PP-5-6 Castration and Tamoxifen Versus Chemotherapy (FAC) for Premenopausal, Node and Receptors Positive Breast Cancer Patients: A Randomized Trial with a 7 Years Median Follow Up

Roché, H.; Mihura, J.; Lafontan, B. De; Reme-Saumon, M.; Martel, Paule Latino; Dubois, J-B.; Naja, A

doi:10.1016/0959-8049(96)84169-4

Cited by 24 publications

(19 citation statements)

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“…The INT 0142 trial enrolled 350 women with N -, <3 cm HR + breast cancer to receive either tamoxifen for 5 years or tamoxifen with any form of OA/OS. Unfortunately the trial was closed prematurely because of poor accrual and lacks statistical [63][64][65]. Although all were relatively small trials, none detected a significant difference between the treatment strategies in terms of either DFS or overall survival.…”

Section: Oa/os Combined With Tamoxifen In the Adjuvant Settingmentioning

confidence: 99%

What Is the Role of Ovarian Ablation in the Management of Primary and Metastatic Breast Cancer Today?

Prowell

Davidson

2004

The Oncologist

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Ovarian ablation has been used for more than a century in the treatment of breast cancer. Methods of irreversible ovarian ablation include surgical oophorectomy and ovarian irradiation. Potentially reversible castration can be accomplished medically using luteinizing hormone releasing hormone (LHRH) analogues. In addition, cytotoxic chemotherapy unpredictably produces amenorrhea and primary ovarian failure in 10%-95% of premenopausal women as a function of patient age, cumulative dose, and the specific agents used. In the metastatic setting, ovarian ablation and tamoxifen monotherapies produce comparable outcomes and may be more effective when used together. While many early adjuvant trials of ovarian ablation were methodologically flawed, a more recent meta-analysis by the Early Breast Cancer Trialists' Collaborative Group of 12 properly designed randomized trials found significantly greater disease-free and overall survival rates for women under the age of 50, regardless of nodal status, receiving ovarian ablation as a single adjuvant therapy. Several important issues regarding the role of ovarian ablation in the treatment of breast cancer remain unresolved. Data suggest that ovarian ablation followed by some years of tamoxifen produces similarThe Oncologist 2004;9:507-517 www.TheOncologist.comCorrespondence: Nancy E. Davidson, M.D., The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 1650 Orleans Street, Room 409, Baltimore, Maryland 21231-1000 Fax: 410-614-4073; e-mail: davidna@jhmi.edu Received November 10, 2003; accepted for publication April 22, 2004. ©AlphaMed Press 1083-7159/2004 The Oncologist ® Breast Cancer LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Discuss the pros and cons of various methods of ovarian ablation, including oophorectomy, radiation therapy, and luteinizing hormone releasing hormone (LHRH) analogues.2. Recall the frequency of chemotherapy-related amenorrhea with commonly used regimens in adjuvant breast cancer treatment.3. Discuss the evidence supporting the use of ovarian ablation in premenopausal women with early-stage breast cancer.4. Discuss the evidence supporting the use of ovarian ablation in premenopausal women with locally advanced and metastatic breast cancer.Access and take the CME test online and receive 1 hour of AMA PRA category 1 credit at CME.TheOncologist.com CME CME by guest on May 11, 2018http://theoncologist.alphamedpress.org/ Downloaded fromThis material is protected by U.S. Copyright law. Unauthorized reproduction is prohibited. For reprints contact: Reprints@AlphaMedPress.com Prowell, Davidson 508 results to those seen with adjuvant chemotherapy in women with hormone-receptor positive breast cancer; however, the value of combining these modalities is still unclear. Other areas of ongoing investigation include the appropriate duration of therapy with LHRH analogues in the adjuvant setting, the long-term sequelae of ovarian suppression among young breast cancer survivors, and refinement of the populatio...

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Section: Oa/os Combined With Tamoxifen In the Adjuvant Settingmentioning

confidence: 99%

What Is the Role of Ovarian Ablation in the Management of Primary and Metastatic Breast Cancer Today?

Prowell

Davidson

2004

The Oncologist

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“…Ovarian suppression/ablation plus tamoxifen vs. chemotherapy (Table 2) Three of four studies published with this design do not show differences in efficiency among the arms of treatment [12][13][14][15]. Only the ABCSG-5 trial shows advantages in 5-year DFS in favour of the group of combined endocrine treatment compared to chemotherapy with CMF [12].…”

Section: Metaanalysis Of Adjuvant Endocrine Therapy In Premenopausal mentioning

confidence: 97%

Adjuvant endocrine therapies for premenopausal women

Sánchez

2007

Clin Transl Oncol

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Adjuvant endocrine treatment for premenopausal woman remains a controversial area in the therapeutical approach of early stages of breast cancer. Metaanalysis show that ovarian ablation and suppression produce, in a global way, significant benefits in terms of reduction of the risk of recurrence and death. Nevertheless, in the presence of adjuvant chemotherapy, the benefits of ovarian suppression or ablation are clearly reduced, probably in relation to the impact that amenorrhoea induced by chemotherapy. On the other hand, in premenopausal patients, the same metaanalysis show that the use of adjuvant tamoxifen produces benefits in disease- free survival and overall survival very similar to those observed in postmenopausal women. Additionally, the benefits from tamoxifen persist independently of whether or not adjuvant chemotherapy is being received. Thus, some of the questions to answer are: first, is there, in premenopausal women, an additional benefit when ovarian suppression is associated to tamoxifen? Second, it remains controversial if ovarian suppression must be indicated for all patients who receive chemotherapy or only those that have not reached amenorrhoea when adjuvant chemotherapy is completed. Moreover, although in the last decades more than 15,000 premenopausal patients have been included in specific trials of adjuvant endocrine therapy with ovarian suppression or ablation, the best modality of treatment has not been established, and what is more important, the role of its association with tamoxifen has not been completely defined. Many of these aspects remain controversial and the decision about the best therapeutical approach must be individualised in each patient.

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“…Would an anthracycline-containing regimen be superior to a combination endocrine therapy regimen? Roche and colleagues evaluated this hypothesis in a randomized trial comparing tamoxifen plus oophorectomy 543 Combination Endocrine Therapy in the Management of Breast Cancer (surgical or radiotherapeutic) with standard FAC (fluorouracil, doxorubicin, and cyclophosphamide) [39]. Patients enrolled in this trial were premenopausal, node-positive, and had ER-and PR-receptor-positive breast cancer.…”

Section: Early-stage Breast Cancermentioning

confidence: 97%

Combination Endocrine Therapy in the Management of Breast Cancer

2001

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Combination endocrine therapy has long been sought after as a means to better treat breast cancer. Agents that suppress estrogen production are given with agents that suppress estrogenic activity at the cellular level. Historically, these combinations have resulted in initial improvements in response rates, but relapse-free and overall survival were not significantly improved. Also, the increased toxicity seen with these regimens was limiting. New endocrine therapies with more potent activity and less toxicity have led to a resurgence of this idea in the management of breast cancer. Complete estrogen blockade has been compared with single-agent treatments in many different settings. The endocrine effects of this type of therapy are intriguing, but apparently do not readily predict a clinical advantage. The combination of an aromatase inhibitor and an antiestrogen, despite pharmacokinetic interactions, may prove to be beneficial. Results from ongoing trials are eagerly awaited to further address this question in postmenopausal breast cancer patients. For premenopausal breast cancer patients the options are more complex. Clinical outcomes with leutinizing hormone releasing hormone (LHRH) agonists plus aromatase inhibitors are limited to very small phase II studies and are not clearly superior to single-agent therapy. Clinical data in the metastatic setting with premenopausal patients favor the use of an LHRH agonist with tamoxifen over the use of an LHRH agonist alone. However, a similar comparison with tamoxifen alone is lacking with only one trial including this as a treatment arm. Adjuvant therapy with this combined endocrine approach (LHRH agonist plus antiestrogen) has been more extensively studied, but lacks crucial comparisons necessary for making complex treatment decisions. Hopefully, through investigative diligence and ingenuity this issue can be adequately understood. However, many exciting new agents are on the horizon that offer hope to further advance the progress made to date although further confounding the questions already answered.

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PP-5-6 Castration and Tamoxifen Versus Chemotherapy (FAC) for Premenopausal, Node and Receptors Positive Breast Cancer Patients: A Randomized Trial with a 7 Years Median Follow Up

Cited by 24 publications

References 0 publications

What Is the Role of Ovarian Ablation in the Management of Primary and Metastatic Breast Cancer Today?

What Is the Role of Ovarian Ablation in the Management of Primary and Metastatic Breast Cancer Today?

Adjuvant endocrine therapies for premenopausal women

Combination Endocrine Therapy in the Management of Breast Cancer

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