Breast Cancer: Ovarian Suppression May Benefit Some Young Patients

Prudence A. Francis, M.D Associate Professor , Peter MacCallum Cancer Centre Melbourne, AustraliaMedicalResearch.com Interview with:
Prudence A. Francis, M.D
Associate Professor, Peter MacCallum Cancer Centre
Melbourne, Australia

Medical Research: What is the background for this study? What are the main findings?

Response: The background for this study was the observation that premenopausal women diagnosed with hormone receptor positive breast cancer under age 35, had an increased risk of recurrence, as compared with older premenopausal women. We postulated that this might be because this age group was less likely to enter menopause after receiving chemotherapy, and so their ovaries were continuing to produce estrogen, which might have the effect of stimulating any remaining cancer cells.

The main findings were that while not all premenopausal women benefit from the addition of treatment with ovarian function suppression to tamoxifen, the women who underwent chemotherapy and remained premenopausal (median age 40) did have improved breast cancer outcomes. This same group of women had even further improvement in recurrence rates if the ovarian suppression was combined with an aromatase inhibitor exemestane, as compared with tamoxifen. The effects of including ovarian suppression were particularly striking in women under 35 years of age. Those premenopausal women who did not receive chemotherapy (median age 46) after discussion with their doctor, did well with tamoxifen alone and do not appear to benefit from ovarian suppression currently.

Medical Research: What should clinicians and patients take away from your report?

Response: That ovarian suppression may be an important treatment for some young women with hormone receptor positive breast cancer.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: With this research, we do not yet have sufficient follow-up to adequately assess the influence these treatments will have on survival for these women and we also need to continue to follow these young women to check on any late side effects from their treatment. Most of the women gave us permission to study their tumor samples further, and we may be able to further refine recommendations after these analyses.

Citation:

Adjuvant Ovarian Suppression in Premenopausal Breast CancerPrudence A. Francis, M.D., Meredith M. Regan, Sc.D., Gini F. Fleming, M.D., István Láng, M.D., Eva Ciruelos, M.D., Meritxell Bellet, M.D., Hervé R. Bonnefoi, M.D., Miguel A. Climent, M.D., Gian Antonio Da Prada, M.D., Harold J. Burstein, M.D., Ph.D., Silvana Martino, D.O., Nancy E. Davidson, M.D., Charles E. Geyer, Jr., M.D., Barbara A. Walley, M.D., Robert Coleman, M.B., B.S., M.D., Pierre Kerbrat, M.D., Stefan Buchholz, M.D., James N. Ingle, M.D., Eric P. Winer, M.D., Manuela Rabaglio-Poretti, M.D., Rudolf Maibach, Ph.D., Barbara Ruepp, Pharm.D., Anita Giobbie-Hurder, M.S., Karen N. Price, B.S., Marco Colleoni, M.D., Giuseppe Viale, M.D., Alan S. Coates, M.D., Aron Goldhirsch, M.D., and Richard D. Gelber, Ph.D. for the SOFT Investigators and the International Breast Cancer Study Group

December 11, 2014DOI: 10.1056/NEJMoa1412379

 

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