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

Ukwelashwa KweHormone Komdlavuza Webele

Yini ama-hormone?

AmaHormone yizinto ezisebenza njengezithunywa zamakhemikhali emzimbeni. Zithinta izenzo zamaseli nezicubu ezindaweni ezahlukahlukene emzimbeni, zivame ukufinyelela ezinhlosweni zazo ngokuhamba kwegazi.

Ama-hormone estrogen ne-progesterone akhiqizwa ama-ovari kwabesifazane be-premenopausal nakwezinye izicubu, kufaka phakathi amafutha nesikhumba, kwabesifazane nabesilisa abangaphambi kokuya esikhathini nokuya esikhathini. I-Estrogen ithuthukisa ukuthuthukiswa kanye nokugcinwa kwezici zobulili besifazane kanye nokukhula kwamathambo amade. Iprogesterone ibamba iqhaza emjikelezweni wokuya esikhathini nokukhulelwa.

I-Estrogen ne-progesterone nazo zigqugquzela ukukhula kweminye yomdlavuza webele, obizwa ngokuthi umdlavuza webele ozwela ama-hormone (noma othembele kuma-hormone). Amaseli womdlavuza webele ozwela i-hormone aqukethe amaprotheni abizwa ngama-hormone receptors aqala ukusebenza lapho ama-hormone ebopheka kuwo. Ama-receptors acushiwe abangela ushintsho ekuvezeni izakhi zofuzo ezithile, ezingakhuthaza ukukhula kwamaseli.

Kuyini ukwelashwa kwamahomoni?

Ukwelashwa kweHormone (okubizwa nangokuthi ukwelashwa kwamahomoni, ukwelashwa kwamahomoni, noma ukwelashwa kwe-endocrine) kubambezela noma kumise ukukhula kwezimila ezizwela ama-hormone ngokuvimba amandla omzimba wokukhiqiza ama-hormone noma ngokuphazamisa imiphumela yamahomoni kumaseli omdlavuza webele. Izimila ezingazweli ama-hormone azinawo ama-hormone receptors futhi aziphenduli ekwelashweni kwamahomoni.

Ukuthola ukuthi amangqamuzana omdlavuza webele aqukethe ama-hormone receptors, odokotela bahlola amasampula wezicubu zomzimba asuswe ngokuhlinzwa. Uma amangqamuzana e-tumor aqukethe ama-estrogen receptors, umdlavuza ubizwa nge-estrogen receptor positive (ER positive), i-estrogen sensitive, noma i-estrogen iyaphendula. Ngokufanayo, uma amaseli wesimila aqukethe ama-progesterone receptors, umdlavuza ubizwa ngokuthi yi-progesterone receptor positive (PR noma PgR positive). Cishe ama-80% omdlavuza webele ane-ER positive (1). Iningi lomdlavuza webele we-ER une-PR une-PR. Izicubu zamabele eziqukethe i-estrogen kanye / noma ama-progesterone receptors kwesinye isikhathi abizwa nge-hormone receptor positive (HR positive).

Umdlavuza webele ongenawo ama-estrogen receptors abizwa nge-estrogen receptor negative (ER negative). Lezi zicubu azizweli i-estrogen, okusho ukuthi azisebenzisi i-estrogen ukukhula. Izicubu zesifuba ezingenawo ama-progesterone receptors zibizwa nge-progesterone receptor negative (PR noma i-PgR negative). Izicubu zesifuba ezingenakho kokubili i-estrogen ne-progesterone receptors kwesinye isikhathi zibizwa nge-hormone receptor negative (HR negative).

Ukwelashwa ngehomoni komdlavuza webele akufanele kudidaniswe nokwelashwa kwama-menopausal hormone therapy (MHT) —ukwelashwa nge-estrogen kuphela noma kuhlanganiswe ne-progesterone ukusiza ukuqeda izimpawu zokunqamuka kokuya esikhathini. Lezi zinhlobo ezimbili zokwelashwa zikhiqiza imiphumela ehlukile: ukwelashwa kwe-hormone yomdlavuza webele kuvimbela ukukhula komdlavuza webele one-HR-positive, kanti i-MHT ingakhuthaza ukukhula komdlavuza webele one-HR. Ngalesi sizathu, lapho owesifazane othatha i-MHT kutholakala ukuthi unomdlavuza webele one-HR-positive uvame ukucelwa ukuba ayeke leyo ndlela yokwelashwa.

Yiziphi izinhlobo zokwelashwa kwamahomoni ezisetshenziselwa umdlavuza webele?

Kusetshenziswa amasu amaningana ukwelapha umdlavuza webele ozwela i-hormone:

Ukuvimba ukusebenza kwe-ovari: Ngoba ama-ovari angumthombo oyinhloko we-estrogen kwabesifazane be-premenopausal, amazinga e-estrogen kulaba besifazane angancishiswa ngokususa noma ukucindezela ukusebenza kwe-ovarian. Ukuvimba ukusebenza kwe-ovari kubizwa ngokuthi yi-ovarian ablation.

Ukukhishwa kwe-ovari kungenziwa ngokuhlinzwa lapho kususwa ama-ovari (okuthiwa i-oophorectomy) noma ngokwelashwa ngemisebe. Lolu hlobo lokukhishwa kwe-ovari luhlala luhlala njalo.

Ngenye indlela, umsebenzi wama-ovari ungacindezelwa okwesikhashana ngokwelashwa ngemithi ebizwa nge-gonadotropin-releasing hormone (GnRH) agonists, eyaziwa nangokuthi yi-luteinizing hormone-releasing hormone (LH-RH) agonists. Le mithi iphazamisa amasignali avela endlala ye-pituitary evuselela ama-ovari ukuthi akhiqize i-estrogen.

Izibonelo zemithi yokucindezela ama-ovari evunyelwe yi-US Food and Drug Administration (FDA) yi-goserelin (Zoladex®) ne-leuprolide (Lupron®).

Ukuvimba ukukhiqizwa kwe-estrogen: Izidakamizwa ezibizwa ngokuthi i-aromatase inhibitors zisetshenziselwa ukuvimba umsebenzi we-enzyme ebizwa ngokuthi i-aromatase, umzimba oyisebenzisayo ukwenza i-estrogen kuma-ovari nakwezinye izicubu. Ama-inhibitors e-Aromatase asetshenziswa ikakhulu kwabesifazane be-postmenopausal ngoba ama-ovari kwabesifazane be-premenopausal akhiqiza i-aromatase eningi kakhulu yokuthi ama-inhibitors avimbe ngempumelelo. Kodwa-ke, le mithi ingasetshenziswa kwabesifazane abangaphambi kokuya esikhathini uma inikezwe kanye nomuthi ocindezela ukusebenza kwe-ovari.

Izibonelo ze-aromatase inhibitors ezivunyelwe yi-FDA yi-anastrozole (Arimidex®) ne-letrozole (Femara®), zombili ezingasebenzi okwesikhashana i-aromatase, ne-exemestane (i-Aromasin®), eyenza i-aromatase ingasebenzi unomphela.

Ukuvimba imiphumela ye-estrogen: Izinhlobo eziningana zemithi ziphazamisa ikhono le-estrogen lokukhuthaza ukukhula kwamangqamuzana omdlavuza webele:

• Ama-modulators we-estrogen receptor akhethiwe (ama-SERMs) abopha kuma-estrogen receptors, evimbela i-estrogen ekuboshweni. Izibonelo zama-SERM agunyazwe yi-FDA ekwelashweni komdlavuza webele yi-tamoxifen (Nolvadex®) ne-toremifene (Fareston®). I-Tamoxifen isetshenziselwe iminyaka engaphezu kwengu-30 ukwelapha umdlavuza webele owamukela i-hormone.

Ngoba ama-SERM abopha ama-estrogen receptors, awakwazi ukuvimba kuphela umsebenzi we-estrogen (okungukuthi, asebenze njengabaphikisi be-estrogen) kepha futhi alingise imiphumela ye-estrogen (okungukuthi, asebenze njengama-agonists e-estrogen). Ama-SERM angaziphatha njengabaphikisi be-estrogen kwezinye izicubu futhi njengama-agonists e-estrogen kwezinye izicubu. Isibonelo, i-tamoxifen ivimba imiphumela ye-estrogen kwizicubu zesifuba kepha isebenza njenge-estrogen esibelethweni nasethanjeni.

• Eminye imishanguzo ye-antiestrogen, efana ne-fulvestrant (Faslodex®), isebenza ngendlela ehlukile ukuvimba imiphumela ye-estrogen. Njengama-SERM, i-fulvestrant ibophezela kwi-estrogen receptor futhi isebenza njengomphikisi we-estrogen. Kodwa-ke, ngokungafani nama-SERM, i-fulvestrant ayinayo imiphumela ye-estrogen agonist. Kuyi-antiestrogen emsulwa. Ngaphezu kwalokho, lapho i-fulvestrant ibopha kwi-estrogen receptor, i-receptor ihloselwe ukubhujiswa.

Ukwelashwa kwamahomoni kusetshenziswa kanjani ekwelapheni umdlavuza webele?

Kunezindlela ezintathu eziyinhloko lapho i-hormone therapy isetshenziswa ukwelapha umdlavuza webele ozwela i-hormone:

Ukwelashwa Adjuvant zakuqala-esiteji umdlavuza webele: Ucwaningo luveza izingozi ukuthi abesifazane abathola okungenani iminyaka engu-5 yokwelapha adjuvant nge tamoxifen ngemva kokuba uhlinzwe ukuze kwelashwe zakuqala-esiteji ER-HIV yomdlavuza webele ziye zanciphisa umdlavuza webele Ukuphinda, kuhlanganise umdlavuza entsha webele kwesinye isifuba, nokufa eneminyaka eyi-15 (2).

I-Tamoxifen yamukelwa yi-FDA yokwelashwa kwe-adjuvant hormone kwabesifazane be-premenopausal kanye ne-postmenopausal (kanye nabesilisa) abanomdlavuza webele webanga lokuqala we-ER-positive, futhi i-aromatase inhibitors anastrozole ne-letrozole zivunyelwe ukusetshenziswa kwalaba besifazane be-postmenopausal.

I-aromatase inhibitor yesithathu, i-exemestane, ivunyelwe ukwelashwa okunciphisayo komdlavuza webele webanga lokuqala kwabesifazane be-postmenopausal abathole i-tamoxifen phambilini.

Kuze kube muva nje, iningi labesifazane abebethola ukwelashwa kwama-hormone adjuvant ukunciphisa amathuba okuphindeka komdlavuza webele bathathe i-tamoxifen nsuku zonke iminyaka emihlanu. Kodwa-ke, ngokwethulwa kwezindlela ezintsha zokwelapha ama-hormone, ezinye zazo eziqhathaniswe ne-tamoxifen ezivivinyweni zomtholampilo, izindlela ezengeziwe zokwelashwa kwama-hormone sezandile (3-5). Isibonelo, abanye besifazane bangathatha i-aromatase inhibitor nsuku zonke iminyaka engu-5, esikhundleni se-tamoxifen. Abanye besifazane bangathola ukwelashwa okwengeziwe nge-aromatase inhibitor ngemuva kweminyaka engu-5 ye-tamoxifen. Ekugcineni, abanye besifazane bangashintshela ku-aromatase inhibitor ngemuva kweminyaka engu-2 noma engu-3 ye-tamoxifen, isikhathi seminyaka emihlanu noma ngaphezulu yokwelashwa kwamahomoni. Ucwaningo lukhombisile ukuthi kwabesifazane abasesikhathini sokuya esikhathini abaye belashelwa umdlavuza webele osanda kuqala,

Izinqumo maqondana nohlobo nobude besikhathi sokwelapha i-adjuvant therapy kufanele zenziwe ngamunye. Le nqubo eyinkimbinkimbi yokwenza izinqumo yenziwa kangcono ngokukhuluma nodokotela we-oncologist, udokotela ogxile ekwelashweni komdlavuza.

Ukwelashwa komdlavuza webele osezingeni eliphakeme noma we-metastatic: Izinhlobo eziningi zokwelashwa kwama-hormone zivunyelwe ukwelapha umdlavuza webele obhekene ne-hormone noma ozwelayo. Ukwelashwa kweHormone futhi kuyindlela yokwelashwa yomdlavuza webele we-ER-positive obuyile esifubeni, odongeni lwesifuba, noma kuma-lymph node aseduze ngemuva kokwelashwa (okubizwa nangokuthi ukuphindeka kwendawo).

Ama-SERM amabili avunyelwe ukwelapha umdlavuza webele we-metastatic, i-tamoxifen ne-toremifene. I-antiestrogen fulvestrant ivunyelwe abesifazane be-postmenopausal abanomdlavuza webele we-ER-positive osakazeke ngemuva kokwelashwa ngamanye ama-antiestrogens (7). Kungasetshenziswa nakwabesifazane be-premenopausal abaye baba nokukhishwa kwe-ovari.

Ama-aromatase inhibitors anastrozole kanye ne-letrozole avunyelwe ukuthi anikezwe abesifazane be-postmenopausal njengokwelashwa kokuqala komdlavuza webele obhekene ne-hormone (8, 9). Le mithi emibili, kanye ne-aromatase inhibitor exemestane, isetshenziselwa ukwelapha abesifazane abangemva kokuya esikhathini nokuhlaselwa yisifo somdlavuza webele osezingeni eliphezulu lapho isifo sesibe sibi kakhulu ngemuva kokwelashwa nge-tamoxifen (10).

Abanye besifazane abanomdlavuza webele osezingeni eliphezulu baphathwa ngenhlanganisela yokwelashwa kwamahomoni kanye nokwelashwa okuhlosiwe. Isibonelo, umuthi wokwelashwa ohlosiwe i-lapatinib (iTykerb®) uvunyelwe ukuthi usetshenziswe ngokuhlangana ne-letrozole ukwelapha i-hormone receptor-positive, umdlavuza webele we-HER2-positive we-metastatic webele kwabesifazane be-postmenopausal okukhonjiswe kubo ukwelashwa kwe-hormone.

Olunye uhlobo lokwelashwa okubhekiswe kulo, i-palbociclib (Ibrance®), inikezwe imvume esheshayo yokusetshenziswa ihlanganiswe ne-letrozole njengokwelashwa kokuqala kokwelashwa komdlavuza webele we-hormone receptor-positive, i-HER2-negative advanced umdlavuza webele kwabesifazane be-postmenopausal. I-Palbociclib ivimbela ama-kinase amabili ancike ku-cyclin (CDK4 ne-CDK6) abonakala ekhuthaza ukukhula kwamangqamuzana omdlavuza webele we-hormone receptor-positive.

IPalbociclib nayo ivunyelwe ukuthi isetshenziswe ngokuhlangana ne-fulvestrant ekwelapheni abesifazane abane-hormone receptor-positive, umdlavuza webele we-HER2-negative noma we-metastatic onomdlavuza wakhe uye waba mubi kakhulu ngemuva kokwelashwa ngomunye umuthi wokwelapha i-hormone.

Ukwelashwa kwe-Neoadjuvant yomdlavuza webele: Ukusetshenziswa kokwelapha i-hormone ukwelapha umdlavuza webele ngaphambi kokuhlinzwa (i-neoadjuvant therapy) kufundwe ekuhlolweni kwemitholampilo (11). Inhloso yokwelashwa kwe-neoadjuvant ukunciphisa usayizi wesimila sebele ukuvumela ukuhlinzekwa kokulondolozwa kwebele. Imininingwane evela kuzilingo ezilawulwa ngokungahleliwe ikhombisile ukuthi i-neoadjuvant hormone therapy - ikakhulukazi, ene-aromatase inhibitors - ingasebenza ekwehliseni usayizi wamathumba esifuba kwabesifazane abangemva kokuya esikhathini. Imiphumela yabesifazane bangaphambi kokuya esikhathini ayicaci kangako ngoba yizilingo ezimbalwa kuphela ezibandakanya abesifazane abambalwa ababekade beyekile ukuya esikhathini kuze kube manje.

Ayikho i-hormone therapy engakavunywa yi-FDA yokwelashwa kwe-neoadjuvant yomdlavuza webele.

Ngabe ukwelashwa kwamahomoni kungasetshenziswa ukuvikela umdlavuza webele?

Yebo. Iningi lomdlavuza webele une-ER positive, futhi izivivinyo zokwelashwa zihlolile ukuthi ngabe ukwelashwa kwama-hormone kungasetshenziswa yini ukuvimbela umdlavuza webele kwabesifazane abasengozini enkulu yokuthola lesi sifo.

Isivivinyo esikhulu somtholampilo esixhaswe yi-NCI esibizwa nge-Breast Cancer Prevention Trial sathola ukuthi i-tamoxifen, ethathwe iminyaka emi-5, yehlise ubungozi bokuba nomdlavuza webele ongahlaseli cishe ngama-50% kwabesifazane be-postmenopausal ababesengozini enkulu (12). Ukulandelwa kwesikhathi eside kwesinye isilingo esingahleliwe, i-International Breast Cancer Intervention Study I, ithole ukuthi iminyaka emihlanu yokwelashwa kwe-tamoxifen inciphisa izehlakalo zomdlavuza webele okungenani iminyaka engama-20 (13). Isilingo esikhulu esalandela esenziwa ngokungahleliwe, i-Study of Tamoxifen neRaloxifene, naso esasixhaswe yi-NCI, sathola ukuthi iminyaka emihlanu ye-raloxifene (i-SERM) inciphisa ingozi yomdlavuza webele kulabo besifazane cishe ngama-38% (14).

Njengomphumela walezi zivivinyo, ama-tamoxifen nama-raloxifene avunyelwe yi-FDA ukunciphisa ingozi yokuba nomdlavuza webele kwabesifazane abasengozini enkulu yalesi sifo. I-Tamoxifen ivunyelwe lokhu kusetshenziswa kungakhathalekile isimo sokuya esikhathini. I-Raloxifene ivunyelwe ukusetshenziswa kuphela kwabesifazane be-postmenopausal.

Ama-aromatase inhibitors amabili — i-exemestane ne-anastrazole — nawo atholakele anciphisa ubungozi besifo somdlavuza webele kubantu besifazane abangemva kokuya esikhathini nokubeka engcupheni yesifo. Ngemuva kweminyaka emithathu yokulandelwa esivivinyweni esingahleliwe, abesifazane abathathe i-exemestane babenamathuba amancane ngama-65% kunalabo abathatha i-placebo ukuthuthukisa umdlavuza webele (15). Ngemuva kweminyaka engu-7 yokulandelwa kwesinye isilingo esingahleliwe, abesifazane abathathe i-anastrozole babenamathuba amancane ngo-50% kunalabo abathatha i-placebo ukuthuthukisa umdlavuza webele (16). Kokubili i-exemestane ne-anastrozole kuvunyelwe yi-FDA ekwelashweni kwabesifazane abanomdlavuza webele we-ER-positive. Yize zombili zisetshenziselwa ukuvimbela umdlavuza webele, futhi akuvunyelwe lokho kukhombisa ngqo.

Yini imiphumela emibi yokwelashwa kwama-hormone?

Imiphumela emibi yokwelashwa kwe-hormone incike kakhulu kumuthi othile noma ohlotsheni lwezokwelapha (5). Izinzuzo nokulimala kokuthatha ukwelashwa ngamahomoni kufanele kukalwe ngokucophelela kowesifazane ngamunye. Isu elijwayelekile lokushintsha elisetshenziselwa ukwelashwa kwe-adjuvant, lapho iziguli zithatha i-tamoxifen iminyaka engu-2 noma engu-3, ​​ilandelwa i-aromatase inhibitor iminyaka engu-2 noma engu-3, ​​ingaveza izinzuzo ezilinganayo nokulimala kwalezi zinhlobo ezimbili zokwelashwa kwama-hormone (17) .

Ukushisa okushisayo, ukujuluka ebusuku, nokoma kwesitho sangasese sowesifazane yimiphumela emibi ejwayelekile yokwelashwa kwamahomoni. Ukwelashwa kweHormone kuphazamisa nomjikelezo wokuya esikhathini kwabesifazane bangaphambi kokuya esikhathini.

Imiphumela engejwayelekile ejwayelekile kodwa emibi yemithi yokwelapha i-hormone ibalwe ngezansi.

I-Tamoxifen

• Ubungozi bamahlule egazi, ikakhulukazi emaphashini nasemilenzeni (12)

• Unhlangothi (17)

• Ama-cataract (18)

• Umdlavuza we-Endometrial nowesibeletho (17, 19)

• Ukulahleka kwamathambo kwabesifazane bangaphambi kokuya esikhathini

• Ukushintsha kwemizwelo, ukudangala, nokulahleka kwe-libido

• Emadodeni: ikhanda, isicanucanu, ukuhlanza, ukuqubuka kwesikhumba, ukungabi namandla, nokwehla kwezintshisekelo zocansi

Raloxifene

• Ubungozi bamahlule egazi, ikakhulukazi emaphashini nasemilenzeni (12)

• Unhlangothi kumaqenjana athile (17)

Ukucindezelwa kwe-Ovarian

• Ukulahleka kwamathambo

• Ukushintsha kwemizwelo, ukudangala, nokulahleka kwe-libido

I-Aromatase inhibitors

• Ubungozi bokuhlaselwa yinhliziyo, i-angina, ukwehluleka kwenhliziyo, kanye ne-hypercholesterolemia (20)

• Ukulahleka kwamathambo

• Ubuhlungu obuhlangene (21-24)

• Ukushintsha kwemizwelo nokudangala

I-Fulvestrant

• Izimpawu zamathumbu (25)

• Ukuphelelwa amandla (24)

• Ubuhlungu

Ngabe ezinye izidakamizwa zingaphazamisa ukwelashwa kwamahomoni?

Izidakamizwa ezithile, kufaka phakathi ama-anti-depressants amaningana anqunyiwe (lawo asesigabeni esibizwa ngokuthi yi-selective serotonin reuptake inhibitors, noma ama-SSRIs), avimbela i-enzyme ebizwa nge-CYP2D6. Le enzyme idlala indima ebaluleke kakhulu ekusetshenzisweni kwe-tamoxifen ngumzimba ngoba ihlanganisa, noma yehle, i-tamoxifen ibe ama-molecule, noma ama-metabolites, asebenza kakhulu kune-tamoxifen uqobo.

Ithuba lokuthi ama-SSRI angahle, ngokuvimbela i-CYP2D6, anciphise imetabolism ye-tamoxifen futhi anciphise ukusebenza kwayo ukukhathazeka okunikezwe ukuthi ingxenye eyodwa kwezine yeziguli zomdlavuza webele ibhekana nokudangala komtholampilo futhi ingalashwa ngama-SSRI. Ngaphezu kwalokho, ama-SSRIs kwesinye isikhathi asetshenziselwa ukwelapha ukukhanya okushisayo okubangelwa ukwelashwa ngama-hormone.

Ochwepheshe abaningi basikisela ukuthi iziguli ezithatha imishanguzo yokucindezela kanye ne-tamoxifen kufanele zixoxe ngezindlela zokwelashwa nodokotela bazo. Isibonelo, odokotela bangancoma ukuthi kususwe i-SSRI eyi-inhibitor enamandla we-CYP2D6, njenge-paroxetine hydrochloride (Paxil®), iye kweye-inhibitor ebuthakathaka, njenge-sertraline (i-Zoloft®), noma engenawo umsebenzi wokuvimbela, njenge-venlafaxine (i-Effexor®) noma i-citalopram (i-Celexa®). Noma bangaphakamisa ukuthi iziguli zabo ze-postmenopausal zithathe i-aromatase inhibitor esikhundleni se-tamoxifen.

Eminye imithi evimbela i-CYP2D6 ifaka okulandelayo:

• I-Quinidine, esetshenziselwa ukwelapha isigqi senhliziyo esingajwayelekile

• IDiphenhydramine, eyi-antihistamine

• I-Cimetidine, esetshenziselwa ukunciphisa i-acid esiswini

Abantu abanikezwe i-tamoxifen kufanele baxoxe ngokusetshenziswa kwayo yonke eminye imithi nodokotela babo.

Izinkomba ezikhethiwe

1. UKohler BA, uSherman RL, uHowlader N, et al. Umbiko Wonyaka Kwisizwe Ngesimo Somdlavuza, ngo-1975-2011, okubandakanya izehlakalo zomdlavuza webele ongaphansi kobuhlanga / ubuhlanga, ubumpofu nezwe. Ijenali yeNational Cancer Institute 2015; 107 (6): djv048. i-doi: 10.1093 / jnci / djv048Exit Disclaimer.
2. Iqembu Lokusebenzisana Lomdlavuza Webele Lokuqala (EBCTCG). Ukusebenza kwama-receptor we-cancer yomdlavuza webele nezinye izinto ekusebenzeni kwe-adjuvant tamoxifen: ukuhlaziywa kwe-meta-level yokuhlolwa kwezilingo ezingahleliwe. ILancet 2011; 378 (9793) 771-784. [I-PubMed Abstract]
3. Untch M, Thomssen C.Izinqumo zomkhuba wokwelashwa ekwelashweni kwe-endocrine. Uphenyo Lomdlavuza 2010; 28 Isigaba 1: 4–13. [I-PubMed Abstract]
4. URegan MM, uNeven P, uGiobbie-Hurder A, et al. Ukuhlolwa kwe-letrozole ne-tamoxifen kuphela futhi ngokulandelana kwabesifazane be-postmenopausal abanomdlavuza webele we-steroid receptor-positive: i-BIG 1-98 yokuhlolwa komtholampilo okungahleliwe eminyakeni eyi-8.1 yokulandelwa okuphakathi. ILancet Oncology 2011; 12 (12): 1101-1108. [I-PubMed Abstract]
5. UBurstein HJ, uGriggs JJ. Ukwelashwa kwe-hormonal Adjuvant yomdlavuza webele wesigaba sokuqala. Imitholampilo Yokuhlinza Nge-Oncology yaseNyakatho Melika 2010; 19 (3): 639-647. [I-PubMed Abstract]
6. Iqembu Lokusebenzisana Lomdlavuza Webele Lokuqala (EBCTCG), uDowsett M, Forbes JF, et al. I-Aromatase inhibitors kuqhathaniswa ne-tamoxifen emdlavuzeni webele wokuqala: ukuhlaziywa kwe-meta-level kwezivivinyo ezingahleliwe. I-Lancet 2015; 386 (10001): 1341-1352. [I-PubMed Abstract]
7. UHowell A, uPippen J, u-Elledge RM, et al. I-Fulvestrant ne-anastrozole ekwelapheni i-advanced breast carcinoma: ukuhlaziywa okuhleliwe okuhlelekile okuhlangene kokuhlolwa kwezilingo eziningi. Umdlavuza 2005; 104 (2): 236–239. [I-PubMed Abstract]
8. UCuzick J, uSestak I, uBaum M, et al. Umphumela we-anastrozole ne-tamoxifen njengokwelashwa kwe-adjuvant komdlavuza webele webanga lokuqala: Ukuhlaziywa kweminyaka eyi-10 kwesilingo se-ATAC. ILancet Oncology 2010; 11 (12): 1135–1141. [I-PubMed Abstract]
9. UMouridsen H, uGershanovich M, uSun Y, et al. Isigaba sesithathu se-letrozole kuqhathaniswa ne-tamoxifen njengokwelashwa komugqa wokuqala komdlavuza webele osezingeni eliphakeme kwabesifazane be-postmenopausal: ukuhlaziywa kokusinda nokuvuselelwa kokusebenza okuqhamuka ku-International Letrozole Breast Cancer Group. Ijenali ye-Clinical Oncology 2003; 21 (11): 2101-2109. [I-PubMed Abstract]
10. UMauri D, uPavlidis N, uPolyzos NP, u-Ioannidis JP. Ukusinda ngama-aromatase inhibitors kanye nama-inactivators uma kuqhathaniswa nokwelashwa okujwayelekile kwe-hormonal kumdlavuza webele osezingeni eliphakeme: ukuhlaziywa kwe-meta. Ijenali yeNational Cancer Institute 2006; 98 (18): 1285–1291. [I-PubMed Abstract]
11. UChia YH, u-Ellis MJ, uMa CX. Ukwelashwa kwe-Neoadjuvant endocrine kumdlavuza webele oyinhloko: izinkomba nokusetshenziswa njengethuluzi locwaningo. IBritish Journal of Cancer 2010; 103 (6): 759-764. [I-PubMed Abstract]
12. IVogel VG, uCostantino JP, uWickerham DL, et al. Imiphumela ye-tamoxifen vs raloxifene engcupheni yokuthola umdlavuza webele kanye neminye imiphumela yezifo: isifundo se-NSABP seTamoxifen neRaloxifene (STAR) P-2. IJAMA 2006; 295 (23): 2727–2741. [I-PubMed Abstract]
13. UCuzick J, uSestak I, uCawthorn S, et al. I-Tamoxifen yokuvimbela umdlavuza webele: ukulandelwa kwesikhathi eside kwesivivinyo se-IBIS-I sokuvikela umdlavuza webele. I-Lancet Oncology 2015; Inombolo 16 (1): 67-75. [I-PubMed Abstract]
14. IVogel VG, uCostantino JP, uWickerham DL, et al. Ukuvuselelwa kweSifundo Sikazwelonke Se-Adjuvant Breast and Bowel Study seTamoxifen neRaloxifene (STAR) P-2 Trial: Ukuvimbela umdlavuza webele. Ucwaningo Lokuvimbela Umdlavuza 2010; 3 (6): 696-706. [I-PubMed Abstract]
15. IGoss PE, u-Ingle JN, u-Alés-Martinez JE, et al. I-Exemestane yokuvimbela umdlavuza webele kwabesifazane be-postmenopausal. I-New England Journal of Medicine 2011; 364 (25): 2381-2391. [I-PubMed Abstract]
16. UCuzick J, Sestak I, Forbes JF, et al. I-Anastrozole yokuvimbela umdlavuza webele kwabesifazane abasengozini enkulu ye-postmenopausal (IBIS-II): isilingo esilawulwa umhlaba wonke, esingaboni kabili, esilawulwa ngokungahleliwe. ILancet 2014; 383 (9922): 1041-1048. [I-PubMed Abstract]
17. UFisher B, uCostantino JP, uWickerham DL, et al. I-Tamoxifen yokuvimbela umdlavuza webele: umbiko weNational Surgical Adjuvant Breast and Bowel Project P-1 Study. Ijenali yeNational Cancer Institute 1998; 90 (18): 1371–1388. [I-PubMed Abstract]
18. UGorin MB, uSuku R, uCostantino JP, et al. Ukusetshenziswa kwe-tamoxifen citrate yesikhathi eside kanye nobuthi obunamandla be-ocular. Ijenali yaseMelika ye-Ophthalmology 1998; 125 (4): 493-501. [I-PubMed Abstract]
19. I-Tamoxifen yomdlavuza webele wokuqala: ukubuka konke kokuhlolwa okungahleliwe. Iqembu Lokuhlanganyela Labahloli Bomdlavuza Webele Lokuqala. ILancet 1998; 351 (9114): 1451-1467. [I-PubMed Abstract]
20. Amir E, Seruga B, Niraula S, Carlsson L, Ocaña A. Toxicity of adjuvant endocrine therapy in postmenopausal breast cancer patients: a systematic review and meta-analysis. Journal of the National Cancer Institute 2011; 103(17):1299–1309. [PubMed Abstract]
21. Coates AS, Keshaviah A, Thürlimann B, et al. Five years of letrozole compared with tamoxifen as initial adjuvant therapy for postmenopausal women with endocrine-responsive early breast cancer: update of study BIG 1–98. Journal of Clinical Oncology 2007; 25(5):486–492. [PubMed Abstract]
22. Arimidex, Tamoxifen, Alone or in Combination (ATAC) Trialists’ Group. Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 100-month analysis of the ATAC trial. Lancet Oncology 2008; 9(1):45–53. [PubMed Abstract]
23. Coombes RC, Kilburn LS, Snowdon CF, et al. Survival and safety of exemestane versus tamoxifen after 2–3 years’ tamoxifen treatment (Intergroup Exemestane Study): a randomised controlled trial. Lancet 2007; 369(9561):559–570. Erratum in: Lancet 2007; 369(9565):906. [PubMed Abstract]
24. Boccardo F, Rubagotti A, Guglielmini P, et al. Switching to anastrozole versus continued tamoxifen treatment of early breast cancer. Updated results of the Italian Tamoxifen Anastrozole (ITA) Trial. Annals of Oncology 2006; 17(Suppl 7):vii10–vii14. [PubMed Abstract]
25. U-Osborne CK, uPippen J, uJones SE, et al. Isivivinyo esiyimpumputhe kabili, esingahleliwe ngokuqhathanisa ukusebenza nokubekezeleleka kwe-fulvestrant kuqhathaniswa ne-anastrozole kwabesifazane be-postmenopausal abanomdlavuza webele osethuthukile othuthuka ekwelashweni kwangaphambili kwe-endocrine: imiphumela yesilingo saseNyakatho Melika. Ijenali ye-Clinical Oncology 2002; 20 (16): 3386--3395. [I-PubMed Abstract]

Izinsiza Ezihlobene

Umdlavuza Webele — Inguqulo Yesineke

Ukuvimbela Umdlavuza Webele (®)

Ukwelashwa Komdlavuza Webele (®)

Izidakamizwa zivunyelwe umdlavuza webele