6.2 Endocrine Therapy for Postmenopausal Breast Ca...
Fig.2
According to the latest CSCO guidelines，the initial treatment recommended for Level I is 5 years of aromatase inhibitor therapy（Class 1A evidence）.If the initial treatment is for his patients，the treatment period can be replaced with aromatase inhibitor treatment for 5 years（Class 1A evidence）.The initial 5 years aromatase inhibitor treatment has been completed for 5 years and has good tolerance，and one of the following conditions is met，consider continuing to use aromatase inhibitors to prolong endocrine therapy：1.lymph node slyetic positive.2.histological grade is 3 levels.3.other risk factors that require line-assisted chemotherapy（see Fig.2）.(https://www.daowen.com)
BIG 1-98 is a large multi-center，randomized，double-blind Phase Ⅲ international clinical study conducted in 27 countries worldwide，with a total of 8,028 patients enrolled.The purpose of the trial was to determine the most effective drug use method and time for teraquat as an auxiliary treatment for patients with preoperative estrogen receptor-positive early breast cancer to minimize the risk of recurrence.From March，1998 to March，2000，a total of 1835 subjects were enrolled in group A and B，as requiredby part 1 of the trial.From September，1999 to May，2003，a total of 6，193 subjects were randomly assigned to four groups.The specific number of people entering each group meets the requirements of the research programme.The main observation already set in this study was disease-free survival rate（DFS），the time from random grouping to the time the first event occurred.The events set in the study included：（1）recurrence［same breast，chest wall，local recurrence（intra-breast/armpit lymph nodes），distant metastasis（including the lymph nodes on the same collarbone）］；（2）lateral breast cancer，（3）recurrence of the second primary malignancy（non-breast cancer）；（4）not recurrence death.Secondary observational endpoints of the study included total survival and safety.
The study showed that the five-year disease-free survival rate was 84.0%in the lectured group，81.4%（P＜0.01）in the Taxifen group，and the absolute difference of 2.6%.The group had a 0.81 risk ratio of recurrence（Hazard Ratio，HR），which meant that the overall risk of recurrence was reduced by 19%.The cumulative recurrence incidence of the five-year group was 10.2%，compared with 13.6%in the moxidine group，and the risk of relapse of leachate breast cancer decreased by 3.4%（P＜0.01）.The advantage of trisophazole to reduce relapse was evident in the 3 years of treatment，with a 1.9%decrease（8.1%and 6.2%respectively）compared to the tamoxifen group.A specific analysis of the end-ofterm events in the BIG 1—98 study showed that the risk of distant metastasis significantly reduced by 27%compared to his moxifen，with a decrease of 27%（P＜0.01）and a 17%reduction in the risk of recurrence throughout the patient（P＜0.05）（i.e.from randomgroup to systemic recurrence，including：the occurrence of the second primary tumor，any cause of death，regardless of which occurred first）.At the same time，the mortality rate in the crankhade group was reduced by 14%，but no statistical difference was shown.From the analysis of the cause，the number of patients dying from breast cancer in the latorium group was significantly lower，but the proportion of cardiovascular deaths was higher than that of the tamoxifen group.Further subgroup analysis found that in high-risk patients，the advantages of cesium in disease-free survival rate were more prominent.For example，patients with early breast cancer who were positive for lymph nodes（3,311 cases）were more likely to have distant metastasis and a higher risk of death，but the improvement in disease-free survival rate in these patients was more pronounced，with the recurrence of HR dropping to 0.71，i.e.reducing the overall risk of recurrence by 29%.At the same time，for patients who received chemotherapy after surgery（2,024 cases），the disease-free survival advantage of the curly abstinence group was more significant，with the relapsed HR dropping to 0.70，reducing the total risk of recurrence by 30%.In the ATAC trial，which compared anaquatin with moxidine as an auxiliary therapy，anaquator had an advantage only to the group of patients who had not received chemotherapy，and there was a greater difference between anaquator.For patients who have received and have not received chemotherapy，the risk of relapse can be reduced，with greater benefits for the radiotherapy group（HR 0.77 and 0.82，respectively）.
As large-scale research on AI treatment for all types of breast cancer patients continues to come to an end，the good news they bring has made 3rd generation AI a first-line drug for breast cancer patients.The results of the BIG 1-98 trial strongly demonstrate that the initial drug use of lequinox as an auxiliary therapy has a disease-free survival advantage over tamoxifen.The evidence from these large studies suggests that，whether it is the rescue treatment of advanced breast cancer，the complementary treatmentfor early breast cancer and the subsequent intensive complementary treatment，the rhododendron has shown an advantage over tamoxifen and benefits patients more.