Researchers from Italy have reported that the administration of the gonadotropin releasing hormone analogue goserelin (Gn-RH) prevents ovarian failure in women with early breast cancer receiving chemotherapy. The details of this report appeared in the February 1, 2006, issue of Cancer .[1]

Premenopausal women with early breast cancer are at high risk of ovarian failure following adjuvant therapy. For women with hormone receptor positive breast cancer, a therapeutic benefit of ovarian ablation is postulated. However, there are many unwanted side effects of early menopause in young women.

Researchers involved in the present study previously reported the outcomes of 64 premenopausal women with early breast cancer treated with goserelin for one year.[2] Approximately half the patients in this study were hormone receptor positive and half were negative. They reported that serum estradiol was significantly suppressed to low levels. The average age of this group of women was 42 years, and 86% resumed menstruation after completion of adjuvant chemotherapy. Hormone positive patients received tamoxifen. They also reported that 84% of these patients were alive and disease-free.

The current study was similar to the previous study except that all ER-positive women received tamoxifen or an aromatase inhibitor for 5 years. This study included 64 women with stage II breast cancer and 36 with stage III breast cancer who had an average age of 43 years. A total of 26 patients received CMF, 74 received anthracycline based regimens and 9 patients received an autologous stem cell transplant. Taxanes were given to those positive for HER-2. The median follow-up of this study was 75 months.

Normal menses returned in all patients younger than age 40 years and 56% of the older women. The projected 5- and 10-year disease-free survival rates were 84% and 76%. They reported that none of the 36 patients who received anastrazole for 2 years had a recurrence. They also stated that patients who received Gn-RH analogue without total estrogen blockade by an aromatase inhibitor had a 16% incidence of recurrence. These authors suggest that ovarian ablation with a Gn-RH analog plus an aromatase inhibitor is very effective for prevention of recurrences of breast cancer in women with ER-positive tumors. This approach allows the return of menses to most women after completion of therapy.

Comments:  These are interesting results which should be confirmed in a formalized randomized clinical trial. However, the disease-free survival reported here are impressive.

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