Whether chemotherapy or endocrine therapy is better for premenopausal women in the adjuvant setting remains an open question. An older study demonstrated that, as adjuvant treatment for node-negative or node-positive, ER+ breast cancer, combination tamoxifen/goserelin treatment reduced the number of recurrences when compared with 6 cycles of CMF in premenopausal women. Most significant was the decrease in local recurrence associated with tamoxifen/goserelin. It is fair to say that several studies demostrate that treatment with goserelin leads to a significant improvement in disease-free survival and reduction of contralateral breast cancer in premenopausal women receiving adjuvant therapy for resected stage I/II breast cancer. Also, a trend towards improvement in overall survival was observed.
The use of ovarian suppression by means of LHRH analogues has been investigated primarily in pre- and peri-menopausal women. The rationale of these trials has included an attempt to achieve ovarian suppression with subsequent inhibition of tumor cell proliferation. Goserelin is a synthetic decapeptide analogue of the naturally occurring LHRH, which, following chronic subcutaneous administration, leads to a reduction in concentrations of LH (luteinizing hormone) and FSH (follicle stimulating hormone) and then to a decrease in circulating estrogen concentrations.
NCCN lists combined ovarian supression as a recommended option for premenopauseal women.
Jonat W, Kaufmann M, Sauerbrei W et al. Goserelin versus cyclophosphamide, methotrexate, and fluorouracil as adjuvant therapy in premenopausal patients with node-positive breast cancer: the Zoladex Early Breast Cancer Research Association Study. J Clin Oncol 2002;20:4628–4635.
Kaufmann M, Jonat W, Blamey R etal. Survival analyses from the ZEBRA study. Goserelin (Zoladex) versus CMF in premenopausal women with node-positive breast cancer. Eur J Cancer 2003;39:1711–1717.
Schmid P, Untch M, Wallwiener D et al. Cyclophosphamide, methotrexate and fluorouracil (CMF) versus hormonal ablation with leuprorelin acetate as adjuvant treatment of node-positive, premenopausal breast cancer patients: preliminary results of the TABLE-study (Takeda Adjuvant Breast cancer study with Leuprorelin Acetate). Anticancer Res 2002;22:2325–2332.
Castiglione-Gertsch M, O3Neill A, Price KN et al. Adjuvant chemotherapy followed by goserelin versus either modality alone for premenopausal lymph node-negative breast cancer: a randomized trial. J Natl Cancer Inst 2003;95:1833–1846
Mariantonietta Colozza, Evandro de Azambuja, Fatima Cardoso, Chantal Bernard, Martine J. Piccart, Breast Cancer: Achievements in Adjuvant Systemic Therapies in the Pre-Genomic Era Oncologist, Vol. 11, No. 2, 111-125, February 2006
Pritchard KI.Ovarian suppression/ablation in premenopausal ER-positive breast cancer patients. Issues and recommendations.Oncology (Williston Park). 2009 Jan;23(1):27-33