Adjuvant Surgical Oophorectomy Plus Tamoxifen: New Efficacy and Secondary Effects Data

Abstract

Recent publication of the 8-year update of the SOFT and TEXT trials indirectly calls attention to the leading role that surgical oophorectomy plus tamoxifen (SO+T) should now play in global breast cancer care. The here-reviewed breadth of its therapeutic effects, and its practicality, distinguish this treatment from GnRH plus tamoxifen treatment. Ovarian function suppression, whether by surgery or by GnRH treatment, in combination with tamoxifen, has been repeatedly-and now conclusively with the TEXT and SOFT results-- demonstrated to be more effective as adjuvant therapy than tamoxifen alone. The magnitude of this benefit should be greater absolutely in more commonly higher-risk cases seen in low- and middle-income countries. SO+T has additional benefits on rates of cardiovascular disease and lung and ovarian cancers, which significantly outweigh minor increases in endometrial cancers and thromboembolism. The bone loss toxicity profile of SO+T is unique and salutary: no loss of hip bone mineral density in the first two years and modest loss only in the first year in the lumbar spine. In contrast, multiple clinical issues compromise the efficacy in clinical practice, safety and practicality of GnRH + tamoxifen treatment, and long-term effects on cardiovascular events and rates of other cancers are unknown. In achieving potential population benefits, surgical oophorectomy plus tamoxifen is an optimal therapy---the surgery can be obtained by the majority of global patients with very low complication rates, tamoxifen is inexpensive, and the drop out from any hormonal treatment is reduced. Key words: Adjuvant therapy;Surgical oophorectomy;Tamoxifen; Secondary effects;