CoBrCa 2017: Ovarian Function Suppression Plus AI in Young Women at Risk of Breast Cancer Recurrence
The combination of ovarian function suppression plus an aromatase inhibitor (AI) should be considered primary therapy for young women with high-risk hormone receptor–positive breast cancer, according to Wolfgang Janni, MD, PhD, of the University of Ulm, Ulm, Germany. He presented his case in favor of this approach during a plenary session at the 2017 World Congress on Controversies in Breast Cancer (CoBrCa) in Tokyo, Japan.
“The benefits outweigh the side effects in young women with substantial risk for recurrence,” stated Dr. Janni. However, he contended, the treatments must be decided on a case-by-case basis, as the effects may differ among women and increased side effects may impair compliance.
Dr. Janni referred to the clinical trial data to support his stance. The ATLAS study indicates the benefit of tamoxifen therapy may extend for up to 10 years. Furthermore, based on data from the MA.17 study, he noted, the benefits of endocrine therapy may continue after 5 years of tamoxifen with up to 5 years of letrozole. In addition, treatment with a gonadotropin-releasing hormone (GnRH) analogue along with tamoxifen or in combination with the AI exemestane for 5 years may be considered in patients whose ovarian function has recovered within the first 8 months after chemotherapy. Dr. Janni recommends a combination of tamoxifen with a GnRH analogue in patients younger than age 35 at sufficient risk of recurrence, based on the results of the SOFT study.