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Back to the Beginning: The Role of Ovarian Suppression in Management of Hormone Sensitive Breast Cancer in Premenopausal Women

Year: 2022
Type: editorial
Abstract: Although many consider targeted therapy a modern concept, targeted therapy in breast cancer dates back to 1889, when Schinzinger 1 first proposed oophorectomy as adjunctive therapy for breast cancer to alter the hormonal milieu of the malignancy.Beatson 2 put the proposal into practice, reporting decreases in cutaneous metastases in a premenopausal woman after oophorectomy in 1896.The mechanism underlying the response to oophorectomy remained mysterious until Jenson identified the estrogen receptor (ER) 75 years later.3 Since that time, the ER has become the most well-studied, and arguably the most important, target for breast cancer therapy.A randomized trial in Vietnam and China found a significant improvement in disease-free survival (DFS; 5-year DFS, 75% v 58%; P 5 .0003)and overall survival (OS, 78% v 70%; P 5 .041)with adjuvant oophorectomy and tamoxifen compared with surgery alone in the absence of chemotherapy or selection based on tumor ER expression, with benefits persisting at 10 years.4 By the 1980s, pharmacological inhibition of estrogen signaling, first with diethylstilbestrol and then tamoxifen, had largely supplanted ovarian suppression in higher-income countries.In fact, many wondered if ovarian suppression still had a role in the era of adjuvant chemotherapy and antiestrogen therapeutics.The INT-0101 (E5188) trial did not show any benefit from the addition of ovarian suppression with an LHRH agonist to chemotherapy and tamoxifen in premenopausal women with ER-positive disease.5 Unfortunately, E5188 failed to recognize and control for impact of chemotherapy on ovarian function, leaving the question largely unanswered.
DOI: 10.1200/jco.22.02319
Language: English
Subfield: Cancer Research
Open Access status: bronze
OpenAlex ID: W4311675894
Cites: 17
Cited by: 2
Related to: 10