Adjuvant ovarian suppression ups survival in premenopausal breast cancer

  • Kim HA & al.
  • J Clin Oncol
  • 16 Sep 2019

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Incorporating 2 years of ovarian function suppression (OFS) with the standard 5-year regimen of tamoxifen is associated with extended DFS in women with stage I-III estrogen receptor-positive breast cancer who remain in a premenopausal state or resume ovarian function after chemotherapy and definitive surgery.

Why this matters

  • Study confirms the benefits of OFS, but for a shorter duration than the 5-year SOFT and TEXT trials.

Study design

  • Multicenter randomized controlled ASTRRA trial of 1293 Korean women receiving 20 mg/day tamoxifen for 5 years, with or without 2 years of OFS (3.6 mg subcutaneous goserelin every 28 days) after definitive surgery and adjuvant or neoadjuvant chemotherapy.
  • Women had to remain premenopausal or resume ovarian function after chemotherapy before randomization; women who had permanent chemotherapy-induced amenorrhea were excluded from the survival analysis.
  • Funding:  AstraZeneca; Korea Institute of Radiological and Medical Sciences.

Key results

  • At a median follow-up of 63 months, OFS plus tamoxifen yielded superior 5-year estimated DFS vs tamoxifen alone (91.1% vs 87.5%; HR, 0.69, P=.033).

  • Add-on OFS also significantly extended 5-year estimated OS (99.4% vs 97.8%; HR, 0.31, P=.029).

Limitations

  • Open-label design.

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