The role of ovarian ablation in the adjuvant therapy of breast cancer

Abstract

Increasing interest has emerged in the role of ovarian function suppression, which has shown equivalence to adjuvant CMF (cyclophosphamide, methotrexate, 5-fluorouracil), whether achieved by surgery or irradiation, in breast cancer patients. Studies have suggested temporary amenorrhea can confer benefit in early breast cancer, giving luteinizing hormone-releasing hormone (LH-RH) agonists an advantage over oophorectomy or radiation. Compared with no therapy, LH-RH agonists reduce risks of recurrence and death among women younger than 50 years of age who have hormone receptor-positive tumors. Trials are assessing the benefits of adding LH-RH agonists to aromatase inhibitors, tamoxifen, or after chemotherapy in women remaining premenopausal, and the necessity for adjuvant chemotherapy with combined ovarian ablation and antiestrogen therapy.

Breast Cancer Version 3.2014

“…193 The role of adjuvant ovarian ablation or suppression in premenopausal women with hormone receptor-positive breast cancer is incompletely defined. [194][195][196] Ovarian ablation may be accomplished through surgical oophorectomy or ovarian irradiation. Ovarian suppression uses luteinizing hormone-releasing hormone (LH-RH) agonists that cause suppression of luteinizing hormone (LH) and release of follicle stimulating hormone (FSH) from the pituitary and reduction in ovarian estrogen production.…”

Oral administration of the GnRH antagonist acyline, in a GIPET®-enhanced tablet form, acutely suppresses serum testosterone in normal men: single-dose pharmacokinetics and pharmacodynamics

“…Currently, hormonal suppression is widely used clinically in the treatment of both breast [13] and prostate cancer [14]. Intriguingly, GnRH antagonists may also exert anti-tumor effects independent of their reduction of hormone levels, as anti-proliferative effects on the division of cancer cells in culture have been observed [15].…”

The development of endocrine therapy for women with breast cancer

“…As such, LHRH agonists have been a key advancement in the treatment of pre-menopausal women, 42 and have provided a more attractive alternative to oophorectomy in young women. 43 Late 1980s onwards: luteinising hormone-releasing hormone agonists approved for treatment of pre-menopausal women with advanced breast cancer…”