Cancer Res Treat.  2016 Oct;48(4):1351-1362. 10.4143/crt.2015.444.

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

Affiliations
  • 1Division of Breast and Endocrine Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ahnsh@amc.seoul.kr
  • 2Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Abstract

PURPOSE
The 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 METHODS
In 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.
RESULTS
A 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.
CONCLUSION
GnRHa+T is a reasonable alternative to AC->T in patients with premenopausal, hormone-responsive, HER2-negative, lymph-node-negative, T1-T2 breast cancer.

Keyword

Breast neoplasms; Premenopause; Chemotherapy; Drug therapy; Tamoxifen

MeSH Terms

Arm
Breast Neoplasms*
Breast*
Cohort Studies
Cyclophosphamide*
Doxorubicin*
Drug Therapy*
Female
Follow-Up Studies
Gonadotropin-Releasing Hormone*
Humans
Lost to Follow-Up
Premenopause
Propensity Score
Retrospective Studies
Survival Rate
Tamoxifen*
Cyclophosphamide
Doxorubicin
Gonadotropin-Releasing Hormone
Tamoxifen

Figure

  • Fig. 1. Inclusion and exclusion diagram. HR, hormone receptor; LN, lymph node; GnRHa+T, combined gonadotropin-releasing hormone agonist and tamoxifen; AC->T, sequential adriamycin and cyclophosphamide chemotherapy and tamoxifen; CTx->T, chemotherapy followed by tamoxifen; CMF->T, sequential cyclophosphamide, methotrexate, 5-fluorouracil chemotherapy, and tamoxifen; Tx, treatment; Premeno, premenopause; Postmeno, postmenopause.

  • Fig. 2. Recurrence-free survival (RFS) (A), cancer-specific survival (CSS) (B), and overall survival (OS) (C) curves according to treatment arm (combined gonadotropin-releasing hormone agonist and tamoxifen [GnRHa+T] vs. sequential adriamycin and cyclophosphamide chemotherapy and tamoxifen [AC->T]) in overall cohorts (n=994). RFS (D) and OS (E) curves according to treatment arm (GnRHa+T vs. AC->T) in the T1a+T1b group (n=115), RFS (F), CSS (G), and OS (H) curves according to treatment arm (GnRHa+T vs. AC->T) in the T1c group (n=559). RFS (I), CSS (J), and OS (K) curves according to treatment arm (GnRHa+T vs. AC->T) in T2 group (n=320).

  • Fig. 3. Recurrence-free survival (RFS) (A), cancer-specific survival (CSS) (B), and overall survival (OS) (C) curves according to treatment arm (combined gonadotropin-releasing hormone agonist and tamoxifen [GnRHa+T] vs. sequential adriamycin and cyclophosphamide chemotherapy and tamoxifen [AC->T]) in propensity-matched cohorts (n=520).

  • Fig. 4. Recurrence-free survival (RFS) (A), cancer-specific survival (CSS) (B), and overall survival (OS) (C) curves according to treatment arm (combined gonadotropin-releasing hormone agonist and tamoxifen [GnRHa+T] vs. sequential adriamycin and cyclophosphamide chemotherapy and tamoxifen [AC->T]) in inverse-probability-weighted cohorts (n=520).


Reference

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