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Current Opinion in Obstetrics & Gynecology:
doi: 10.1097/GCO.0b013e3282f226bd
Breast cancer: Edited by Anne O. Rodriguez

Adjuvant therapy for premenopausal patients with early breast cancer

Kurebayashi, Junichi

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Abstract

Purpose of review: Current topics on adjuvant therapy for premenopausal patients with breast cancer are reviewed.

Recent findings: The Early Breast Cancer Trialists' Collaborative Group overview showed that women under 50 received a remarkable benefit from postoperative chemotherapy and endocrine therapy. The impact of chemotherapy-induced amenorrhea on patient outcome remains to be defined. The addition of luteinizing-hormone-releasing hormone agonists to tamoxifen, chemotherapy or both significantly reduced both recurrence and death in premenopausal patients with endocrine-responsive breast cancer. Exploratory trials are investigating the use of more complete estrogen suppression with luteinizing-hormone-releasing hormone agonists with aromatase inhibitors. There is no consensus on how long these agonists should be used in the adjuvant setting. Chemotherapy-induced ovarian failure is frequently associated with infertility. The suppression of ovarian function using luteinizing-hormone-releasing hormone agonists during chemotherapy seems promising for preserving ovarian function. Chemotherapy-induced ovarian failure and prolonged luteinizing-hormone-releasing hormone agonist therapy cause premature menopausal symptoms. To minimize the menopausal symptoms, intervention strategies should be investigated.

Summary: There are a number of unresolved issues in terms of the optimal use of chemotherapy and endocrine therapy in premenopausal patients with breast cancer. Well-designed and well-organized randomized clinical trials are essential to resolve these issues.

© 2008 Lippincott Williams & Wilkins, Inc.

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