Bilateral Salpingo-oophorectomy Compared to Gonadotropin-Releasing Hormone Agonists in Premenopausal Hormone Receptor?Positive Metastatic Breast Cancer Patients Treated with Aromatase Inhibitors.
- Author:
Koung Jin SUH
1
;
Se Hyun KIM
;
Kyung Hun LEE
;
Tae Yong KIM
;
Yu Jung KIM
;
Sae Won HAN
;
Eunyoung KANG
;
Eun Kyu KIM
;
Kidong KIM
;
Jae Hong NO
;
Wonshik HAN
;
Dong Young NOH
;
Maria LEE
;
Hee Seung KIM
;
Seock Ah IM
;
Jee Hyun KIM
Author Information
- Publication Type:Original Article
- Keywords: Breast neoplasms; Premenopause; Aromatase inhibitors; Ovariectomy; Gonadotropin-releasing hormone
- MeSH: Aromatase Inhibitors*; Aromatase*; Breast Neoplasms*; Breast*; Cohort Studies; Disease-Free Survival; Female; Gonadotropin-Releasing Hormone*; Humans; Multivariate Analysis; Ovariectomy; Phenobarbital; Premenopause; Propensity Score; Receptor, Epidermal Growth Factor; Retrospective Studies
- From:Cancer Research and Treatment 2017;49(4):1153-1163
- CountryRepublic of Korea
- Language:English
- Abstract: PURPOSE: Although combining aromatase inhibitors (AI) with gonadotropin-releasing hormone agonists (GnRHa) is becoming more common, it is still not clear if GnRHa is as effective as bilateral salpingo-oophorectomy (BSO). MATERIALS AND METHODS: We retrospectively analyzed data of 66 premenopausal patients with hormone receptor– positive, human epidermal growth factor receptor 2–negative recurrent and metastatic breast cancer who had been treated with AIs in combination with GnRHa or BSO between 2002 and 2015. RESULTS: The median patient age was 44 years. Overall, 24 (36%) received BSO and 42 (64%) received GnRHa. The clinical benefit rate was higher in the BSO group than in the GnRHa group (88% vs. 69%, p=0.092). Median progression-free survival (PFS) was longer in the BSO group, although statistical significance was not reached (17.2 months vs. 13.3 months, p=0.245). When propensity score matching was performed, the median PFS was 17.2 months for the BSO group and 8.2 months for the GnRHa group (p=0.137). Multivariate analyses revealed that the luminal B subtype (hazard ratio, 1.67; 95% confidence interval [CI], 1.08 to 2.60; p=0.022) and later-line treatment (≥ third line vs. first line; hazard ratio, 3.24; 95% CI, 1.59 to 6.59; p=0.001) were independent predictive factors for a shorter PFS. Incomplete ovarian suppression was observed in a subset of GnRHa-treated patients whose disease showed progression, with E2 levels higher than 21 pg/mL. CONCLUSION: Both BSO and GnRHa were found to be effective in our AI-treated premenopausal metastatic breast cancer patient cohort. However, further studies in larger populations are needed to determine if BSO is superior to GnRHa.
