CMF versus goserelin as adjuvant therapy for node-negative, hormone-receptor-positive breast cancer in premenopausal patients: A randomised trial (GABG trial IV-A-93)

Minckwitz, Gϋnter von; Graf, Erika; Geberth, M.; Eiermann, W.; Jonat, W.; Conrad, Bettina; Brunnert, K.; Gerber, Bernd; Vescia, Sabine; Wollert, Jörg; Kaufmann, M.

doi:10.1016/j.ejca.2006.04.006

Cited by 45 publications

(25 citation statements)

References 18 publications

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“…197 Studies in premenopausal women of ovarian ablation or suppression alone versus CMF chemotherapy alone generally demonstrate similar antitumor efficacy in patients with hormone receptor-positive tumors, and superior outcomes with CMF in patients with hormone receptor-negative tumors. [197][198][199][200][201][202][203][204][205] Findings also suggest that the benefits of ovarian suppression/ablation may be greater in the younger premenopausal group. Studies of ovarian ablation/ suppression plus tamoxifen versus chemotherapy alone in premenopausal women generally demonstrate no difference in rates of recurrence or survival between the treatments.…”

Section: Adjuvant Endocrine Therapymentioning

confidence: 99%

Breast Cancer Version 3.2014

Gradishar¹,

Anderson²,

Blair³

et al. 2014

J Natl Compr Canc Netw

175

117

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Section: Adjuvant Endocrine Therapymentioning

confidence: 99%

Breast Cancer Version 3.2014

Gradishar¹,

Anderson²,

Blair³

et al. 2014

J Natl Compr Canc Netw

175

117

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“…However, the addition of ovarian suppression improves disease outcomes in women who remain premenopausal after chemotherapy [3]. On the other hand, several trials have shown that ovarian suppression or ablation can exert effects similar to that of chemotherapy in the treatment of ER-positive breast cancer in premenopausal women [4-7]. In addition, because it is widely documented that patients treated with a GnRH agonist alone showed a better quality of life than patients treated with chemotherapy, a few studies have evaluated GnRH agonists as substitutes for chemotherapy in hormone-responsive breast cancer patients [8-12].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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PurposeThe 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 MethodsIn 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.ResultsA 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.ConclusionGnRHa+T is a reasonable alternative to AC->T in patients with premenopausal, hormone-responsive, HER2-negative, lymph-node–negative, T1-T2 breast cancer.

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“…OS was not significantly improved (p ¼ 0.195). Several other randomized trials [20,21] have compared CMF vs. ovarian suppression with or without tamoxifen, and two compared FAC (5-fluorouracil, doxorubicin and cyclophosphamide) or FEC (5-fluorouracil, epirubicin and cyclophosphamide) vs. ovarian suppression plus tamoxifen [12,22]. All of these studies suggested equivalence or superiority for the endocrine arm.…”

Section: Chemotherapy Vs To Ovarian Suppression With Tamoxifenmentioning

confidence: 98%

Adjuvant endocrine therapy of premenopausal women with early breast cancer: an overview

Hubalek

Brantner

Marth

2010

Wien Med Wochenschr

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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.

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CMF versus goserelin as adjuvant therapy for node-negative, hormone-receptor-positive breast cancer in premenopausal patients: A randomised trial (GABG trial IV-A-93)

Cited by 45 publications

References 18 publications

Breast Cancer Version 3.2014

Breast Cancer Version 3.2014

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

Adjuvant endocrine therapy of premenopausal women with early breast cancer: an overview

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