title: Adjuvant endocrine therapy of premenopausal women with early breast cancer: an overview.
abstract: Tamoxifen is currently the standard of care for premenopausal women with hormone receptor-positive early breast cancers. However, endocrine strategies in premenopausal women include not only estrogen receptor blockade with tamoxifen but also temporary suppression of ovarian estrogen synthesis by luteinizing hormone-releasing hormone (LHRH) agonists, or permanent interruption of ovarian estrogen synthesis with oophorectomy or radiotherapy. Luteinizing hormone-releasing hormone agonists have proven to be as effective as surgical oophorectomy in adjuvant treatment of premenopausal breast cancer. The addition of LHRH agonists compared to no therapy reduces the annual odds of recurrence and death in premenopausal women aged less than 50 years with estrogen receptor-positive tumors. Luteinizing hormone-releasing hormone agonists alone or in combination with tamoxifen have shown disease-free survival rates similar to chemotherapy with CMF (cyclophosphamide/methotrexate/5-fluorouracil) and other second-generation chemotherapies. The role of aromatase inhibitors in combination with ovarian suppression is still not established, especially as a large phase III randomized study (Austrian Breast and Colorectal Cancer Study Group Trial 12) did not show superior efficacy compared with ovarian suppression plus tamoxifen in premenopausal early stage disease. Patients currently continue to receive ovarian suppression and tamoxifen. CYP2D6 status may become an important discriminator for the type of endocrine therapy for the premenopausal patient in the future.
authors.affiliation: Department of Gynecology and Obstetrics, Medical University of Innsbruck, Innsbruck, Austria. michael.hubalek@i-med.ac.at
authors.forename: Michael
authors.initials: M
authors.lastname: Hubalek
authors.forename: Christine
authors.initials: C
authors.lastname: Brantner
authors.forename: Christian
authors.initials: C
authors.lastname: Marth
mesh_terms: D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001317:Austria; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D019389:Cytochrome P-450 CYP2D6 / Q000235:genetics; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D017697:Premenopause; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic
chemical_list: D018931:Antineoplastic Agents, Hormonal; D019389:Cytochrome P-450 CYP2D6
references.citation: J Natl Cancer Inst. 2003 Dec 17;95(24):1833-46
references.pmid: 14679153
references.citation: J Clin Oncol. 2003 Apr 15;21(8):1431-9
references.pmid: 12668651
references.citation: Eur J Cancer. 2006 May;42(7):895-904
references.pmid: 16545560
references.citation: J Clin Oncol. 2005 Sep 1;23(25):5973-82
references.pmid: 16087950
references.citation: N Engl J Med. 2009 Feb 12;360(7):679-91
references.pmid: 19213681
references.citation: Lancet. 1992 Jan 4;339(8784):1-15
references.pmid: 1345950
references.citation: Lancet. 1993 May 22;341(8856):1293-8
references.pmid: 8098446
references.citation: Lancet. 2007 May 19;369(9574):1711-23
references.pmid: 17512856
references.citation: Oncology (Williston Park). 2009 May;23(6):482, 487
references.pmid: 19544688
references.citation: Breast Cancer Res. 2005;7(3):R284-90
references.pmid: 15987423
references.citation: Ann Oncol. 2006 Aug;17(8):1221-7
references.pmid: 16731539
references.citation: Breast Cancer Res Treat. 2004 May;85(2):151-9
references.pmid: 15111773
references.citation: J Clin Oncol. 2001 Jan 15;19(2):343-53
references.pmid: 11208825
references.citation: J Clin Oncol. 2006 Nov 1;24(31):4956-62
references.pmid: 17075113
references.citation: J Clin Oncol. 2007 Jun 20;25(18):2509-15
references.pmid: 17577027
references.citation: Eur J Cancer. 1991;27(8):966-70
references.pmid: 1832904
references.citation: J Clin Oncol. 1998 Mar;16(3):994-9
references.pmid: 9508182
references.citation: J Clin Oncol. 2000 Jul;18(14):2718-27
references.pmid: 10894871
references.citation: Br J Cancer. 2004 Feb 9;90(3):590-4
references.pmid: 14760369
references.citation: Lancet. 2005 May 14-20;365(9472):1687-717
references.pmid: 15894097
references.citation: N Engl J Med. 1988 Dec 29;319(26):1681-92
references.pmid: 3205265
references.citation: Eur J Cancer. 2003 Aug;39(12):1711-7
references.pmid: 12888366
references.citation: Lancet Oncol. 2008 Sep;9(9):840-9
references.pmid: 18718815
references.citation: J Clin Oncol. 2005 Jan 20;23(3):619-29
references.pmid: 15545664
references.citation: Eur J Cancer. 2006 Aug;42(12):1780-8
references.pmid: 16765589
references.citation: Anticancer Res. 2002 Jul-Aug;22(4):2325-32
references.pmid: 12174922
references.citation: Lancet. 1998 May 16;351(9114):1451-67
references.pmid: 9605801
references.citation: J Clin Oncol. 2002 Dec 15;20(24):4621-7
references.pmid: 12488405
references.citation: Breast Cancer Res. 2007;9(1):R7
references.pmid: 17244352
references.citation: J Clin Oncol. 2002 Dec 15;20(24):4628-35
references.pmid: 12488406
references.citation: J Clin Oncol. 2005 Dec 20;23(36):9312-8
references.pmid: 16361630