Abstract
Endocrine therapy remains important in premenopausal women with hormone receptor positive breast cancer. Ovarian ablation, used alone, is effective in delaying recurrence and increasing survival in such women. When added to chemotherapy, it is less clear that it is effective perhaps because of the endocrine ablative effect of chemotherapy. Trials comparing ovarian ablation with or without tamoxifen to CMF-type chemotherapy suggest that the endocrine therapy is equivalent to or better than this chemotherapy in women whose tumors have estrogen and/or progesterone receptor. Tamoxifen is also effective in preventing recurrence and prolonging survival in the adjuvant setting in premenopausal women. While most of the available data deals with tamoxifen given alone, it appears to have a similar beneficial effect when added to chemotherapy in the premenopausal adjuvant setting. Adjuvant aromatase inhibitors should not be used in premenopausal women.
Highlights
Endocrine therapy, developed over a century ago [1,2], remains the most effective and the most clearly targeted form of systemic therapy for breast cancer
When the meta-analytic techniques used in the Early Breast Cancer Trialists Collaborative Group (EBCTCG) overview were applied to these small trials, it became apparent that ovarian ablation (OA) was associated with a reasonably large positive effect on both disease-free survival (DFS) and overall survival (OS) in node-positive and node-negative premenopausal women [3,4,5]
Standard Bonadonna CMF [16], and doxorubicin and chemotherapy; in the FCNLCC (Fédération Nationale des cyclophosphamide (AC) taxol, which produces better Centres de Lutte contre le Cancer) French trial, all women results than AC alone [17], it is unclear what final received chemotherapy before being randomly assigned conclusions one should draw from studies that compare to Zoladex or control; and in the ZIPP trial 1173 out of
Summary
Endocrine therapy, developed over a century ago [1,2], remains the most effective and the most clearly targeted form of systemic therapy for breast cancer. There 1640 premenopausal and perimenopausal node-positive was no significant difference between the effects of CMF women whose tumours were ER positive or negative were and those of ovarian removal on either DFS or OS Those randomly assigned to receive Zoladex for 2 years or CMF with ER levels greater than 100 fmol/mg, had for six cycles. Various LHRH analogues (in particular Zoladex) study medical castration with Zoladex for 2 years in have been tested in adjuvant therapy using study premenopausal ER-positive patients produced a designs that compare Zoladex, tamoxifen, or Zoladex plus statistically significant benefit in terms of DFS, and a trend tamoxifen versus chemotherapy in the premenopausal toward improvement in OS, irrespective of concurrent setting, or that add Zoladex, tamoxifen, or Zoladex plus adjuvant tamoxifen or chemotherapy. Women phosphamide) versus ovarian suppression plus tamoxifen, receiving the endocrine therapy had significantly improved all with similar results suggesting equivalence or 71
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