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

Abstract

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.

Survival outcome of combined GnRH agonist and tamoxifen is comparable to that of sequential adriamycin and cyclophosphamide chemotherapy plus tamoxifen in premenopausal patients with early breast cancer

“…To the best of our knowledge, at present, there is no randomised controlled trial that compared combined ovarian function suppression and TAM with sequential AC-TAM. The present retrospective study found comparable survival outcome between these two treatment regimens similar to other previous retrospective studies of a Korean population (39,40). There was only one local recurrence in the GnRH-TAM group while in the AC-TAM group, 2 patients with distant metastasis were identified.…”

Effectiveness of a 6-Month 22.5-mg Leuprolide Acetate Depot Formulation With Tamoxifen for Postoperative Premenopausal Estrogen Suppression in Hormone Receptor-Positive Breast Cancer

“…In breast cancer, mainstream chemotherapy has been changed from CMF to adriamycin/cyclophosphamide (AC), and the difference between OFS therapy and AC has been studied ( 12 , 13 , 25 ). Kim et al.…”

“…( 13 ) analyzed two groups of patients, an OFS+tamoxifen (n = 260) and a sequential AC+tamoxifen (n = 260) group, among 994 patients with T1-2N0, HR+ HER2- breast cancer with propensity score matching and inverse probability weighting. A comparison of the prognosis over a median follow-up period of 7.4 years showed no difference between the two groups ( 13 ). Sa-Nguanraksa et al.…”

Change in Estradiol Levels among Premenopausal Patients with Breast Cancer Treated Using Leuprolide Acetate 11.25 Milligrams 3-Month Depot and Tamoxifen

“…Particularly, inhibition of estradiol (E2) production is the basis of treatment in premenopausal women, and various methods of suppressing the ovarian function, such as ovarian ablation, have been implemented [ 5 ]. In several clinical studies, luteinizing hormone-releasing hormone analogs (LHRHa) are used as an adjuvant therapy after surgery in patients with HR(+), human epidermal growth factor receptor 2 negative (−), and lymph node (+/−) breast cancer, and they are considered a replacement for chemotherapy (CTx) by exerting the same effect as CTx, but with fewer side effects [ 7 8 9 10 11 ]. In clinical studies involving patients with breast cancer, LHRHa is mainly administered as a 1-month regimen (3.75 mg leuprolide, 3.6 mg goserelin, and 3.75 mg triptorelin); therefore, a 1-month formulation is recommended in the guidelines [ 2 3 4 ].…”

“…Kim et al [ 9 ] reported that LHRHa + T treatment could be an option for premenopausal women with endocrine-responsive, node-negative breast cancer. Sohn et al [ 10 ] showed no difference in recurrence-free, cancer-specific, and overall survival rate after a median follow-up of 5 years. As a result, hormone therapy + LHRHa can replace CTx in certain patients with low tumor burden, such as node-negative tumors, despite the insufficiency of evidence.…”