Goserelin Ovarian Ablation Failure in Premenopausal Women With Breast Cancer

Introduction. Breast cancer is the most frequent malignant disease in women with about 25% compared to all malignant tumours. Chemotherapy, antiestrogen and ovarian ablation/ supression present effective adjuvant approach for premenopausal women diagnosed with hormonal depended, operable breast cancer. Objective. To evaluate benefits of combined chemo/hormonal therapy that is undutiful, but optimal application has not yet been clearly determined. Methods. Thirty-six women were divided into three therapy groups. The first group (13 women) was treated with six cycles of adjuvant FAC chemotherapy followed by regular check-ups; the second group (13 women) after six cycles of adjuvant FAC chemotherapy continued treatment with a two-year application of goserelin given by subcutaneous injections (FAC-Z); the third group (10 women), after six cycles of adjuvant FAC chemotherapy continued with once per month application of gorselin for two years and a daily application of 20 mg tamoxifen for five years (FAC-Z-T). The length of overall disease free period and survival were analyzed in all three groups. Results. The benefit of LH-RH analogues in premenopausal women with hormone-dependent breast cancer was found to be low, and probably limited to smaller subgroups of patients, possibly such as those with either both steroid receptors positive (ER and PR) or those with an extremely high level of steroid receptors. In our paper, analyses of such subgroups could not been performed due to a small sample of patients. The effect of therapy is better in patients, who developed amenorrhoea, regardless of the type of later hormonal therapy. Conclusion. Ovarial ablation, whatever the method, should be probably applied as early as possible within the treatment of early breast cancer, especially in patients in whom chemotherapy induced amenorrhoea is not expected, i.e. in very young female patients.

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Surgical ovarian ablation for hormone receptor positive primary breast cancer in premenopausal women.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e12536 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e12536-e12536

Author(s):

Anton Oseledchyk ◽

Mary Gemignani ◽

Maura N. Dickler ◽

Shari Beth Goldfarb ◽

Alexia Iasonos ◽

...

Keyword(s):

Breast Cancer ◽

Endocrine Therapy ◽

Hormone Receptor ◽

De Novo ◽

Premenopausal Women ◽

Complication Rates ◽

Ovarian Ablation ◽

Hormone Receptor Positive ◽

Younger Age ◽

Grade 3

e12536 Background: Ovarian ablation is increasingly used to complement endocrine therapy in select premenopausal women with hormone-receptor positive (HR+) breast cancer (BC). It can be achieved by either medical ovarian suppression (OS) or therapeutic bilateral salpingo-oophorectomy (BSO). We sought to investigate trends of therapeutic BSO in premenopausal patients at our institution. Methods: Premenopausal women with HR+ primary BC diagnosed from 2010-2014 were identified in our prospectively maintained BC database. Patients with confirmed BRCA1/2 mutations were excluded. Distribution of patient and disease characteristics between treatment groups were assessed using univariate logistic regression analyses. Surgical details and complications were extracted from our surgical database. Results: We identified 2,854 eligible patients; 2,113 (74%) received endocrine therapy without ovarian ablation, 246 (9%) received endocrine therapy plus medical OS, 180 (6%) underwent additional BSO, and 315 (11%) did not receive endocrine therapy at the time of analysis. Independent predictors for undergoing ovarian ablation were younger age (OR 0.98; 95%CI, 0.96-0.99; p < 0.001), higher grade (grade 3 vs 1: OR 3.17; 95%CI, 1.70-5.90; grade 2 vs 1: OR 3.13; 95%CI, 1.64-5.95; p < 0.001), lymph node involvement (OR 1.46; 95%CI, 1.19-1.80; p < 0.001), and higher AJCC stage as well as de novo metastatic BC (II vs I: OR = 1.35; 95%CI, 1.03-1.76; III vs I: OR 2.57; 95%CI, 1.86-3.55; IV vs I: OR 19.69; 95%CI, 12.76-30.39; p < 0.001). Among patients who underwent ovarian ablation, patients of younger age (1.04; 95%CI, 1.01-1.07; p = 0.009) and with metastatic BC (stage IV vs I: OR 0.36; 95%CI, 0.20-0.68; p = 0.007) were less likely to undergo BSO than OS. In 180 patients undergoing BSO, five adverse events were noted: two grade 1, two grade 2, and one grade 3 complication. Conclusions: Premenopausal women with HR+ BC with high-risk features or metastatic disease were more likely to undergo ovarian ablation at our institution. Surgical ovarian ablation is a safe alternative, with low complication rates. Understanding patient preferences, side effects, and quality of life implications will help guide personalized treatment decisions.

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Amenorrhea in Premenopausal Women After Adjuvant Chemotherapy for Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2006.07.2793 ◽

2006 ◽

Vol 24 (36) ◽

pp. 5769-5779 ◽

Cited By ~ 226

Author(s):

Janice M. Walshe ◽

Neelima Denduluri ◽

Sandra M. Swain

Keyword(s):

Breast Cancer ◽

Comprehensive Evaluation ◽

Premenopausal Women ◽

Outcome Analysis ◽

Premature Menopause ◽

Ovarian Ablation ◽

Hormone Receptor Positive ◽

Direct Cytotoxicity ◽

Dual Mechanism ◽

The Impact

Chemotherapy and ovarian ablation both independently improve survival in premenopausal women with hormone-sensitive breast cancer. Amenorrhea is a well-recognized occurrence after chemotherapy. The rate of chemotherapy-induced amenorrhea varies with patient age and chemotherapy regimens administered. However, the impact of chemotherapy-induced amenorrhea on prognosis is still being defined. Older studies in premenopausal women argue that the benefit with chemotherapy is a result of direct cytotoxicity alone. However, studies that restrict outcome analysis to hormone receptor–positive tumors suggest that chemotherapy has a dual mechanism in women with hormone-responsive tumors; indirect endocrine manipulation secondary to chemotherapy-induced ovarian suppression and direct cytotoxicity. The significant health ramifications involved with the induction of premature menopause as well as potential benefits necessitate a comprehensive evaluation of chemotherapy-induced amenorrhea. This review will discuss the incidence of amenorrhea with commonly-used adjuvant chemotherapeutic regimens, the possible benefits of chemotherapy-induced amenorrhea, and the challenges of interpreting the existing data in breast cancer trials.

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An individual patient-based meta-analysis of tamoxifen versus ovarian ablation as first line endocrine therapy for premenopausal women with metastatic breast cancer

Breast Cancer Research and Treatment ◽

10.1023/a:1005833811584 ◽

1997 ◽

Vol 44 (3) ◽

pp. 201-210 ◽

Cited By ~ 52

Author(s):

Michael Crump ◽

Carol A. Sawka ◽

Gerrit DeBoer ◽

Roger B. Buchanan ◽

James N. Ingle ◽

...

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Endocrine Therapy ◽

Meta Analysis ◽

Metastatic Breast ◽

Premenopausal Women ◽

First Line ◽

Ovarian Ablation

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American Society of Clinical Oncology Endorsement of the Cancer Care Ontario Practice Guideline on Adjuvant Ovarian Ablation in the Treatment of Premenopausal Women With Early-Stage Invasive Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2011.36.4950 ◽

2011 ◽

Vol 29 (29) ◽

pp. 3939-3942 ◽

Cited By ~ 45

Author(s):

Jennifer J. Griggs ◽

Mark R. Somerfield ◽

Holly Anderson ◽

N. Lynn Henry ◽

Clifford A. Hudis ◽

...

Keyword(s):

Breast Cancer ◽

Invasive Breast Cancer ◽

Systemic Therapy ◽

Cancer Care ◽

Ad Hoc ◽

Early Stage ◽

Premenopausal Women ◽

Review Panel ◽

Ovarian Ablation ◽

American Society

Purpose The American Society of Clinical Oncology (ASCO) has policies and procedures for endorsing practice guidelines that have been developed by other professional organizations. Methods The Cancer Care Ontario (CCO) Guideline on Adjuvant Ovarian Ablation (OA) in the Treatment of Premenopausal Women With Early-Stage Invasive Breast Cancer was reviewed for developmental rigor by methodologists. An ad hoc review panel of experts reviewed the content. Results The ASCO ad hoc OA guideline review panel concurred that the recommendations are clear, thorough, based on the most relevant scientific evidence in this content area, and present options that will be acceptable to patients. According to the CCO guideline: one, OA should not be routinely added to systemic therapy with chemotherapy, tamoxifen, or the combination of tamoxifen and chemotherapy; two, OA alone is not recommended as an alternative to any other form of systemic therapy, except in the specific case of patients who are candidates for other forms of systemic therapy but who, for some reason, will not receive any other systemic therapy (eg, patients who cannot tolerate other forms of systemic therapy or patients who choose no other form of systemic therapy); and three, when chemical suppression using luteinizing hormone–releasing hormone agonists is the chosen method of OA, in the opinion of the Breast Cancer Disease Site Group, monthly injection is the recommended mode of administration. The mode of administration in nearly all of the available trials has been monthly administration. Conclusion The ASCO review panel agrees with the recommendations as stated in the CCO guideline, with the qualification that ongoing research studies may alter the recommendations of the panel.

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Combined ovarian ablation and aromatase inhibition as first-line therapy for hormone receptor-positive metastatic breast cancer in premenopausal women: report of three cases

Anti-Cancer Drugs ◽

10.1097/01.cad.0000224456.28898.37 ◽

2006 ◽

Vol 17 (8) ◽

pp. 999-1002 ◽

Cited By ~ 2

Author(s):

Nagi S. El-Saghir ◽

Ihab I. El-Hajj ◽

Jawad A. Makarem ◽

Zaher K. Otrock

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Metastatic Breast ◽

Premenopausal Women ◽

First Line ◽

Aromatase Inhibition ◽

Ovarian Ablation ◽

First Line Therapy ◽

Hormone Receptor Positive ◽

Line Therapy

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Surgical ovarian suppression for adjuvant treatment in hormone receptor positive breast cancer in premenopausal patients

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001966 ◽

2020 ◽

pp. ijgc-2020-001966

Author(s):

Anton Oseledchyk ◽

Mary L Gemignani ◽

Qin C Zhou ◽

Alexia Iasonos ◽

Rahmi Elahjji ◽

...

Keyword(s):

Breast Cancer ◽

Hormone Receptor ◽

Primary Breast Cancer ◽

Premenopausal Women ◽

Multivariate Model ◽

Stage I ◽

Endocrine Treatment ◽

Ovarian Suppression ◽

Ovarian Ablation ◽

Hormone Receptor Positive

ObjectiveOvarian suppression is recommended to complement endocrine therapy in premenopausal women with breast cancer and high-risk features. It can be achieved by either medical ovarian suppression or therapeutic bilateral salpingo-oophorectomy. Our objective was to evaluate characteristics of patients with stage I–III hormone receptor positive primary breast cancer who underwent bilateral salpingo-oophorectomy at our institution.Materials and methodsPremenopausal women with stage I–III hormone receptor positive primary breast cancer diagnosed between January 2010 and December 2014 were identified from a database. Patients with confirmed BRCA1/2 mutations were excluded. Distribution of characteristics between treatment groups was assessed using χ2 test and univariate logistic regression. A multivariate model was based on factors significant on univariate analysis.ResultsOf 2740 women identified, 2018 (74%) received endocrine treatment without ovarian ablation, 516 (19%) received endocrine treatment plus ovarian ablation, and 206 (7.5%) did not receive endocrine treatment. Among patients undergoing ovarian ablation 282/516 (55%) received medical ovarian suppression, while 234 (45%) underwent bilateral salpingo-oophorectomy. By univariate logistic analyses, predictors for ovarian ablation were younger age (OR 0.97), histology (other vs ductal: OR 0.23), lymph node involvement (OR 1.89), higher International Federation of Gynecology and Obstetrics (FIGO) stage (stage II vs I: OR 1.48; stage III vs I: OR 2.86), higher grade (grade 3 vs 1: OR 3.41; grade 2 vs 1: OR 2.99), chemotherapy (OR 1.52), and more recent year of diagnosis (2014 vs 2010; OR 1.713). Only year of diagnosis, stage, and human epidermal growth factor receptor 2 (HER-2) treatment remained significant in the multivariate model. Within the cohort undergoing ovarian ablation, older age (OR 1.05) was associated with therapeutic bilateral salpingo-oophorectomy. Of 234 undergoing bilateral salpingo-oophorectomy, 12 (5%) mild to moderate adverse surgical events were recorded.ConclusionsBilateral salpingo-oophorectomy is used frequently as an endocrine ablation strategy. Older age was associated with bilateral salpingo-oophorectomy. Perioperative morbidity was acceptable. Evaluation of long-term effects and quality of life associated with endocrine ablation will help guide patient/provider decision-making.

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