Types/breast/breast-hormone-therapy-fact-sheet

Unyango lweHormone loMhlaza weSifuba

Yintoni iihomoni?

IiHormone zizinto ezisebenza njengezithunywa zamachiza emzimbeni. Zichaphazela iintshukumo zeeseli kunye nezicubu kwiindawo ezahlukeneyo emzimbeni, zihlala zifikelela kwiithagethi zazo ngegazi.

Ihomoni i-estrogen kunye neprogesterone ziveliswa zii-ovari kwabasetyhini be-premenopausal nakwezinye izicubu, kubandakanya amanqatha kunye nolusu, kubo bobabini abantu besifazane nabangaphambi kokuyeka ukuya exesheni. I-Estrogen ikhuthaza ukukhula kunye nokugcinwa kweempawu zesini sabasetyhini kunye nokukhula kwamathambo amade. Iprogesterone idlala indima kumjikelo wokuya esikhathini kunye nokukhulelwa.

I-Estrogen kunye neprogesterone zikwakhuthaza ukukhula kwezinye iintlobo zomhlaza webele, ezibizwa ngokuba zii-cancer ze-breast-sensitive (okanye i-hormone -xhomekeke). Iiseli zomhlaza webele ezibuthathaka iHormone zineeprotein ezibizwa ngokuba zii-hormone receptors ezenziwa zisebenze xa iihomoni zibopha kubo. Ii-receptors ezisebenzayo zenze utshintsho kwinkcazo yemfuza ethile, enokuthi ikhuthaze ukukhula kweseli.

Yintoni unyango lwehomoni?

Unyango lwehormone (ekwabizwa ngokuba lonyango lwehomoni, unyango lwehomoni, okanye unyango lwe-endocrine) lucothisa okanye luyekise ukukhula kwezidumbu ezibuthathaka nehomoni ngokuthintela amandla omzimba ekuveliseni iihomoni okanye ngokungenelela kwimiphumo yehomoni kwiiseli zomhlaza wamabele. Izidumba ezingenangqondo kwihomoni azinazo ii-hormone receptors kwaye aziphenduli kunyango lwehomoni.

Ukuchonga ukuba ngaba iiseli zomhlaza wamabele zinee-receptors ze-hormone, ovavanyo bavavanya iisampulu zethishu esuswe ngotyando. Ukuba iiseli zethumba ziqulethe ii-estrogen receptors, umhlaza ubizwa ngokuba yi-estrogen receptor (i-ER), i-estrogen sensitive, okanye i-estrogen iyaphendula. Kwangokunjalo, ukuba iiseli zethumba ziqulethe ii-progesterone receptors, umhlaza ubizwa ngokuba yi-progesterone receptor positive (PR okanye iPgR). Phantse iipesenti ezingama-80 zomhlaza webele zine-ER (1). Uninzi lwee-cancer ezinesifo se-ER nazo zine-PR. Amathumba ebele aqukethe i-estrogen kunye / okanye i-progesterone receptors ngamanye amaxesha ibizwa ngokuba yi-hormone receptor (i-HR positive).

Umhlaza webele oswele i-estrogen receptors ubizwa ngokuba yi-estrogen receptor negative (i-ER negative). Ezi tumors zingenantlonelo nge-estrogen, oko kuthetha ukuba abayisebenzisi i-estrogen ukukhula. Amathumba ebele angenayo i-progesterone receptors ibizwa ngokuba yiprogesterone receptor negative (PR okanye iPgR). Izidumbu zesifuba ezingenazo zombini i-estrogen kunye ne-progesterone receptors ngamanye amaxesha zibizwa ngokuba yi-hormone receptor engalunganga (HR negative).

Unyango lwehormone lomhlaza webele akufuneki ludidaniswe nonyango lwe-menopausal hormone (MHT) -unyango lwe-estrogen yodwa okanye ngokudibeneyo neprogesterone ukunceda ukukhulula iimpawu zokuyeka ukuya exesheni. Ezi ntlobo zimbini zonyango zivelisa iziphumo ezichaseneyo: Unyango lwehomoni kumhlaza webele luthintela ukukhula komhlaza webele one-HR, ngelixa i-MHT inokukhuthaza ukukhula komhlaza webele one-HR. Ngesi sizathu, xa owasetyhini othatha i-MHT efunyaniswe enomhlaza webele one-HR-positive uhlala ecelwa ukuba ayeke olo nyango.

Zeziphi iintlobo zonyango lwehomoni ezisetyenziselwa umhlaza webele?

Kusetyenziswa iindlela ngeendlela ukunyanga umhlaza webele onovakalelo webele:

Ukuthintela ukusebenza kwe-ovari: Ngenxa yokuba ii-ovari zingumthombo ophambili we-estrogen kubafazi be-premenopausal, amanqanaba e-estrogen kula mabhinqa anokuncitshiswa ngokususa okanye ukucinezela umsebenzi we-ovari. Ukuthintela umsebenzi we-ovari kubizwa ngokuba yi-ovarian ablation.

Ukuchithwa kwe-Ovarian kungenziwa ngophando ekusebenzeni ukususa ii-ovari (ezibizwa ngokuba yi-oophorectomy) okanye ngonyango ngemitha. Olu hlobo lokususwa kwe-ovari luhlala lusisigxina.

Ngenye indlela, umsebenzi we-ovari unokucinezelwa okwethutyana ngonyango ngamachiza abizwa ngokuba yi-gonadotropin-releasing hormone (GnRH) agonists, ekwabizwa ngokuba yi-luteinizing hormone-releasing hormone (LH-RH) agonists. La mayeza aphazamisa imiqondiso evela kwidlala yebhinqa evuselela amaqanda ukuba avelise i-estrogen.

Imizekelo yamachiza okucinezela ovari avunyiweyo yi-US Food and Drug Administration (FDA) yi-goserelin (Zoladex®) kunye ne-leuprolide (Lupron®).

Ukuthintela ukuveliswa kwe-estrogen: Amachiza abizwa ngokuba yi-aromatase inhibitors asetyenziselwa ukuvimba umsebenzi we-enzyme ebizwa ngokuba yi-aromatase, ethi isetyenziswe ngumzimba ukwenza i-estrogen kwii-ovari nakwezinye izicwili. I-Aromatase inhibitors isetyenziswa ikakhulu kubafazi abasemva kwemini ngenxa yokuba ama-ovari kumanina angaphambi kokuyeka ukuya esikhathini avelisa iaromatase eninzi kakhulu ukuze inhibitors ibhloke ngokufanelekileyo. Nangona kunjalo, la machiza anokusetyenziswa kubafazi be-premenopausal ukuba banikwe kunye neyeza elicinezela ukusebenza kwe-ovari.

Imizekelo ye-aromatase inhibitors evunyiweyo yi-FDA yi-anastrozole (Arimidex®) kunye ne-letrozole (Femara®), zombini ezingasebenzi okwethutyana i-aromatase, kunye ne-exemestane (Aromasin®), engasebenziyo ngokusisigxina iaromatase.

Ukuthintela iziphumo ze-estrogen: Iindidi ezininzi zamachiza ziphazamisa amandla e-estrogen okukhuthaza ukukhula kweeseli zomhlaza wamabele:

• Iimodyuli ezikhethiweyo ze-estrogen (ii-SERMs) zibopha ii-estrogen receptors, zithintela i-estrogen ekubophelelweni. Imizekelo yee-SERM ezivunyiweyo yi-FDA kunyango lomhlaza wamabele yi-tamoxifen (Nolvadex®) kunye ne-toremifene (Fareston®). I-Tamoxifen isetyenziselwe ngaphezulu kweminyaka eyi-30 ukunyanga umhlaza webele we-hormone receptor-positive.

Ngenxa yokuba ii-SERM zibophelela kwii-estrogen receptors, azinako nje ukubhloka umsebenzi we-estrogen (okt, zisebenza njengabachasi be-estrogen) kodwa zikwalinganise iziphumo ze-estrogen (okt, zisebenza njengee-agonists ze-estrogen). Ii-SERM zinokuziphatha njengabachasi be-estrogen kwezinye izicubu kunye nee-estrogen agonists kwezinye izicwili. Umzekelo, i-tamoxifen ibhloka ifuthe le-estrogen kwithishu yebele kodwa isebenza njenge-estrogen kwisibeleko nakwithambo.

• Amanye amachiza e-antiestrogen, anjenge-fulvestrant (Faslodex®), asebenza ngendlela eyahlukileyo yokuthintela iziphumo ze-estrogen. Njengee-SERMs, i-fulvestrant ibophelela kwi-estrogen receptor kunye nemisebenzi njenge-estrogen antagonist. Nangona kunjalo, ngokungafaniyo nee-SERM, i-fulvestrant ayinaziphumo ze-agonist ye-estrogen. Yi-antiestrogen emsulwa. Ukongeza, xa i-fulvestrant ibophelela kwi-estrogen receptor, i-receptor ijolise ekutshatyalalisweni.

Unyango lwehomoni lusetyenziselwa njani ukunyanga umhlaza wamabele?

Zintathu iindlela eziphambili ekusetyenzisweni kwazo kunyango lwehomoni ukunyanga umhlaza webele onovakalelo webele:

Unyango lwe-Adjuvant kunyango lomhlaza wamabele: Uphando lubonakalisile ukuba abasetyhini abafumana ubuncinci iminyaka emihlanu yonyango lwe-adjuvant kunye ne-tamoxifen emva kotyando lomhlaza webele we-ER-positive baye banciphisa umngcipheko wokuphindaphinda komhlaza webele, kubandakanya nomhlaza wamabele omtsha kwelinye isifuba, nasekufeni kwiminyaka eli-15 (2).

I-Tamoxifen yamkelwe yi-FDA yonyango lwe-adjuvant ye-premenopausal kunye ne-postmenopausal yabasetyhini (kunye namadoda) ane-ER-positive yomhlaza webele kwangoko, kunye ne-aromatase inhibitors anastrozole kunye ne-letrozole evunyiweyo ukuze isetyenziselwe abafazi be-postmenopausal.

Isithinteli sesithathu se-aromatase inhibitor, exemestane, samkelwe sonyango lwe-adjuvant somhlaza webele webele kwithuba lokuqala kwabasetyhini abasele beyekile ukufumana i-tamoxifen ngaphambili.

Kude kube kutshanje, uninzi lwabasetyhini abafumene unyango lwehomoni ye-adjuvant ukunciphisa ithuba lokuphindaphinda komhlaza wamabele bathatha i-tamoxifen yonke imihla kangangeminyaka emi-5. Nangona kunjalo, ngokungeniswa kwonyango olutsha lwe-hormone, ezinye zazo ziye zathelekiswa ne-tamoxifen kwizilingo zeklinikhi, iindlela ezongezelelweyo zonyango lwe-hormone sele ziqhelekile (3-5). Umzekelo, abanye abantu basetyhini banokuthatha i-aromatase inhibitor yonke imihla kangangeminyaka emi-5, endaweni ye-tamoxifen. Abanye abantu basetyhini banokufumana unyango olongezelelweyo nge-aromatase inhibitor emva kweminyaka emi-5 ye-tamoxifen. Okokugqibela, abanye abantu basetyhini banokutshintshela kwi-aromatase inhibitor emva kweminyaka emi-2 okanye emi-3 ye-tamoxifen, iyonke iminyaka emi-5 okanye nangaphezulu yonyango lwehomoni. Uphando lubonakalisile ukuba kubantu basetyhini abasele beyekile ukuya kunyanga abaye baphathwa umhlaza webele kwangoko,

Izigqibo malunga nohlobo kunye nexesha lonyango lwehomoni yonyango kufuneka lwenziwe ngokwahlukeneyo. Le nkqubo inzima yokwenza izigqibo iyenziwa ngokuthetha nengcali yesifo somhlaza, ugqirha ogxile kunyango.

Unyango lomhlaza webele osele uqhubekile okanye we-metastatic: Iindidi ezininzi zonyango lwehomoni zivunyiwe ukuba zinyange umhlaza webele onomdla wehomoni. Unyango lweHormone lukwayindlela yokwenza unyango lomhlaza webele we-ER-obuye wabuya ebeleni, eludongeni lwesifuba, okanye kwiindawo ezikufutshane ne-lymph emva konyango (ekwabizwa ngokuba kukuphindaphinda kwendawo).

Ii-SERMs ezimbini zivunyiwe ukunyanga umhlaza webele we-metastatic, tamoxifen kunye ne-toremifene. I-antiestrogen fulvestrant ivunyiwe kubantu basetyhini abasemva kwendoda kunye nomhlaza webele we-metastatic ER-positive osasazeke emva konyango nezinye i-antiestrogens (7). Inokusetyenziswa nakwabafazi be-premenopausal abaye bafumana i-ovarian ablation.

I-aromatase inhibitors anastrozole kunye ne-letrozole zivunyiwe ukuba zinikwe abasetyhini abasele beyekile ukuya kunyango njengonyango lokuqala lomhlaza webele onomdla we-hormone (8, 9). La machiza mabini, kunye ne-aromatase inhibitor exemestane, asetyenziselwa ukunyanga abasetyhini abasemva kwe-postmenopausal abanomhlaza webele ophucukileyo onesifo esiye sanda emva konyango nge-tamoxifen (10).

Abanye abantu basetyhini abanesifo somhlaza webele esiqhubele phambili baphathwa ngokudibanisa unyango lwehomoni kunye nonyango ekujolise kulo. Umzekelo, unyango ekujolise kulo ngamachiza e-lapatinib (iTykerb®) yamkelwe ukuba isetyenziswe ngokudibanisa ne-letrozole yokunyanga i-hormone receptor-positive, umhlaza webele we-HER2-positive we-metastatic webele kubafazi abasemva kwe-postmenopausal ekuboniswe kubo unyango lwehomoni.

Olunye unyango ekujoliswe kulo, i-palbociclib (Ibrance®), inikwe imvume ekhawulezileyo yokusetyenziswa ngokudibanisa ne-letrozole njengonyango lokuqala kunyango lwe-hormone receptor-positive, umhlaza webele we-HER2-negative ohambele phambili kumhlaza wabasetyhini kwi-postmenopausal women. I-Palbociclib inqanda ii-kinase ezixhomekeke kwi-cyclin (CDK4 kunye ne-CDK6) ezibonakala ngathi zikhuthaza ukukhula kweeseli zomhlaza webele ezamkela i-hormone.

I-Palbociclib ikwavunyiwe ukuba isetyenziswe ngokudibanisa ne-fulvestrant kunyango lwabasetyhini abane-hormone receptor-positive, i-HER2-negative okanye umhlaza webele we-metastatic onomhlaza uye waba mandundu emva konyango ngolunye unyango lwehomoni.

Unyango lwe-Neoadjuvant lomhlaza wamabele: Ukusetyenziswa kwonyango lwehomoni ukunyanga umhlaza wamabele ngaphambi kotyando (unyango lwe-neoadjuvant) kuye kwafundwa kuvavanyo lweklinikhi (11). Injongo yonyango lwe-neoadjuvant kukunciphisa ubungakanani besisu esibuhlungu sokuvumela utyando lokugcina ibele. Idatha evela kuvavanyo olulawulwa ngokungenamkhethe ibonakalise ukuba unyango lwehormone ye-neoadjuvant-ngakumbi i-aromatase inhibitors- inokusebenza ukunciphisa ubungakanani beemvumba zebele kubafazi abasele besemva kokuya esikhathini. Iziphumo zabafazi be-premenopausal azicacanga ncam kuba zimbalwa kuphela izilingo ezincinci ezibandakanya abesetyhini abangaphambi kokuba baye exesheni abaye baqhutywa ngoku.

Akukho lonyango lwehormoni esele luvunyiwe yi-FDA kunyango lwe-neoadjuvant lomhlaza wamabele.

Ngaba unyango lwehomoni lunokusetyenziselwa ukuthintela umhlaza wamabele?

Ewe. Uninzi lwee-cancer zomhlaza zine-ER, kwaye iimvavanyo zeklinikhi ziye zavavanya ukuba unyango lwehomoni lungasetyenziselwa ukuthintela umhlaza wamabele kubafazi abasemngciphekweni omkhulu wokuhlaselwa sisifo.

Uvavanyo olukhulu lweklinikhi oluxhaswe ngononophelo olubizwa ngokuba yi-Breast Cancer Trial Trial lufumanise ukuba i-tamoxifen, ethathwe iminyaka emi-5, inciphise umngcipheko wokuba nomhlaza webele ongenayo malunga ne-50% kwabasetyhini abasemva komama abasesichengeni (12). Ukulandelwa kwexesha elide kolunye uvavanyo olungenamkhethe, i-International Breast Cancer Intervention Study I, yafumanisa ukuba iminyaka emi-5 yonyango lwe-tamoxifen inciphisa izehlo zomhlaza wamabele ubuncinci iminyaka engama-20 (13). Isilingo esikhulu esilandelayo, iSifundo seTamoxifen kunye neRaloxifene, ekwaxhaswa yiNCI, yafumanisa ukuba iminyaka emi-5 ye-raloxifene (i-SERM) inciphisa umngcipheko womhlaza wamabele kwabafazi malunga ne-38% (14).

Ngenxa yezi zilingo, zombini i-tamoxifen kunye ne-raloxifene zivunyiwe yi-FDA ukunciphisa umngcipheko wokuba nomhlaza webele kubafazi abasemngciphekweni omkhulu wesifo. I-Tamoxifen yamkelwe kolu setyenziso ngaphandle kokuma kwe-menopausal. I-Raloxifene ivunyiwe ukuba isetyenziswe kuphela kubafazi be-postmenopausal.

Ii-aromatase inhibitors ezimbini-i-exemestane kunye ne-anastrazole-kuye kwafunyanwa ukunciphisa umngcipheko womhlaza wamabele koomama abasemva kokuyeka ukuya emngciphekweni wesifo. Emva kweminyaka emi-3 yokulandelwa kwetyala elingenamsebenzi, abasetyhini abathathe i-exemestane babengaphantsi kwe-65% kunalabo bathatha indawo ye-placebo yokuphuhlisa umhlaza webele (15). Emva kweminyaka esi-7 yokulandelwa kolunye uvavanyo olungenamsebenzi, abasetyhini abathathe i-anastrozole babengaphantsi kwe-50% kunalabo bathatha indawo ye-placebo ukuba nomhlaza webele (16). Zombini i-exemestane kunye ne-anastrozole zamkelwe yi-FDA kunyango lwabasetyhini abanomhlaza webele we-ER-positive. Nangona zombini zisetyenziselwa uthintelo lomhlaza webele, akukho nto ivunyelweyo kulwalathiso ngokukodwa.

Zithini iziphumo zonyango lwehomoni?

Iziphumo zonyango lwehomoni zixhomekeka ikakhulu kwichiza elithile okanye kuhlobo lonyango (5). Izibonelelo kunye nokwenzakala kokuthatha unyango lwehomoni kufuneka kulinganiswe ngononophelo kumfazi ngamnye. Isicwangciso esiqhelekileyo sokutshintsha esisetyenziselwa unyango lwe-adjuvant, apho abaguli bathatha i-tamoxifen ye-2 okanye ye-3 iminyaka, elandelwa yi-aromatase inhibitor ye-2 okanye ye-3 iminyaka, inokuvelisa ezona zibonelelo zilungileyo kunye nokwenzakala kwezi ntlobo zimbini zonyango lwehomoni (17) .

Ukukhanya okushushu, ukubila ebusuku, kunye nokoma kwilungu lobufazi ziziphumo ebezingalindelekanga zonyango lwehomoni. Unyango lweHormone luphazamisa ukujikeleza sexesheni kwabasetyhini abangaphambi kokuya exesheni.

Zingaqhelekanga kangako kodwa iziphumo ebezingalindelekanga zonyango lweziyobisi zehomoni zidweliswe apha ngezantsi.

Tamoxifen

• Umngcipheko wamahlwili egazi, ngakumbi kwimiphunga nakwimilenze (12)

• Ukubetha (17)

• Iimpawu (18)

• Umhlaza we-Endometrial kunye nomhlaza wesibeleko (17, 19)

• Ukuphulukana nethambo kwabasetyhini abangaphambi kokuya esikhathini

• Ukutshintsha kwemo yoxinzelelo, uxinzelelo kunye nelahleko ye-libido

• Emadodeni: iintloko, isicaphucaphu, ukugabha, irhashalala, ukungabi namandla, kunye nokwehla komdla wesondo

Raloxifene

• Umngcipheko wamahlwili egazi, ngakumbi kwimiphunga nakwimilenze (12)

• Stroke kumaqelana athile (17)

Uxinzelelo lwe-Ovarian

• Ukuphulukana nethambo

• Ukutshintsha kwemo yoxinzelelo, uxinzelelo kunye nelahleko ye-libido

Inhibitors yeAromatase

• Umngcipheko wokuhlaselwa sisifo sentliziyo, i-angina, ukusilela kwentliziyo, kunye ne-hypercholesterolemia (20)

• Ukuphulukana nethambo

• Intlungu edibeneyo (21-24)

• Ukutshintsha kwemo nokudakumba

Umgcini mali

• Iimpawu zesisu (25)

• Ukuphelelwa ngamandla (24)

• Intlungu

Ngaba ezinye iziyobisi zingaphazamisa unyango lwehomoni?

Amachiza athile, kubandakanya uninzi lwee-anti-depressants (ezo zikwicandelo elibizwa ngokuba yi-serotonin reuptake inhibitors, okanye ii-SSRIs), zithintela i-enzyme ebizwa ngokuba yi-CYP2D6. Le enzyme idlala indima ebalulekileyo ekusetyenzisweni kwe-tamoxifen ngumzimba kuba ityhafisa, okanye iyaphula, i-tamoxifen kwiimolekyuli, okanye ii-metabolites, ezisebenza ngakumbi kune-tamoxifen uqobo.

Ithuba lokuba i-SSRI inokuthi, ngokuthintela i-CYP2D6, icothise imetabolism ye-tamoxifen kunye nokunciphisa ukusebenza kwayo yinkxalabo enikwe ukuba uninzi lwesine lwabaguli abanomhlaza wamabele bafumana uxinzelelo lweklinikhi kwaye banokuphathwa nge-SSRI. Ukongeza, ii-SSRI ngamanye amaxesha zisetyenziselwa ukunyanga ubushushu obubangelwa lonyango lwehomoni.

Iingcali ezininzi zicebisa ukuba izigulana ezithatha i-anti-depressants kunye ne-tamoxifen kufuneka zixoxe ngeendlela zonyango kunye noogqirha babo. Umzekelo, oogqirha banokucebisa ukutshintshela kwi-SSRI enesithinteli esinamandla se-CYP2D6, njenge-paroxetine hydrochloride (Paxil®), iye kwi-inhibitor engenamandla, njenge-sertraline (i-Zoloft®), okanye engenamsebenzi wokuthintela, njenge-venlafaxine (i-Effexor®) okanye i-citalopram (i-Celexa®). Okanye banokucebisa ukuba abaguli babo be-postmenopausal bathathe i-aromatase inhibitor endaweni ye-tamoxifen.

Amanye amayeza athintela i-CYP2D6 abandakanya oku kulandelayo:

• Iquinidine, esetyenziselwa ukunyanga isingqisho sentliziyo esingaqhelekanga

• I-Diphenhydramine, eyi-antihistamine

• I-Cimetidine, esetyenziselwa ukunciphisa isisu esiswini

Abantu abanikwe i-tamoxifen kufuneka baxoxe ngokusetyenziswa kwawo onke amayeza kunye noogqirha babo.

Izalathiso ezikhethiweyo

1. UKohler BA, uSherman RL, uHowlader N, et al. INgxelo yoNyaka kwiSizwe ngeMeko yoMhlaza, ngo-1975-2011, inezinto ezenzeka kumhlaza wamabele ngohlanga / ubuhlanga, intlupheko, kunye nelizwe. Ijenali yeZiko loMhlaza leSizwe 2015; 107 (6): djv048. ikhonkco: 10.1093 / jnci / djv048
2. IQela eliDibeneyo lokuHlolwa koMhlaza weSifuba seBele (i-EBCTCG). Ukubaluleka kokufumana i-hormone yomhlaza wamabele kunye nezinye izinto ekusebenzeni kwe-adjuvant tamoxifen: inqanaba lesigulana sokuvavanywa kweemeta kwizilingo ezingahleliwe. ILancet 2011; 378 (9793) 771-784. [PubMed Abstract]
3. I-Untch M, i-Thomssen C. Izigqibo zeklinikhi yokuziqhelanisa nokunyanga. Uphando ngomhlaza 2010; 28 Imveliso 1: 4–13. [PubMed Abstract]
4. URegan MM, uNeven P, uGiobbie-uHurder A, et al. Uvavanyo lwe-letrozole kunye ne-tamoxifen yodwa kunye nokulandelelana kwabafazi be-postmenopausal abanesifo somhlaza webele se-steroid receptor-positive: i-BIG 1-98 yolingo lwezonyango olwenziwe ngononophelo kwiminyaka eyi-8.1 yokulandelelana. I-Lancet Oncology 2011; I-12 (12): 1101-1108. [PubMed Abstract]
5. UBurstein HJ, uGriggs JJ. Unyango lwe-hormonal adjuvant kumhlaza webele kwangoko. Iiklinikhi zeOncology zoNyango zaseMntla Melika 2010; 19 (3): 639-647. [PubMed Abstract]
6. Iqela elidibeneyo lokuvavanywa komhlaza wamabele webele (EBCTCG), uDowsett M, Forbes JF, et al. I-Aromatase inhibitors xa ithelekiswa ne-tamoxifen kumhlaza webele kwangoko: uhlalutyo lweemeta zovavanyo lwezigulana ezilingwayo. ILancet 2015; 386 (10001): 1341-1352. [PubMed Abstract]
7. UHowell A, uPippen J, uElledge RM, et al. I-Fulvestrant xa ithelekiswa ne-anastrozole kunyango lwe-carcinoma ebelethwe kwangaphambili: uhlalutyo lokuphila olucwangcisiweyo oluhlangeneyo lwezilingo ezimbini. Umhlaza 2005; 104 (2): 236-239. [PubMed Abstract]
8. UCuzick J, uSestak I, uBaum M, et al. Iziphumo ze-anastrozole kunye ne-tamoxifen njengonyango olunomdla kwisifo somhlaza webele kwangoko: Uhlalutyo lweminyaka ye-10 yovavanyo lwe-ATAC. ILancet Oncology 2010; 11 (12): 1135–1141. [PubMed Abstract]
9. I-Mouridsen H, Gershanovich M, iLanga Y, et al. Isigaba sesi-III sokufundwa kwe-letrozole kunye ne-tamoxifen njengonyango lokuqala lomhlaza webele ophambili kubafazi be-postmenopausal: uhlalutyo lokusinda kunye nokuhlaziywa kokusebenza kwiqela leLetrozole Breast Cancer Group. Ijenali ye-Clinical Oncology 2003; 21 (11): 2101-2109. [PubMed Abstract]
10. UMauri D, uPavlidis N, uPolyzos NP, uIoannidis JP. Ukusinda nge-aromatase inhibitors kunye nee-inactivators xa kuthelekiswa nonyango oluqhelekileyo lwehomoni kunyango lomhlaza webele: uhlalutyo lweemeta. Ijenali yeZiko loMhlaza leSizwe 2006; 98 (18): 1285-1291. [PubMed Abstract]
11. UChia YH, uEllis MJ, Ma CX. Unyango lwe-Neoadjuvant endocrine kumhlaza webele ophambili: izikhombisi kunye nokusetyenziswa njengesixhobo sophando. Ijenali yaseBritane yoMhlaza 2010; 103 (6): 759-764. [PubMed Abstract]
12. IVogel VG, uCostantino JP, uWickerham DL, et al. Iziphumo ze-tamoxifen vs raloxifene kumngcipheko wokuhlaselwa ngumhlaza webele kunye nezinye iziphumo zezifo: isifundo se-NSABP seTamoxifen kunye neRaloxifene (STAR) P-2. IJAMA 2006; 295 (23): 2727–2741. [PubMed Abstract]
13. UCuzick J, uSestak mna, uCawthorn S, et al. I-Tamoxifen yokuthintela umhlaza wamabele: ukolulwa kwexesha elide kwe-IBIS-I yokulinga umhlaza webele. I-Lancet Oncology 2015; Isaziso: 16 (1): 67-75. [PubMed Abstract]
14. IVogel VG, uCostantino JP, uWickerham DL, et al. Ukuhlaziywa koPhando lweSizwe lwe-Adjuvant Breast kunye ne-Bowel Study yeTamoxifen kunye neRaloxifene (STAR) P-2 Trial: Ukuthintela umhlaza wamabele. Uthintelo loMhlaza ngo-2010; 3 (6): 696-706. [PubMed Abstract]
15. Goss PE, Ingle JN, Alés-Martinez JE, okqhubekayo. Exemestane yothintelo-lomhlaza webele kubafazi abasele besemva kokuba sexesheni. Ijenali eNtsha yaseNgilani yoNyango ka-2011; 364 (25): 2381-2391. [PubMed Abstract]
16. UCuzick J, uSestak I, uForbes JF, et al. I-Anastrozole yothintelo lomhlaza webele kubasetyhini abasemngciphekweni omkhulu wokugqibela emva kokuyeka ukuya kumama (IBIS-II): ityala elilawulwa yi-placebo elilawulwa kwilizwe jikelele. ILancet 2014; 383 (9922): 1041-1048. [PubMed Abstract]
17. UFisher B, uCostantino JP, uWickerham DL, et al. I-Tamoxifen yokuthintela umhlaza wamabele: ingxelo yeProjekthi yeSizwe yoNcedo lweBele kunye neProjekthi yePillus P-1 Study. Ijenali yeZiko loMhlaza leSizwe 1998; 90 (18): 1371–1388. [PubMed Abstract]
18. IGorin MB, uSuku R, uCostantino JP, et al. Ukusetyenziswa kwetamoxifen citrate yexesha elide kunye nobungozi beoyile obunokubakho. Ijenali yaseMelika yeOphthalmology 1998; 125 (4): 493-501. [PubMed Abstract]
19. I-Tamoxifen yomhlaza wamabele wokuqala: ukujonga ngokubanzi izilingo ezingenamsebenzi. Iqela elidibeneyo lokuvavanywa komhlaza webele. ILancet 1998; 351 (9114): 1451-1467. [PubMed Abstract]
20. U-Amir E, uSeruga B, uNiraula S, uCarlsson L, u-Ocaña A. Ityhefu yonyango lwe-endocrine ye-adjuvant kwizigulana ezinomhlaza wamabele we-postmenopausal: uphononongo olucwangcisiweyo kunye nohlalutyo lweemeta. Ijenali yeZiko loMhlaza leSizwe ngo-2011; 103 (17): 1299-1309. [PubMed Abstract]
21. Amabala AS, uKeshaviah A, Thürlimann B, et al. Iminyaka emihlanu ye-letrozole xa ithelekiswa ne-tamoxifen njengonyango lokuqala oluncedisayo lwabasetyhini abasemva kwe-postmenopausal abanomdlavuza webele osabelayo kwi-endocrine: uhlaziyo lwesifundo BIG 1-98. Ijenali ye-Clinical Oncology 2007; 25 (5): 486--492. [PubMed Abstract]
22. I-Arimidex, iTamoxifen, iyodwa okanye kwiQela lokuDibanisa (i-ATAC). Iziphumo ze-anastrozole kunye ne-tamoxifen njengonyango oluncedisayo kumhlaza webele webele: Uhlalutyo lweenyanga ezili-100 lwetyala le-ATAC. ILancet Oncology 2008; 9 (1): 45-53. [PubMed Abstract]
23. Iibhola ze-RC, i-Kilburn LS, i-Snowdon CF, et al. Ukusinda kunye nokukhuseleka kwe-exemestane kunye ne-tamoxifen emva kweminyaka eyi-2-3 yonyango lwe-tamoxifen (i-Intergroup Exemestane Study): ityala elilawulwa ngokungahleliwe. ILancet 2007; 369 (9561): 559-570. I-Erratum kwi: Lancet 2007; 369 (9565): 906. [PubMed Abstract]
24. UBoccardo F, uRubagotti A, uGuglielmini P, et al. Ukutshintshela kwi-anastrozole xa kuthelekiswa nonyango lwe-tamoxifen yomhlaza webele kwangoko. Iziphumo ezihlaziyiweyo zovavanyo lwesiTalixifen Anastrozole (ITA). Izibhengezo zeOncology 2006; 17 (iSuppl 7): vii10-vii14. [PubMed Abstract]
25. I-Osborne CK, uPippen J, uJones SE, et al. Imfama ephindwe kabini, ulingo olungenamkhethe ngokuthelekisa ukusebenza kunye nokunyamezeleka kwe-fulvestrant ngokuchasene ne-anastrozole kubafazi abasemva kokubeleka abanomhlaza webele osele uqhubekile kunyango lwangaphambili lwe-endocrine: iziphumo zolingo lwaseNyakatho Melika. Ijenali ye-Clinical Oncology 2002; 20 (16): 3386-3395. [PubMed Abstract]

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