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Nazário ACP et al.
552 Rev Assoc Med Bras 2015; 61(6):543-552
After menopause, estrogen production occurs at the ex-
pense of the peripheral conversion of androgens to estro-
gens mediated by aromatase, which is abundant in fatty tis-
sue. Thus, aromatase inhibitors present a more rational
fundament, because they prevent the production of estro-
gen, while tamoxifen blocks estrogen, which has already
been produced. Inhibitors may bind irreversibly (exemes-
tane) or reversible (anastrozole and letrozole) to aromatase,
and can be given in three manners: (a) sequentially for five
years after the usual five years of tamoxifen therapy; (b) se-
quentially after two to three years of tamoxifen and, in this
case, aromatase inhibitors are continued until the comple-
tion of five years of endocrine therapy; (c) single isolated
form, for five years. The best scheme, which results in lon-
ger survival, has not yet been defined. The main side effects
are hot flushes, arthralgia, myalgia and the negative effect
on bone mass, increasing the risk of osteoporosis. Anastro-
zole, letrozole and exemestane are prescribed orally at dos-
es of 1 mg, 2.5 mg and 25 mg, respectively.
Fulvestrant is an estrogen receptor antagonist, pro-
ducing degradation and blocking transcription. It is free
of agonist effects after binding to the receptor and it is
used at a dose of 500 mg, once a month, intramuscular-
ly. The drug is indicated for cases of relapse after treat-
ment with tamoxifen or aromatase inhibitors.
Resumo
Câncer demama: novidades no diagnóstico e no tratamento
Os autores discutem as principais novidades no diagnósti-
co e no tratamento do câncer de mama, particularmente
no diagnóstico por imagem, no rastreamento e nas tera-
pêuticas locorregional e sistêmica.
Palavras-chave: câncer de mama, diagnóstico, tratamento.
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