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Adjuvant ovarian function suppression extends breast cancer-free interval in young women
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Adjuvant ovarian function suppression with either tamoxifen or exemestane significantly improved the breast cancer–free interval in young women with hormone receptor–positive breast cancer, study data showed.
“Women younger than 35 years with breast cancer have historically had poor outcomes, with increased rates of both local and distant recurrence,” Gini F. Fleming, MD, he University of Chicago, and colleagues wrote. “Although women younger than 35 years have higher rates of triple-negative breast cancer, it is paradoxically in the hormone receptor-positive subgroup that the most significantly worse outcomes have been observed.”
Some studies have indicated a relationship between different outcomes and the likelihood of patients experiencing chemotherapy-induced ovarian function suppression.
“However, age-related differences in outcomes persist in the face of endocrine therapy,” Fleming and colleagues wrote.
Researchers analyzed outcomes from women enrolled in the Suppression of Ovarian Function Trial (SOFT) and the Tamoxifen and Exemestane Trial (TEXT).
The SOFT trial randomly assigned women who were still premenopausal after breast cancer surgery to either tamoxifen, tamoxifen with ovarian function suppression or exemestane with ovarian function suppression.
In the TEXT study, all patients underwent ovarian function suppression either with or without concomitant chemotherapy. randomly assigned to either tamoxifen or exemestane in addition to ovarian function suppression.
Fleming and colleagues evaluated the quality of life, adherence and treatment efficacy among women aged younger than 35 years in both trials (n = 582) and compared the outcomes data from women who were older, but still premenopausal.
Women aged younger than 35 years 5-year breast cancer–free interval 67.1% (95% CI, 54.6-76.9) tamoxifen alone, compared with 75.9% (95% CI, 64-84.4) who received suppression and tamoxifen and 83.2% (95% CI, 72.7-90) with suppression and exemestane.
For thewomen enrolled in the TEXT study, the 5-year breast cancer–free interval was 79.2% (95% CI, 66.2-87.7) with tamoxifen 81.6% (95% CI, 69.8%-89.2%) exemestane.
Vosomotor symptoms the “most prominent” quality of life symptom among women aged younger than 35 years who underwent ovarian function suppression. These worsened mostly from baseline to 6 months, with changes ranging from 30 to 40 points. ifficulties with sexual arousal and loss of sexual interest.
Older premenopausal women showed a similar burden of symptoms. Nearly onefifth (19.8%) of women aged younger than 35 years stopped all endocrine therapy early.
“Given the lack of survival advantage demonstrated to date between ovarian function suppression plus exemestane over ovarian function suppression plus tamoxifen (and vs. tamoxifen) in SFT and TEXT (with essentially equivalent proportions free of distant recurrence in TEXT), the decision to use aromatase inhibitors or tamoxifen with ovarian function suppression should be individualized, and the threshold to switch from ovarian function suppression plus exemestane to ovarian function plus tamoxifen should be low, particularly for women who struggle with adherence to ovarian function syndrome or who break through ovarian function suppression,” Philip D. Poorvu, MD, and Ann H. Partridge, MD, MPH, of Dana-Farber Cancer Institute and Harvard Medical School, wrote. “Thus, judicious use of ovarian function syndrome represents an opportunity to improve breast cancer outcomes for our youngest patients, but we must select patients carefully, actively manage the consequences, and adapt to the individual patient’s experience and preferences.” – by Andy Polhamus
Disclosure: Fleming reports a relationship with Aeterna Zentaris and research funding from Corcept Therapeutics. Please see the study for a full list of all other researchers’ relevant financial disclosures.
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