Adjuvant chemo plus goserelin may be effective for some early breast cancers

Adjuvant chemotherapy benefits premenopausal women with estrogen receptor-negative, lymph node-negative breast cancer, according to a report by in the International Breast Cancer Study Group (IBCSG). Patients with estrogen-positive tumors may also benefit additionally from goserelin to suppress ovarian function.

Some earlier studies have shown longer disease-free survival in women who experienced amenorrhea from ovarian suppression after chemotherapy, the investigators explain, whereas others have not. The IBCSG studied the effectiveness of adjuvant chemotherapy with or without goserelin in treating 1109 pre- and peri-menopausal women with lymph node-negative breast cancer. The results are reported in the December 17th Journal of the National Cancer Institute.Overall, disease-free survival and overall survival did not differ according to treatment with CMF (cyclophosphamide, methotrexate, 5-fluorouracil) chemotherapy, goserelin, or CMF chemotherapy followed by goserelin, the study group found. However, there were differences when subgroups were analyzed.Among women with estrogen receptor (ER)-negative tumors, disease-free survival with the CMF-containing regimens was superior to that with goserelin alone, regardless of the ages of the women, the results indicate. [p. 1835, col. 2, para. 1]In contrast, the researchers note, younger women (but not older women) with ER-positive tumors fared best when treated with CMF followed by goserelin. Goserelin treatment was associated with earlier amenorrhea than with chemotherapy, the report indicates, and resumption of menses was slower after cessation of goserelin among women who received initial CMF chemotherapy. CMF-containing regimens were associated with lower rates of local recurrence than were regimens containing only goserelin among women with either ER-positive or ER-negative tumors, the investigators report.”Premenopausal women with ER-negative, lymph node-negative breast cancer should receive adjuvant chemotherapy,” the authors conclude. “For patients with ER-positive disease, the combination of chemotherapy with ovarian function suppression or other endocrine agents and the use of endocrine therapy alone should be studied.” “Endocrine therapy may be enough for ER-positive patients,” Dr. Monica Castiglione from IBCSG told Reuters Health. “For young patients with ER-positive [tumors], we have to consider chemotherapy, but endocrine therapy has to be a part of the treatment concept.” Further research “is mandatory,” Dr. Castiglione said, “and that I hope that many [physicians] will include their patients in the new trials (SOFT, TEXT, and PERCHE) asking important questions in this population.” “We agree with the authors that the way forward is to study, in randomized trials, the selective use of ovarian suppression in women who are not rendered menopausal by chemotherapy,” write Dr. Joseph L. Pater and Dr. Wendy R. Parulekar from National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada in a related editorial. (Source: J Natl Cancer Inst 2003;95:1833-1846,1811-1812: Reuters Health: Will Boggs, MD: December 22, 2003: Oncolink)