Combined Tamoxifen and Luteinizing Hormone-Releasing Hormone (LHRH) Agonist Versus LHRH Agonist Alone in Premenopausal Advanced Breast Cancer: A Meta-Analysis of Four Randomized Trials

Abstract

The combination of LHRH agonist plus tamoxifen is superior to LHRH agonist alone in premenopausal women with advanced breast cancer. Therefore, if a premenopausal woman with advanced breast cancer is thought to be suitable for endocrine treatment, it is proposed that the combination of a LHRH agonist plus tamoxifen be considered as the new standard treatment.

Chemotherapy-Induced Amenorrhea and Fertility in Women Undergoing Adjuvant Treatment for Breast Cancer

“…In the metastatic setting, one trial demonstrated a 1-year survival benefit from buserelin, the gonadotropin-releasing hormone (GnRH) agonist, combined with tamoxifen compared to either treatment alone in premenopausal women with ER+ breast cancers. 31 Houghton et al 32 presented their findings from the "Zoladex in Premenopausal Patients" (ZIPP) trial in 2000. Women with early-stage breast cancer (n = 2,631) were randomized to receive either tamoxifen for 2 years, goserelin for 26 months, tamoxifen plus goserelin, or no adjuvant treatment.…”

Clinical and endocrine data for goserelin plus anastrozole as second-line endocrine therapy for premenopausal advanced breast cancer

“…An early nonrandomised clinical study suggested possible extension of the duration of response upon addition of the antioestrogen tamoxifen to goserelin in premenopausal patients with advanced breast cancer (Dixon et al, 1991). More recently, a meta-analysis of four studies has revealed that using the combination of goserelin and tamoxifen as initial therapy produced a significantly longer time to first progression than using goserelin alone (Klijn et al, 2001). The rationale for this therapy is that, having effectively rendered the patient postmenopausal with the use of goserelin, the effect of peripheral E2 production in promoting hormone-sensitive breast cancer growth is inhibited by tamoxifen, as in postmenopausal women.…”

ABC3 Consensus Commented from the Perspective of the German Guidelines

“…Furthermore, from the viewpoint of the ABC3 panelists (90.6 %), radiomenolysis is also an option in order to achieve lasting ovarian ablation. The German expert group specifies that additional ovarian suppression is standard for premenopausal patients [19]. Permanent suppression of the ovaries using radiotherapy should only take place in case of contraindications against GnRH analogues and if a bilateral oophorectomy as endocrine ablation is significantly delayed.…”