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Breast Cancer Research and Treatment
Published in: Breast Cancer Research and Treatment 2/2017

01-01-2017 | Review

Ovarian suppression in combination endocrine adjuvant therapy in premenopausal women with early breast cancer

Authors: Rowan T. Chlebowski, Kathy Pan, Nananda F. Col

Published in: Breast Cancer Research and Treatment | Issue 2/2017

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Abstract

Purpose

The benefits of adding ovarian suppression to either tamoxifen or aromatase inhibitors as adjuvant breast cancer therapy in premenopausal women are controversial. Therefore, we performed a systematic literature review and meta-analysis of relevant randomized trials.

Methods

We identified and combined four qualifying trials reporting disease-free survival (DFS) and overall survival (OS) using meta-analysis.

Results

Combining ABCSG-12, SOFT, and TEXT studies, there were 65 fewer DFS events (HR 0.89, 95% CI 0.57–1.39) but 30 more deaths for ovarian suppression plus aromatase inhibitor compared to ovarian suppression plus tamoxifen (HR 1.31, 95% CI 0.93–1.84, P = 0.12, τ = 0.03, heterogeneity, P = 0.18). DFS and OS were more concordant for combined SOFT and E-3193 findings; for ovarian suppression plus tamoxifen compared to tamoxifen alone, there were 24 fewer DFS events (HR 0.83, 95% CI 0.67–1.07, P = 0.09, τ 2 = 0) and 14 fewer deaths (HR 0.76, 95% CI 0.53–1.07). The SOFT Estrogen Substudy demonstrated inconsistent estrogen suppression with combined ovarian suppression and aromatase inhibitor.

Conclusion

Given the discordance between DFS and OS and inconsistent estrogen suppression with ovarian suppression plus aromatase inhibitor, adding aromatase inhibitor to ovarian suppression as adjuvant therapy in premenopausal women is premature.
Literature
1.
Francis PA, Regan MM, Fleming GF et al (2015) Adjuvant ovarian suppression in premenopausal breast cancer. N Engl J Med 372:436–446CrossRefPubMed
2.
3.
Gnant M, Mlineritsch B, Schippinger W et al (2009) Endocrine therapy plus zoledronic acid in premenopausal breast cancer. N Engl J Med 360:679–691CrossRefPubMed
4.
Tevaarwerk AJ, Wang M, Zhao F et al (2014) Phase III comparison of tamoxifen versus tamoxifen plus ovarian function suppression in premenopausal women with node-negative, hormone receptor-positive breast cancer (E-3193, INT-0142): a trial of the Eastern Cooperative Oncology Group. J Clin Oncol 32:3948–3958CrossRefPubMedPubMedCentral
5.
Burstein HJ, Lacchertti C, Anderson H et al (2016) Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: American society of clinical oncology clinical practice guideline update on ovarian suppression. J Clin Oncol 34(14):1689–1701CrossRefPubMed
6.
7.
Coates AS, Winer EP, Goldhirsch A et al (2015) Tailoring therapies-improving the management of early breast cancer: St Gallen international expert consensus on the primary therapy of early breast cancer 2015. Ann Oncol 26(8):1533–1546CrossRefPubMedPubMedCentral
8.
Gnant M, Mlineritsch B, Stoeger H et al (2015) Zoledronic acid combined with adjuvant endocrine therapy of tamoxifen versus anastrozole plus ovarian function suppression in premenopausal early breast cancer: final analysis of the Austrian Breast and Colorectal Cancer Study Group Trial 12. Ann Oncol 26:313–320CrossRefPubMed
9.
Chlebowski RT (2015) Interpreting quality of life data from the SOFT and TEXT trials. Lancet Oncol 16:749–751CrossRefPubMed
10.
Dowsett M, Lonning PE, Davidson NE (2016) Incomplete estrogen suppression with gonadotropin-releasing hormone agonists may reduce clinical efficacy in premenopausal women with early breast cancer. J Clin Oncol. doi:10.​1200/​JCO.​2015.​62.​3728
11.
Papkonstantinou A, Foukakis T, Rodriguez-Wallberg K, Bergh J (2016) Is estradiol monitoring necessary in women receiving ovarian suppression for breast cancer? J Clin Oncol 34(14):1573–1579CrossRef
12.
13.
Haidich AB (2010) Meta-analysis in medical research. Hippokratia 14(Supll 1):29–37
14.
Wallace BC, Schmid CH, Lau J, Trikalinos TA (2009) Meta-analyst: software for meta-analysis of binary, continuous and diagnostic data. BMC Med Res Methodol 9:80CrossRefPubMedPubMedCentral
15.
Regan MM, Francis PA, Pagani O et al (2016) Absolute benefit of adjuvant endocrine therapies for premenopausal women with hormone receptor positive, human epidermal growth factor receptor 2 negative early breast cancer: TEXT and SOFT trials. J Clin Oncol. doi:10.​1200/​JCO.​2015.​64.​3171
16.
17.
Bellet M, Gray KP, Francis PA et al (2016) Twelve-month estrogen levels in premenopausal women with hormone receptor-positive breast cancer receiving adjuvant triptorelin plus exemestane or tamoxifen in the suppression of ovarian function trial (SOFT): the SOFT-EST substudy. J Clin Oncol 34(14):1584–1593CrossRef
18.
Pfeiler G, Konigsberg R, Fesl C et al (2011) Impact of body mass index on the efficacy of endocrine therapy in premenopausal patients with breast cancer: an analysis of the prospective ABCSG-12 trial. J Clin Oncol 29:2653–2659CrossRefPubMed
19.
Pfeiler G, Konigsberg R, Hadji P et al (2013) Impact of body mass index on estradiol depletion by aromatase inhibitors in postmenopausal women with early breast cancer. Br J Cancer 109:1522–1527CrossRefPubMedPubMedCentral
20.
21.
Pan K, Chlebowski RT (2014) Adjuvant endocrine therapy of perimenopausal and recently postmenopausal women with hormone receptor-positive breast cancer. Clin Breast Cancer 14:147–153CrossRefPubMed
22.
Regan MM, Francis PA, Pagani O et al (2016) Absolute benefit of adjuvant endocrine therapies for premenopausal women with hormone receptor-positive human epidermal growth factor receptor 2-negative early breast cancer: TEXT and SOFT Trials. J Clin Oncol 34:2221–2231CrossRefPubMed
23.
Smith IE, Dowsett M, Yap YS et al (2006) Adjuvant aromatase inhibitors for early breast cancer after chemotherapy-induced amenorrhea: caution and suggested guidelines. J Clin Oncol 24:2444–2447CrossRefPubMed
24.
Krekow LK, Hellerstedt BA, Collea RP et al (2016) Incidence and predictive factors for recovery of ovarian function in amenorrheic women in their 40’s treated with letrozole. J Clin Oncol 34:1594–1600CrossRefPubMed
25.
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2011) Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomized trials. Lancet 378:771–784CrossRef
Metadata
Title
Ovarian suppression in combination endocrine adjuvant therapy in premenopausal women with early breast cancer
Authors
Rowan T. Chlebowski
Kathy Pan
Nananda F. Col
Publication date
01-01-2017
Publisher
Springer US
Published in
Breast Cancer Research and Treatment / Issue 2/2017
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-016-4024-4

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