Cancer Research and Treatment

Original Articles

Bilateral Salpingo-oophorectomy Compared to Gonadotropin-Releasing Hormone Agonists in Premenopausal Hormone Receptor–Positive Metastatic Breast Cancer Patients Treated with Aromatase Inhibitors: Koung Jin Suh, Se Hyun Kim, Kyung-Hun Lee, Tae-Yong Kim, Yu Jung Kim, Sae-Won Han, Eunyoung Kang, Eun-Kyu Kim, Kidong Kim, Jae Hong No, Wonshik Han, Dong-Young Noh, Maria Lee, Hee Seung Kim, Seock-Ah Im, Jee Hyun Kim; Cancer Res Treat. 2017;49(4):1153-1163. Published online February 27, 2017; DOI: https://doi.org/10.4143/crt.2016.463

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Purpose
Although combining aromatase inhibitors (AI) with gonadotropin-releasing hormone agonists (GnRHa) is becoming more common, it is still not clear if GnRHa is as effective as bilateral salpingo-oophorectomy (BSO).
Materials and Methods
We retrospectively analyzed data of 66 premenopausal patients with hormone receptor– positive, human epidermal growth factor receptor 2–negative recurrent and metastatic breast cancer who had been treated with AIs in combination with GnRHa or BSO between 2002 and 2015.
Results
The median patient age was 44 years. Overall, 24 (36%) received BSO and 42 (64%) received GnRHa. The clinical benefit rate was higher in the BSO group than in the GnRHa group (88% vs. 69%, p=0.092). Median progression-free survival (PFS) was longer in the BSO group, although statistical significance was not reached (17.2 months vs. 13.3 months, p=0.245). When propensity score matching was performed, the median PFS was 17.2 months for the BSO group and 8.2 months for the GnRHa group (p=0.137). Multivariate analyses revealed that the luminal B subtype (hazard ratio, 1.67; 95% confidence interval [CI], 1.08 to 2.60; p=0.022) and later-line treatment (≥ third line vs. first line; hazard ratio, 3.24; 95% CI, 1.59 to 6.59; p=0.001) were independent predictive factors for a shorter PFS. Incomplete ovarian suppression was observed in a subset of GnRHa-treated patients whose disease showed progression, with E2 levels higher than 21 pg/mL.
Conclusion
Both BSO and GnRHa were found to be effective in our AI-treated premenopausal metastatic breast cancer patient cohort. However, further studies in larger populations are needed to determine if BSO is superior to GnRHa.

Citations

Citations to this article as recorded by

Incomplete ovarian function suppression in premenopausal breast cancer patients treated with gonadotropin-releasing hormone agonists
Jinna Lin, Shuqi Zheng, Qiang Liu
Cancer Treatment Reviews.2025; 133: 102879. CrossRef
Effectiveness of gonadotropin-releasing hormone agonists for ovarian function suppression in premenopausal patients with hormone receptor-positive breast cancer: a retrospective single-center real-world study
Yifei Chen, Ruyan Zhang, Ying Yan, Huiping Li, Guohong Song
Breast Cancer Research and Treatment.2024; 206(3): 543. CrossRef
Oophorectomy in Premenopausal Patients with Estrogen Receptor-Positive Breast Cancer: New Insights into Long-Term Effects
Fatima Khan, Kristin Rojas, Matthew Schlumbrecht, Patricia Jeudin
Current Oncology.2023; 30(2): 1794. CrossRef
Comparison of outcomes in patients with luminal type breast cancer treated with a gonadotropin-releasing hormone analog or bilateral salpingo-oophorectomy: A cohort retrospective study
Dwi Ris Andriyanto, Prihantono, Salman Ardi Syamsu, Muhammad Ihwan Kusuma, Joko Hendarto, Indra, Nilam Smaradania, Elridho Sampepajung, Asrul Mappiwali, Muhammad Faruk
Annals of Medicine & Surgery.2022;[Epub] CrossRef
Awareness of the Causes Leading to Surgical Ablation of Ovarian Function in Premenopausal Breast Cancer—A Single-Center Analysis
Joana Correia Oliveira, Filipa Costa Sousa, Inês Gante, Margarida Figueiredo Dias
Medicina.2021; 57(4): 385. CrossRef
Long-term effect of repeated deslorelin acetate treatment in bitches for reproduction control
Brändli SP, Palm J, Kowalewski MP, Reichler IM
Theriogenology.2021; 173: 73. CrossRef
Prognostic Factors in Hormone Receptor-Positive/Human Epidermal Growth Factor Receptor 2-Negative (HR+/HER2–) Advanced Breast Cancer: A Systematic Literature Review
Gebra Cuyún Carter, Maitreyee Mohanty, Keri Stenger, Claudia Morato Guimaraes, Shivaprasad Singuru, Pradeep Basa, Sheena Singh, Vanita Tongbram, Sherko Kuemmel, Valentina Guarneri, Sara M Tolaney
Cancer Management and Research.2021; Volume 13: 6537. CrossRef
Oophorectomy as a Hormonal Ablation Therapy in Metastatic and Recurrent Breast Cancer: Current Indications and Results
Islam H. Metwally, Omar Hamdy, Saleh S. Elbalka, Mohamed Elbadrawy, Dina M. Elsaid
Indian Journal of Surgical Oncology.2019; 10(3): 542. CrossRef
Targeted Therapy for Premenopausal Women with HR+, HER2− Advanced Breast Cancer: Focus on Special Considerations and Latest Advances
Aditya Bardia, Sara Hurvitz
Clinical Cancer Research.2018; 24(21): 5206. CrossRef

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Survival Outcome of Combined GnRH Agonist and Tamoxifen Is Comparable to That of Sequential Adriamycin and Cyclophosphamide Chemotherapy Plus Tamoxifen in Premenopausal Patients with Lymph-Node–Negative, Hormone-Responsive, HER2-Negative, T1-T2 Breast Cancer: Guiyun Sohn, Sei Hyun Ahn, Hee Jeong Kim, Byung-Ho Son, Jong Won Lee, Beom Seok Ko, Yura Lee, Sae Byul Lee, Seunghee Baek; Cancer Res Treat. 2016;48(4):1351-1362. Published online April 6, 2016; DOI: https://doi.org/10.4143/crt.2015.444

Abstract PDF PubReader ePub

Purpose
The purpose of this study was to compare treatment outcomes between combined gonadotropin-releasing hormone agonist and tamoxifen (GnRHa+T) and sequential adriamycin and cyclophosphamide chemotherapy and tamoxifen (AC->T) in premenopausal patients with hormone-responsive, lymph-node–negative breast cancer.
Materials and Methods
In total, 994 premenopausal women with T1-T2, lymph-node–negative, hormone-receptor-positive, HER2-negative breast cancer between January 2003 and December 2008 were included in this retrospective cohort study. GnRHa+T and AC->T were administered to 608 patients (61.2%) and 386 patients (38.8%), respectively. Propensity score matching and inverse probability weighting were applied to the original cohort, and 260 patients for each treatment arm were included in the final analysis. Recurrence-free, cancer-specific, and overall survival was compared between the two treatment groups.
Results
A total of 994 patients were followed up for a median of 7.4 years (range, 0.5 to 11.4 years). The 5-year follow-up rate was 98.7%, and 13 patients were lost to follow-up. In propensity=matched cohorts (n=520), there was no difference in recurrence-free, cancer-specific, and overall survival rates between the two treatment groups (p=0.306, p=0.212, and p=0.102, respectively), and this was maintained after applying inverse probability weighting.
Conclusion
GnRHa+T is a reasonable alternative to AC-> T in patients with premenopausal, hormoneresponsive, HER2-negative, lymph-node–negative, T1-T2 breast cancer.

Citations

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Effectiveness of post-mastectomy adjuvant chemotherapy for the treatment of patients with prognostic stage IB breast cancer: A SEER-based study
HongMei Wang, Yi Peng, Jianbin Wu, ZhuangWei Chen, HuaLe Zhang
Asian Journal of Surgery.2023; 46(9): 3634. CrossRef
Risk of recurrence among patients with HR-positive, HER2-negative, early breast cancer receiving adjuvant endocrine therapy: A systematic review and meta-analysis
Elizabeth M. Salvo, Abril Oliva Ramirez, Jenilee Cueto, Ernest H. Law, Aaron Situ, Chris Cameron, Imtiaz A. Samjoo
The Breast.2021; 57: 5. CrossRef
Effectiveness of a 6-Month 22.5-mg Leuprolide Acetate Depot Formulation With Tamoxifen for Postoperative Premenopausal Estrogen Suppression in Hormone Receptor-Positive Breast Cancer
Zhen-Yu Wu, Young-jin Lee, Heejeong Kim, Jongwon Lee, Il Yong Chung, Jisun Kim, Saebyeol Lee, Byung-Ho Son, Sung-Bae Kim, Jae Ho Jeong, Gyungyub Gong, Sei-Hyun Ahn, BeomSeok Ko
Frontiers in Oncology.2021;[Epub] CrossRef
Changes in bone mineral density during 5 years of adjuvant treatment in premenopausal breast cancer patients
Minsung Kim, Hanna Kim, Sei Hyun Ahn, Vafa Tabatabaie, Sung Wook Choi, Guiyun Sohn, Sae Byul Lee, Beom Seok Ko, Il Yong Chung, Jisun Kim, Jong Won Lee, Byung Ho Son, Hee Jeong Kim
Breast Cancer Research and Treatment.2020; 180(3): 657. CrossRef
Change in Estradiol Levels among Premenopausal Patients with Breast Cancer Treated Using Leuprolide Acetate 11.25 Milligrams 3-Month Depot and Tamoxifen
Young-jin Lee, Zhen-Yu Wu, Hee jeong Kim, Jong Won Lee, Il Yong Chung, Jisun Kim, Sae Byul Lee, Byung Ho Son, Sung-Bae Kim, Jae Ho Jung, Gyungyub Gong, Sei-Hyun Ahn, BeomSeok Ko
Journal of Breast Cancer.2020; 23(5): 553. CrossRef
Survival outcome of combined GnRH agonist and tamoxifen is comparable to that of sequential adriamycin and cyclophosphamide chemotherapy plus tamoxifen in premenopausal patients with early breast cancer
Doonyapat Sa‑Nguanraksa, Thitikon Krisorakun, Wanee Pongthong, Pornchai O‑Charoenrat
Molecular and Clinical Oncology.2019;[Epub] CrossRef

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Ovarian Ablation Using Goserelin Improves Survival of Premenopausal Patients with Stage II/III Hormone Receptor-Positive Breast Cancer without Chemotherapy-Induced Amenorrhea: Juan Zhou, San-Gang Wu, Jun-Jie Wang, Jia-Yuan Sun, Feng-Yan Li, Qin Lin, Huan-Xin Lin, Zhen-Yu He; Cancer Res Treat. 2015;47(1):55-63. Published online August 21, 2014; DOI: https://doi.org/10.4143/crt.2013.165

Abstract PDF PubReader ePub

Purpose
The purpose of this study was to assess the value of ovarian ablation using goserelin in premenopausal patients with stage II/III hormone receptor-positive breast cancer without chemotherapy-induced amenorrhea (CIA). Materials and Methods We retrospectively reviewed the data of breast patients treated between October 1999 and November 2007 without CIA. The Kaplan-Meier method was used for calculation of the survival rate. Log rank method and Cox regression analysis were used for univariate and multivariate prognostic analysis. Results The median follow-up period was 61 months. Initially, 353 patients remained without CIA after chemotherapy and 98 among those who received goserelin and tamoxifen (TAM). In univariate analysis, goserelin improved locoregional recurrence-free survival (LRFS) (98.9% vs. 94.1%, p=0.041), distant metastasis-free survival (DMFS) (85.4% vs. 71.9%, p=0.006), disease-free survival (DFS) (85.4% vs. 71.6%, p=0.005), and overall survival (OS) (93.5% vs. 83.5%, p=0.010). In multivariate analysis, goserelin treatment was an independent factor influencing DMFS (hazard ratio [HR], 1.603; 95% confidence interval [CI], 1.228 to 2.092; p=0.001), DFS (HR, 1.606; 95% CI, 1.231 to 2.096; p=0.001), and OS (HR, 3.311; 95% CI, 1.416 to 7.742; p=0.006). In addition, treatment with goserelin resulted in significantly improved LRFS (p=0.039), DMFS (p=0.043), DFS (p=0.036), and OS (p=0.010) in patients aged < 40 years. In patients aged ≥ 40 years, goserelin only improved DMFS (p=0.028) and DFS (p=0.027). Conclusion Ovarian ablation with goserelin plus TAM resulted in significantly improved therapeutic efficacy in premenopausal patients with stage II/III hormone receptor-positive breast cancer without CIA.

Citations

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An updated systematic review about various effects of microplastics on cancer: A pharmacological and in-silico based analysis
Akmaral Baspakova, Afshin Zare, Roza Suleimenova, Aidar B. Berdygaliev, Bibigul Karimsakova, Kymbat Tussupkaliyeva, Nadiar M. Mussin, Kulyash R. Zhilisbayeva, Nader Tanideh, Amin Tamadon
Molecular Aspects of Medicine.2025; 101: 101336. CrossRef
Adjuvant ovarian function suppression and tamoxifen in premenopausal breast cancer patients: A meta-analysis
Hamdy A. Azim, Kyrillus S. Shohdy, David F. Kaldas, Loay Kassem, Hatem A. Azim
Current Problems in Cancer.2020; 44(6): 100592. CrossRef
Feasibility and efficacy of ultrasonographic and laparoscopic guidance for microwave ablation of clinically normal canine ovaries
Valentine D. Verpaalen, J. Brad Case, Michael J. Dark, S. Joel Cardenas-Goicoechea, Matt D. Winter, Sarah E. Boston, Fernando Garcia-Pereira, Alice S. Rhoton-Vlasak, Beau B. Toskich
American Journal of Veterinary Research.2020; 81(9): 747. CrossRef
Breast cancer in young patients. Peculiarities of prognosis and adjuvant hormone therapy (a literature review)
D. N. Kravchenko, A. A. Parokonnaya, M. I. Nechushkin, E. A. Nikitina, N. D. Hakurinova
Tumors of female reproductive system.2018; 14(3): 55. CrossRef
Evaluating the Survival Benefit Following Ovarian Function Suppression in Premenopausal Patients with Hormone Receptor Positive Early Breast Cancer
Lin Qiu, Fangmeng Fu, Meng Huang, Yuxiang Lin, Yazhen chen, Minyan Chen, Chuan Wang
Scientific Reports.2016;[Epub] CrossRef
Evaluation of a Survivorship Care Plan: Long-Term Use, Care Coordination and Quality of Life in Breast Cancer Survivors
Meagan E Brennan, Frances M Boyle, Phyllis N Butow, Andrew J Spillane
Breast Cancer Management.2015; 4(3): 145. CrossRef
More Options for Fertility Preservation for Patients With Cancer
Pamela N. Munster
Journal of Clinical Oncology.2015; 33(22): 2413. CrossRef

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Comparison of Risk Factor in Breast Cancer Patients by Menopausal Status: Woo Suk Kim, Koo Jeong Kang, You Sah Kim; J Korean Cancer Assoc. 1996;28(5):829-835.

Abstract PDF: Some of the risk factors for breast cancer were compared by menopausal status on 427 patients with proven breast cancer. Statistical analysis was performed with t-test or Chi-Square test and five-year survival rate was obtained by Kaplan-Meier survival method. The results were as follows. 1) In premenopausal patients, the mean age was 40 years old and the peak incidence was in the 5th decades. In postmenopausal patients, the mean age was 55 and the peak incedence was in the 6th decades. 2) Breast feeding was used in 170 premenopausal patients (79.8%) and in 109 postmenopausal patients (94.9%) and the difference was statistically significant (p=0.0001). 3) The mean body weight of premenopausal patients was 59.5Kg and that op postmenopausal patients was 56.4 Kg and there was no statistically significant difference. 4) The mean ages at menarch were 15.7 and 16.4 years old for pre and postmenopausal patients respectively, and the difference was statistically significant. 5) In premenopausal patients the first full term delivery occurred most frequently between the ages of 24 and 29 years and in postmenopausal patients this occurred most frequently before the age of 23. There were 16 nulliparous women in premenopausal patients and l9 in postmenopausal patients. 6) Infiltrating ductal carcinoma was the most common histologic type in both pre and postmeaopausal patients. The histologic types were similar in both group of patients except mucinous carcinoma which was more common in premenopausal patients 7) The five-year survival rates of pre and postmenopausal patients were 86.7% and 81.0 %, respectively, and there was no statistically significant difference (p=0.315).

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