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1 Pharmaceutical Sciences 藥物科學大豆食物對乳癌荷爾蒙療法的影響 英國 RNP 國際醫學營養研究中心研究員彭建彰 小太陽藥局藥師黃泰卿 摘要 (World Cancer Research Fund) % 11% 50-60% 60-75% (estrogen receptor, ER) 1 ER 2 ER (selective estrogen receptor modulators, SERMs) (aromatase inhibitors, AIs) SERMs tamoxifen ( ) tamoxifen 41% 34% 3 70% (ER+) 2/3 tamoxifen (ER-) 5-10% 30% ( ) ER tamoxifen THE JOURNAL OF TAIWAN PHARMACY Vol.32 No.2 Jun

2 4 ER , , tamoxifen 6,7 4.3% 8,9 tamoxifen (American Society of Clinical Oncology, ASCO) bisphosphonate 藥物科 學壹 前言 10 貳 營養概論 (soybean, Glycine max Merrial) 38% 30% 18% 14% 10 (lecithin) (isoflavones) (saponin) (Phytic acid) (trypsin inhibitors) 32 2 藥學雜誌 Jun

3 藥Pharmaceutical Sciences 物科學 參 大豆與乳癌相關爭議一 大豆異黃酮結構 17 -estradiol 2-phenylnaphthalene isoflavonoids isoflavones coumestans prenylflavonoids lignans stilbenes isoflavones 12 (Peñalvo and Adlercreutz, 2004) 6 daidzin (D)23% genistin (G)64% glycitin (Gly) 13% daidzein (De) genistein (Ge) glycitein (Glye) D G Gly (glucoside form) 20% De Ge Glye (aglycones form) 90% % -glucosidase (Hendrich, 2002) 2-3% daidzin daidzein (equol) equol 17 -estradiol 11 二 大豆異黃酮誘發乳癌疑慮 58% 三 大豆類食品預防乳癌實驗 Choi (2009) equol caspase-3 caspase-9 MDA-MB µm equol µm equol 72 59% equol 11 Charalambous 30 THE JOURNAL OF TAIWAN PHARMACY Vol.32 No.2 Jun

4 equol 10 µm MCF µm equol 10 µm tamoxifen MCF-7 tamoxifen ER- ER- equol ER- ER- ER- 595 (66Kda) 530 (54Kda) ER- ER- 12 ER (JAMA) Soy Food Intake and Breast Cancer Survival (The Shanghai Breast Cancer Survival Study) , % 藥物科學Constantinou (2012) equol tamoxifen 10.3% 8.0% 11.2% (ER+) (ER-) tamoxifen 13 肆 食用大豆與預防乳癌建議 ER- tamoxifen 藥學雜誌 Jun

5 Pharmaceutical Sciences 藥物科學Study of the Effect of Soy-Based Food on Hormone Therapy for Breast Cancer Rudy Peng 1, Tai-Ching Huang 2 Research of RNP International Research Center On Medical Nutrition 1 Pharmacist of Junior Sun Drug Store 2 Abstract Breast cancer is one of the biggest threats to women health globally. Clinical data indicated that 50-60% of breast cancer in premenopausal women and 60-75% of breast cancer in postmenopausal women are positive for estrogen receptor (ER). Hence, hormone therapy takes advantage of reducing the amount of estrogen or interrupting the cellular signaling via the ER pathway. There are two types of hormone therapies including selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs). Tamoxifen is the most widely used of SERMs. Continuous therapy with tamoxifen for 5 years reduced the recurrence rate by 41% and mortality by 34%, and if tamoxifen is not effective for postmenopausal women, AIs can be considered. Clinical data suggests that the efficacy of AIs likely extends beyond 5 years. Previous studies showed that soy beans are excellent natural products; however, several studies indicated that isoflavones in soy beans and soy-based products mimic hormoneassociated signaling pathways and occupy ER, hindering the effects of tamoxifen. Since 2009, studies on the safety of soy bean and soy bean-based products in breast cancer patients showed that intake of moderate amount of soy bean-based products does not increase the risk of recurrence of breast cancer and to the contrary higher intake of soy bean-based products leads to lower recurrence rate and mortality rate of breast cancer. A long term follow up study also showed that intake of soy bean-based products are beneficial to the health of breast cancer patients. The current study intends to investigate whether intake of soy bean-based products exerted effects as generally predicted in the prevention and treatment of breast cancer patients. The study will offer guidance to physicians and dieticians in providing nutritional advice or support to breast cancer patients. 32 THE JOURNAL OF TAIWAN PHARMACY Vol.32 No.2 Jun

6 藥物科學 大豆食物對乳癌荷爾蒙療法的影響 參考資料 張金堅 晚期乳癌荷爾蒙治療的新曙光 臺灣醫界 8. five years of tamoxifen therapy for breast cancer patients 曾令民 認識乳癌荷爾蒙治療 中華民國乳癌病友協 with negative lymph nodes and estrogen receptor-positive tumors. J Natl Cancer Inst, 1996:88: 會 asp?ser_no=20 3. Clin Onco, 1996: 14: Judy Feinerman 測試罹患乳癌危險因素的新方法 黃 health_022003_03.pdf 張金堅等 台灣乳癌之流行病學 中華癌醫學誌 吳淑芬 植物雌激素及其微生物轉化 食品科學雜誌 : Messina M, McCaskill-Stevens W, Lampe JW: Ad :85 dressing the soy and breast cancer relationship:review, Fisher B, Dignam J, Bryant J, et al: Five versus more than commentary,and workshop proceedings. JNatl Cancer five years of tamoxifen for lymph node-negative breast cancer: updated findings from the National Surgical Ad- 7. Yang PS et al: A case-control study of breast cancer in Taiwan-a low-incidence area. Br J Cancer, 1997: 75(5): 豆可降低危險因素 The Soy Daily Saphner T, Tormey D, Gray R et al: Annual hazard rates of recurrence for breast cancer after primary therapy.j 謝永宏等 評估芳香酶抑制劑對於乳癌患者的安全 性 藥學雜誌 :58 4. Fisher B, Dignam J, Bryant J, et al: Five versus more than 2013;56 14 inst, 98: , The Shanghai Breast Cancer Survival Study: Soy Food juvant Breast and Bowel Project B-14 randomized trial.j Intake and Breast Cancer Survival. JAMA, Vol. 302, No. Natl Cancer Inst, 2001:93: , 2009: Fisher B, Costantino J, Redmond CK, et al: Endometrial cancer in tamoxifen- treated breast cancer patients: find- =bw9kpxdtnszwywdlpwrldgfpbczozxdzsuq9n ings from the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-14.J Natl Cancer Inst, 1994: 86: TM=&pn= 王麗民 黃豆類食品與乳癌 和信治癌中心醫院 2013 第 32 卷第 2 期 Jun 藥學雜誌 第127冊 33

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評估芳香酶抑制劑對於乳癌患者的安全性 能因為抑制雌激素作用, 而引起如 : 熱潮紅 噁心 嘔吐 陰道不適及陰道出血等副作用 ; 在子宮及骨骼組織,tamoxifen 則扮演致效劑的角色, 會引起血栓 造成子宮內膜癌等副作用, 因此有血栓性栓塞病史的病人, 需考慮服用 tamoxifen 的危險性 研 THE JOURNAL OF TAIWAN PHARMACY 第 25 卷第 2 期臨床藥學 評估芳香酶抑制劑對於乳癌患者的安全性 國軍臺中總醫院藥劑科藥師謝永宏 陳文樑 陳俊源 壹 前言乳癌是和女性荷爾蒙息息相關的癌症, 臨床上會藉由抑制雌激素的量或是阻斷雌激素受體 (estrogen receptor, ER) 的訊息傳遞路徑等荷爾蒙療法來治療乳癌 這些荷爾蒙療法包括選擇性雌激素受體調節劑 (selective

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