Bilateral Salpingo-oophorectomy Compared to Gonadotropin-Releasing Hormone Agonists in Premenopausal Hormone Receptor-Positive Metastatic Breast Cancer Patients Treated with Aromatase Inhibitors.

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.

• Authors: Koung Jin Suh, 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
• Journal: Cancer research and treatment (Cancer Res Treat) Vol. 49 Issue 4 Pg. 1153-1163 (Oct 2017) ISSN: 2005-9256 [Electronic] Korea (South)
• PMID: 28253566 (Publication Type: Journal Article)

Chemical References

• Antineoplastic Agents, Hormonal
• Aromatase Inhibitors
• Receptors, Estrogen
• Receptors, Progesterone
• Gonadotropin-Releasing Hormone

Topics

• Adult
• Antineoplastic Agents, Hormonal (administration & dosage, adverse effects, therapeutic use)
• Aromatase Inhibitors (administration & dosage, adverse effects, therapeutic use)
• Breast Neoplasms (metabolism, mortality, pathology, therapy)
• Combined Modality Therapy (adverse effects, methods)
• Female
• Follow-Up Studies
• Gonadotropin-Releasing Hormone (agonists)
• Humans
• Kaplan-Meier Estimate
• Middle Aged
• Premenopause
• Propensity Score
• Receptors, Estrogen (metabolism)
• Receptors, Progesterone (metabolism)
• Retrospective Studies
• Salpingo-oophorectomy (adverse effects, methods)
• Treatment Outcome
• Young Adult