Luteal versus follicular phase surgical oophorectomy plus tamoxifen in premenopausal women with metastatic hormone receptor-positive breast cancer

• Published in: European journal of cancer (1990) 2016-06, Vol.60, p.107-116
• Main Authors: Love, Richard R, Hossain, Syed Mozammel, Hussain, Md. Margub, Mostafa, Mohammad Golam, Laudico, Adriano V, Siguan, Stephen Sixto S, Adebamowo, Clement, Sun, Jing-zhong, Fei, Fei, Shao, Zhi-Ming, Liu, Yunjiang, Akram Hussain, Syed Md, Zhang, Baoning, Cheng, Lin, Panigaro, Sonar, Walta, Fardiana, Chuan, Jiang Hong, Mirasol-Lumague, Maria Rica, Yip, Cheng-Har, Navarro, Narciso S, Huang, Chiun-sheng, Lu, Yen-shen, Ferdousy, Tahmina, Salim, Reza, Akhter, Chameli, Nahar, Shamsun, Uy, Gemma, Young, Gregory S, Hade, Erinn M, Jarjoura, David
• Format: Article
• Language: English
• Subjects: Acute effects; Adult; Anovulatory; Antineoplastic Agents, Hormonal - therapeutic use; Breast Neoplasms - physiopathology; Breast Neoplasms - therapy; Combined Modality Therapy - methods; Female; Follicular Phase - physiology; Hematology, Oncology and Palliative Medicine; Humans; Luteal Phase - physiology; Metastatic; Oophorectomy; Ovariectomy - methods; Premenopause - physiology; Tamoxifen - therapeutic use; Treatment Outcome
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2016.03.011

Abstract Purpose In premenopausal women with metastatic hormone receptor-positive breast cancer, hormonal therapy is the first-line therapy. Gonadotropin-releasing hormone analogue + tamoxifen therapies have been found to be more effective. The pattern of recurrence risk over time after primary surgery suggests that peri-operative factors impact recurrence. Secondary analyses of an adjuvant trial suggested that the luteal phase timing of surgical oophorectomy in the menstrual cycle simultaneous with primary breast surgery favourably influenced long-term outcomes. Methods Two hundred forty-nine premenopausal women with incurable or metastatic hormone receptor-positive breast cancer entered a trial in which they were randomised to historical mid-luteal or mid-follicular phase surgical oophorectomy followed by oral tamoxifen treatment. Kaplan–Meier methods, the log-rank test, and multivariable Cox regression models were used to assess overall and progression-free survival (PFS) in the two randomised groups and by hormone-confirmed menstrual cycle phase. Results Overall survival (OS) and PFS were not demonstrated to be different in the two randomised groups. In a secondary analysis, OS appeared worse in luteal phase surgery patients with progesterone levels