BMC Med：他莫昔芬可抑制男性乳房发育症和男性乳房疼痛

一项新的发表在BMC Medicine杂志上的新研究证实：他莫昔芬，一种用来抗雌激素治疗乳腺癌的药物也可以抑制男性乳房发育症和男性乳房疼痛。

前列腺癌是男性中最常见的癌症之一，早期治疗通常是非常成功的。抑制雄激素疗法常常用于减缓晚期疾病的进展。然而，抗雄激素治疗会带来一定的有害的副作用如乳房增大。睾酮可以驱动前列腺癌的增长，抗雄激素药物是通过防止睾丸激素与雄激素受体结合来抑制前列腺癌生长的。但是，细胞内雄激素受体也会遭到封锁，并开始代偿性地产生更多的睾丸激素。一些额外的睾酮将转化为雌激素，这是乳腺组织增生和其他乳腺事件的主要诱因。

抗雌激素的方法主要是通过干扰雌激素受体，而芳香化酶抑制剂能防止睾酮转化成雌激素。埃尔兰根大学医院合作四个独立的他莫昔芬治疗乳腺癌的临床试验将数据进行了循证医学分析。所有四个试验的荟萃分析表明，与没有接受治疗的男性相比，他莫昔芬治疗3、6、9和12个月后能降低男性乳房发育症和乳房疼痛的风险。总体而言，与芳香酶抑制剂或放射治疗相比，他莫昔芬是能较为成功的减少乳腺癌的症状。虽然目前还没有更多研究数据证实这一点，但一些接受他莫昔芬治疗的男性，无论是作为预防还是作为治疗手段，通常在治疗期间就能停止服用药物，不需接受药物治疗，同时也不会产生显著的不利影响。

这项研究的主要领导者Frank Kunath博士解释说，并非所有男性在接受抗雄激素治疗过程中会患上男性乳房发育症，但是，如果我们知道，有一个成功方法可以减少前列腺癌治疗过程中乳房症状，他们可能会更容易在第一时间出现症状时采取措施，以减少许多不必要的死亡。

与他莫昔芬相关的拓展阅读： 

• CCC：咖啡可降低乳腺癌术后接受他莫昔芬治疗后复发的风险
• Lancet：他莫昔芬等雌激素受体调节剂可能降低乳腺癌风险
• Cancer Res：他莫昔芬耐药性乳腺癌的治疗方法
• JCO：他莫昔芬可降低患浸润性乳腺癌的风险（NSABP B-24研究） 更多信息请点击：有关他莫昔芬更多资讯

Tamoxifen for the management of breast events induced by non-steroidal antiandrogens in patients with prostate cancer: A systematic review.

Background
 
Tamoxifen has emerged as a potential management option for gynecomastia and breast pain due to non-steroidal antiandrogens, and it is considered an alternative to surgery or radiotherapy. The objective of this systematic review was to assess the benefits and harms of tamoxifen, in comparison to other treatment options, for either the prophylaxis or treatment of breast events induced by non-steroidal antiandrogens in prostate cancer patients.
 
Methods
 
We searched CENTRAL, MEDLINE, EMBASE, reference lists, the abstracts of three major conferences and three trial registers to identify ongoing randomized controlled trials (RCTs). Two authors independently screened the articles identified, assessed the trial quality and extracted data. The protocol was prospectively registered (CRD42011001320; http://www.crd.york.ac.uk/PROSPERO).
 
Results
 
Four studies were identified. Tamoxifen significantly reduced the risk of suffering from gynecomastia (RR 0.10, 95% CI 0.05-0.22) or breast pain (RR 0.06, 95% CI 0.02-0.17) at 6 months compared to untreated controls. Tamoxifen also showed a significant benefit for the prevention of gynecomastia (RR 0.22, 95%CI 0.08-0.58) and breast pain (RR 0.25, 95% CI 0.10-0.64) when compared to anastrozole after a median of 12 months. One study showed a significant benefit of tamoxifen for the prevention of gynecomastia (RR 0.24, 95%CI 0.09-0.65) and breast pain (RR 0.20, 95% CI 0.06-0.65) when compared with radiotherapy at 6 months. Radiotherapy increased the risk of suffering from nipple erythema and skin irritation, but there were no significant differences for any other adverse events (all p>0.05).
 
Conclusions
 
The currently available evidence suggests good efficacy of tamoxifen for the prevention and treatment of breast events induced by non-steroidal antiandrogens. The impact of tamoxifen therapy on long-term adverse events, disease progression and survival remains unclear. Further large, well-designed RCTs, including long-term follow-ups, are warranted. Also, the optimal dose needs to be clarified.