effects are nausea, vomiting, etc., in addition to breast enlargement, skin relaxation nipple and areola coloring department, it is worth noting that about 10% of the patients estrogen treatment can cause tumor development.
(4) anti-estrogen drugs: endocrine therapy, the non-simplified hormone tamoxifen (c phenoxy adhesive) has been widely used clinically safe and effective, its mechanism of action of estradiol is to compete in the target organs of estrogen receptors, thereby reducing the cytosolic content of estrogen receptors, blocking estrogen into the cancer cells. Also blocked the nuclear transcription of estrogen production, delaying cell division, preventing further synthesis of estrogen receptors. Also tamoxifen efficacy in postmenopausal than in premenopausal patients as well, effective in selected patients without the 30% _40%, while the hormone receptor-positive patients was 55% _60%. Fabian reported that postmenopausal patients with tamoxifen response rate was 38%, 20% pre-menopausal patients, while pre-menopausal patients on tamoxifen, not a substitute for ovariectomy. Tamoxifen for endocrine therapy effective in the past were effective rate, ineffective and effective rates; of soft tissue and bone metastases is better, while the liver, lungs and other organs are less effective transfer of effective medication for several weeks in the case of constant after effects, maintain time in August. Tamoxifen as a post-menopausal, hormone receptor-positive patients, especially postoperative adjuvant therapy, can reduce the rate of early postoperative recurrence.
(5) self-similar drugs luteum: yellow body intoxicated drugs to treat breast cancer may be the mechanism of high-dose estrogen and luteinizing hormone intoxicated have antagonistic role against the effect of estrogen on breast and endometrial effect. Corpus luteum on the soft tissue from the same metastasis, local recurrence better, followed by bone metastasis, liver and lung and other organs of the less effective transfer of postmenopausal estrogen receptor-positive patients and the efficacy of those good, yellow body from the same A commonly used agents in pregnancy paid, 1_1.5g / day, intramuscular injection effect, which a pregnant intoxicated 40mg, 4 times / days. Luteal pay occasional side effects are hypertension, vaginal bleeding, skin Yan, are generally often as second-line drugs.
(6) estrogen synthesis inhibitors: aminoglutethimide is a barbiturate derivative, can inhibit the synthesis of simplified hormone, leading to adrenal insufficiency, which play the effect of adrenalectomy. Since aminoglutethimide and adrenalectomy in the treatment of non-discrimination, and there is no lack of adrenal function after resection of the phenomenon, and do not require long-term added after stopping hormone drugs, so the application of aminoglutethimide since bilateral adrenalectomy surgery has been rarely used. Aminoglutethimide the efficient selection of cases without the 30% _35%, while estrogen receptor-positive cases were 50% _ 55%, effective cases, the average survival time was 11_17 months, aminoglutethimide 250mg, 2 times / day, while serving daily hydrocortisone 100mg, take 2 weeks, without side effects, can be changed to aminoglutethimide 250mg, 4 times / day, hydrocortisone 75mg, 2 times / day, ammonia Lu Mitt common side effects are drowsiness, nausea, skin Yan and so on, with the effective cases, such as aminoglutethimide can be reused after the failure of other endocrine drugs, the effective rate of 9% _10%, which aminoglutethimide as endocrine therapy is currently often second-line drugs.
(7) endocrine therapy clinical applications: in addition to the clinical application of premenopausal oophorectomy cases are still outside, on the general use of postmenopausal patients with tamoxifen or aminoglutethimide treatment, instead of adrenalectomy or pituitary removal surgery. Therefore, surgical methods of endocrine therapy is gradually reduced. Clinically, such as from surgery to recurrence interval length, soft tissue or bone metastasis and the patient after menopause, in particular the estrogen receptor and progesterone receptor-positive disease had better intoxicated, and determination of hormone receptor-negative tumors on the rapid development , inflammatory mastitis, liver metastasis, lung cancer, lymphangitis are not suitable for endocrine therapy. However, the other for advanced cases are often the preferred treatment.
Drug treatment of breast cancer, endocrine therapy clinical principle is: if in postmenopausal patients with hormone receptor-positive determination, the development of unpleasant or tumor, tamoxifen is the most common first-line drugs, a pregnancy from the same or aminoglutethimide often used as second-line drugs; tamoxifen after treatment failure cases with half of aminoglutethimide is effective; which a pregnancy can make 35% _40% intoxicated cases mitigation; of cases of pre-menopausal or menstrual endocrine therapy is the preferred oophorectomy, tamoxifen effective in these cases is low, while tamoxifen can not replace the oophorectomy, even if a valid case of failure of ovariectomy may also consider the use of aminoglutethimide in pregnancy or while intoxicated with a treatment ; tumor cases of the rapid development of endocrine therapy is not suitable, should be based chemotherapy; clinical endocrine therapy combined with chemotherapy to improve the effective rate is only slightly, while the survival rate and survival did not improve.