Cancer Res Treat.  2017 Oct;49(4):1153-1163. 10.4143/crt.2016.463.

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

• Suh KJ
• Kim SH
• Lee KH
• Kim TY
• Kim YJ
• Han SW
• Kang E
• Kim EK
• Kim K
• No JH
• Han W
• Noh DY
• Lee M
• Kim HS
• Im SA
• Kim JH

• KMID: 2394833
• DOI: http://doi.org/10.4143/crt.2016.463

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.

Keyword

Breast neoplasms; Premenopause; Aromatase inhibitors; Ovariectomy; Gonadotropin-releasing hormone

MeSH Terms

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
Aromatase
Aromatase Inhibitors
Gonadotropin-Releasing Hormone
Phenobarbital
Receptor, Epidermal Growth Factor

Figure

• 

  Fig. 1. Kaplan-Meier plots of progression-free survival (PFS) based on ovarian function suppression modality. BSO, bilateral salpingo-oophorectomy; GnRHa, gonadotropin-releasing hormone agonists.

• 

  Fig. 2. Kaplan-Meier plots of progression-free survival (PFS) with propensity score matching according to ovarian function suppression modality. BSO, bilateral salpingooophorectomy; GnRHa, gonadotropin-releasing hormone agonists.

• 

  Fig. 3. The line charts show the individual changes in estradiol (E2) (A) and follicle-stimulating hormone (FSH) (B) between baseline and at progression in patients treated with aromatase inhibitors and gonadotropin-releasing hormone agonist. The value of same individuals on each graphs are marked with same symbols. Only patients with increased E2 levels compared to baseline are marked.

Reference

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