OBR OncologyMeta-Analysis Shows Value of Ovarian Suppression in Patients With Early Breast Cancer

A recent meta-analysis has shed new light on the role of ovarian suppression in the treatment of early breast cancer, particularly among pre-menopausal women. The analysis reveals significant improvements in outcomes, including lower rates of recurrence and mortality, thereby potentially influencing future clinical guidelines and patient-specific treatment options.

HCN Medical Memo
The meta-analysis makes a compelling case for the inclusion of ovarian suppression as an effective treatment strategy in the management of early-stage breast cancer for pre-menopausal women. This information is crucial for physicians, as it not only influences the choices made in personalized treatment plans but may also reshape clinical guidelines. The benefit appears most striking in younger pre-menopausal women, adding another layer of precision to hormone-sensitive breast cancer management.

Key Points:

• The meta-analysis utilized patient-level data from 25 randomized trials, covering 14,993 pre-menopausal women with estrogen receptor (ER)-positive or unknown tumor types.
• Overall, ovarian ablation or suppression led to a notable decrease in breast cancer recurrences (RR = 0.82, 95% CI 0.77–0.88; P < 0.0001).
• Most significant benefits were observed in women confirmed to be premenopausal before treatment, with a 15-year recurrence risk improved by 12.1% and 15-year breast cancer mortality improved by 8%.
• The treatment showed more pronounced effects in premenopausal women below 45 years of age (RR = 0.63, P < 0.0001) compared to those aged 45 to 54 (RR = 0.84, P = 0.045).

Additional Points:

• The study also hinted at the need for future trials to compare the efficacy of reversible ovarian suppression methods like GnRH agonists with irreversible ovarian ablation, particularly for patients concerned about fertility.
• Variation in treatment duration for ovarian suppression, ranging from 18 months to 5 years, calls for further investigation into optimal treatment duration.

“A particularly intriguing aspect of the study is the comparison between GnRH agonist-based ovarian suppression and the irreversible ovarian ablation methods. Although both methods appear to yield similar efficacy in subgroup analyses done by the authors, there is a need for rigorous trials that directly compare their outcomes.”
– Shruti Patel, MD, Oncology Fellow, Stanford University

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