Management of premenopausal women with early-stage breast cancer: is there a role for ovarian suppression?
There is an overwhelming body of evidence that adjuvant ovarian ablation/suppression has a favorable impact on survival for premenopausal women with hormone-responsive early-stage breast cancer. This article reviews the randomized controlled trials that provide these data and the indirect evidence suggesting that much of the benefit seen for adjuvant chemotherapy in estrogen receptor-positive patients < 50 years of age is an indirect consequence of a chemical castration. Therefore, carefully selected women may have a choice of ovarian suppression with a gonadotropin-releasing hormone (GnRH) analogue, such as goserelin, as an alternative to chemotherapy, which would allow younger premenopausal women to retain fertility. In addition, if chemotherapy is selected and the patient does not develop permanent amenorrhoea, then additional treatment with a GnRH analogue is indicated.
Baum
Michael
M
University College London Medical School, The Portland Hospital, 212-214 Great Portland Street, London W1W 5QN, UK. m.baum@ctc.ucl.ac.uk
O'Shaughnessy
Joyce A
JA
D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D005260:Female; D017273:Goserelin / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010052:Ovariectomy / Q000379:methods*; D010053:Ovary / Q000187:drug effects / Q000528:radiation effects / Q000601:surgery; D017410:Practice Guidelines as Topic; D017697:Premenopause; D011960:Receptors, Estrogen / Q000502:physiology
D018931:Antineoplastic Agents, Hormonal; D011960:Receptors, Estrogen; D017273:Goserelin