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LeVasseur N, Manna M, Jerzak KJ. An Overview of Long-Acting GnRH Agonists in Premenopausal Breast Cancer Patients: Survivorship Challenges and Management. Curr Oncol 2024; 31:4209-4224. [PMID: 39195297 DOI: 10.3390/curroncol31080314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/13/2024] [Accepted: 07/23/2024] [Indexed: 08/29/2024] Open
Abstract
Managing breast cancer in premenopausal women poses unique challenges due to its considerable effect on both morbidity and mortality. Goserelin, a gonadotropin-releasing hormone agonist, has emerged among the various modalities as a preferred option for ovarian function suppression, owing to its efficacy in reducing ovarian estrogen production in premenopausal women with hormone receptor-positive breast cancer. Recent studies have affirmed the efficacy and safety of long-acting (LA) goserelin 10.8 mg every 12 weeks, offering comparable outcomes to monthly injections. This flexibility enables personalized treatment approaches, potentially enhancing patient satisfaction. Off-label utilization of goserelin LA surged during the coronavirus disease pandemic, prompting initiatives to broaden its use for breast cancer treatment. Switching to goserelin LA can streamline treatment, boost adherence, and optimize resource utilization. With the recent approval of goserelin 10.8 mg LA by Health Canada on 6 May 2024, for use in breast cancer, Canada is the latest to join over 60 countries worldwide to expand the accepted indications for goserelin LA and ensure its availability to potentially enhance healthcare delivery, patient care, and breast cancer outcomes. Goserelin LA offers premenopausal patients a means to more effectively manage the constraints imposed by breast cancer treatment and its impact on survivorship.
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Affiliation(s)
- Nathalie LeVasseur
- BC Cancer Vancouver Centre, University of British Columbia, Vancouver, BC V5Z 4E6, Canada
| | - Mita Manna
- Department of Medicine and Department of Oncology, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
| | - Katarzyna J Jerzak
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
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Sukumar JS, Quiroga D, Kassem M, Grimm M, Shinde NV, Appiah L, Palettas M, Stephens J, Gatti-Mays ME, Pariser A, Cherian M, Stover DG, Williams N, Van Deusen J, Wesolowski R, Lustberg M, Ramaswamy B, Sardesai S. Patient preferences and adherence to adjuvant GnRH analogs among premenopausal women with hormone receptor positive breast cancer. Breast Cancer Res Treat 2021; 190:183-188. [PMID: 34498153 PMCID: PMC8560558 DOI: 10.1007/s10549-021-06368-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/13/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Adjuvant ovarian function suppression (OFS) in premenopausal hormone receptor (HR) positive breast cancer (BC) improves survival. Adherence to adjuvant gonadotropin-releasing hormone analogs (GnRHa) remains a challenge and is associated with toxicities and inconvenient parenteral administration. The goal of this study was to describe real-world adherence patterns and patient preferences surrounding adjuvant GnRHa. METHODS We analyzed the medical records of premenopausal women with non-metastatic HR positive BC from January 2000 to December 2017; participants received adjuvant monthly goserelin or leuprolide at The Ohio State University. Data collected included demographics, clinicopathologic characteristics, and OFS adherence/side effects. We defined non-adherence as discontinuation of GnRHa within 3 years for a reason other than switching to an alternate OFS, delay > 7 days from a dose, or a missed dose. Chi-square tests assessed associations between clinical characteristics and outcomes. RESULTS A total of 325 patients met eligibility. Of these, 119 (37%) patients were non-adherent to GnRHa; 137 (42%) underwent elective bilateral salpingo-oophorectomy after initial GnRHa. Those opting for surgery reported significantly more hot flashes (74% vs 48%, p < 0.001), arthralgias (46% vs 30%, p = 0.003), and vaginal dryness (37% vs 21%, p = 0.001) compared with patients remaining on GnRHa. CONCLUSION Non-adherence to adjuvant GnRHa occurred in over a third of patients and almost half the patients initiating GnRHa underwent subsequent surgical ablation. These high frequencies highlight real-world patterns of OFS. Additionally, treatment toxicities may impact personal preference of OFS modality. Personalized practices to target predictors of adjuvant GnRHa non-adherence are critical to optimize symptoms, adherence, and survivorship.
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Affiliation(s)
- Jasmine S Sukumar
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, The Ohio State University Comprehensive Cancer Center, 1204A Lincoln Tower, 1800 Cannon Dr., Columbus, OH, 43210, USA
| | - Dionisia Quiroga
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, The Ohio State University Comprehensive Cancer Center, 1204A Lincoln Tower, 1800 Cannon Dr., Columbus, OH, 43210, USA
| | - Mahmoud Kassem
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, The Ohio State University Comprehensive Cancer Center, 1204A Lincoln Tower, 1800 Cannon Dr., Columbus, OH, 43210, USA
| | - Michael Grimm
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, The Ohio State University Comprehensive Cancer Center, 1204A Lincoln Tower, 1800 Cannon Dr., Columbus, OH, 43210, USA
| | - Namrata Vilas Shinde
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, The Ohio State University Comprehensive Cancer Center, 1204A Lincoln Tower, 1800 Cannon Dr., Columbus, OH, 43210, USA
| | - Leslie Appiah
- Division of Academic Specialists in Obstetrics and Gynecology, University of Colorado Anshultz, Aurora, CO, USA
| | - Marilly Palettas
- Center for Biostatistics, Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Julie Stephens
- Center for Biostatistics, Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Margaret E Gatti-Mays
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, The Ohio State University Comprehensive Cancer Center, 1204A Lincoln Tower, 1800 Cannon Dr., Columbus, OH, 43210, USA
| | - Ashley Pariser
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, The Ohio State University Comprehensive Cancer Center, 1204A Lincoln Tower, 1800 Cannon Dr., Columbus, OH, 43210, USA
| | - Mathew Cherian
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, The Ohio State University Comprehensive Cancer Center, 1204A Lincoln Tower, 1800 Cannon Dr., Columbus, OH, 43210, USA
| | - Daniel G Stover
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, The Ohio State University Comprehensive Cancer Center, 1204A Lincoln Tower, 1800 Cannon Dr., Columbus, OH, 43210, USA
| | - Nicole Williams
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, The Ohio State University Comprehensive Cancer Center, 1204A Lincoln Tower, 1800 Cannon Dr., Columbus, OH, 43210, USA
| | - Jeffrey Van Deusen
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, The Ohio State University Comprehensive Cancer Center, 1204A Lincoln Tower, 1800 Cannon Dr., Columbus, OH, 43210, USA
| | - Robert Wesolowski
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, The Ohio State University Comprehensive Cancer Center, 1204A Lincoln Tower, 1800 Cannon Dr., Columbus, OH, 43210, USA
| | - Maryam Lustberg
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, The Ohio State University Comprehensive Cancer Center, 1204A Lincoln Tower, 1800 Cannon Dr., Columbus, OH, 43210, USA
| | - Bhuvaneswari Ramaswamy
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, The Ohio State University Comprehensive Cancer Center, 1204A Lincoln Tower, 1800 Cannon Dr., Columbus, OH, 43210, USA
| | - Sagar Sardesai
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, The Ohio State University Comprehensive Cancer Center, 1204A Lincoln Tower, 1800 Cannon Dr., Columbus, OH, 43210, USA.
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Parisi F, Razeti MG, Blondeaux E, Arecco L, Perachino M, Tagliamento M, Levaggi A, Fregatti P, Poggio F, Lambertini M. Current State of the Art in the Adjuvant Systemic Treatment of Premenopausal Patients With Early Breast Cancer. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2020; 14:1179554920931816. [PMID: 32647477 PMCID: PMC7325453 DOI: 10.1177/1179554920931816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/06/2020] [Indexed: 01/13/2023]
Abstract
Breast cancer is the most frequent malignancy diagnosed in premenopausal women. In this age group, breast tumors tend to be diagnosed at more advanced stages and to harbor more aggressive biological features. In addition, specific age-related issues including genetic counseling, fertility preservation, impact on social and couple relationships, working life, and management of long-term side effects should be considered highly relevant when managing early breast cancer in premenopausal women. Therefore, the care of these patients is particularly complex and a multidisciplinary approach is mandatory. The present review summarizes the current state of art in the adjuvant systemic treatment of premenopausal women with early breast cancer focusing on the optimal chemotherapy, endocrine therapy, and targeted therapy approaches in this specific patient population.
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Affiliation(s)
- Francesca Parisi
- Department of Medical Oncology, U.O.C Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Maria Grazia Razeti
- Department of Medical Oncology, U.O.C Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Eva Blondeaux
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy.,Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Luca Arecco
- Department of Medical Oncology, U.O.C Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Marta Perachino
- Department of Medical Oncology, U.O.C Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Marco Tagliamento
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy.,Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Alessia Levaggi
- Department of Medical Oncology, U.O.C Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Piero Fregatti
- U.O.C. Clinica di Chirurgia Senologica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Integrated Diagnostic Surgical Sciences, School of Medicine, University of Genova, Genova, Italy
| | - Francesca Poggio
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Lambertini
- Department of Medical Oncology, U.O.C Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
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Lambertini M, Demeestere I, Viglietti G, de Azambuja E. Oncofertility counselling in premenopausal women with HER2-positive breast cancer. Oncotarget 2019; 10:926-929. [PMID: 30847021 PMCID: PMC6398182 DOI: 10.18632/oncotarget.26565] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/07/2018] [Indexed: 12/31/2022] Open
Abstract
A complete oncofertility counselling should be offered to all premenopausal patients before the administration of anticancer treatments. This important discussion is a crucial step for allowing them to take fully informed decisions about the proposed therapy and its potential long-term consequences as well as on their need and interest of accessing the available strategies for ovarian function and/or fertility preservation. In premenopausal women with HER2-positive early breast cancer, limited evidence exists to counsel them about the potential added gonadotoxicity of targeted agents beyond the damage already caused by chemotherapy. In addition, the prognostic role of treatment-induced amenorrhea in this setting was unknown. In our exploratory analysis within the ALTTO (BIG 2-06) trial, we have recently described the rates of treatment-induced amenorrhea after chemotherapy plus trastuzumab and/or lapatinib and the prognostic value of developing this side effect according to the hormone receptor status of their tumours. We observed similar rates of treatment-induced amenorrhea in the four anti-HER2 treatment arms. The lack of an increased rate of treatment-induced amenorrhea in the dual anti-HER2 blockade arm suggests the possible gonadal safety of these agents. In addition, women with HER2-positive/hormone receptor-positive tumours showed significantly better survival outcomes if they developed treatment-induced amenorrhea, while no difference was observed for those with HER2-positive/hormone receptor-negative disease. Future research efforts are needed to address the gonadotoxicity of the new available targeted agents as well as to elucidate which is the best adjuvant endocrine therapy in premenopausal women with HER2-positive/hormone receptor-positive disease.
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Affiliation(s)
- Matteo Lambertini
- Department of Medical Oncology, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium.,Breast Cancer Translational Research Laboratory, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium
| | - Isabelle Demeestere
- Fertility Clinic, CUB-Hôpital Erasme and Research Laboratory on Human Reproduction, Université Libre de Bruxelles, Brussels, Belgium
| | - Giulia Viglietti
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium
| | - Evandro de Azambuja
- Department of Medical Oncology, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium
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Caparica R, Bruzzone M, Poggio F, Ceppi M, de Azambuja E, Lambertini M. Anthracycline and taxane-based chemotherapy versus docetaxel and cyclophosphamide in the adjuvant treatment of HER2-negative breast cancer patients: a systematic review and meta-analysis of randomized controlled trials. Breast Cancer Res Treat 2018; 174:27-37. [PMID: 30465156 DOI: 10.1007/s10549-018-5055-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/16/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Standard adjuvant chemotherapy for HER2-negative breast cancer consists generally in an anthracycline and taxane-based regimen (A+T). The TC (docetaxel and cyclophosphamide) regimen arises as a potential alternative, although individual randomized controlled trials (RCTs) could not demonstrate the non-inferiority of TC over A+T. This is a systematic review and meta-analysis of RCTs comparing 6 cycles of TC versus sequential A+T in the adjuvant treatment of HER2-negative breast cancer. METHODS A systematic literature search was performed to identify RCTs comparing TC versus A+T. Disease-free survival (DFS) and overall survival (OS) were assessed. Subgroup analyses of DFS according to hormone receptor status, lymph node involvement, and menopausal status were performed. Hazard ratios (HRs) and 95% confidence intervals (CI) for DFS and OS were extracted from each trial, and a pooled analysis was conducted using the random-effect model. The Higgins' I-Squared Test was used to quantify heterogeneity. RESULTS Seven RCTs were included (12,741 patients). Overall, no difference was observed between TC and A+T in DFS (HR 1.08, 95% CI 0.96-1.20) and OS (HR 1.05; 95% CI 0.90-1.22). A trend favoring A+T was observed in hormone receptor-negative (HR 1.12, 95% CI 0.93-1.34) and N2 patients (HR 1.25; 95% CI 0.82-1.90). Emesis/vomiting, mucositis, thrombocytopenia and sensory neuropathy were significantly more frequent with A+T. CONCLUSION As adjuvant treatment of HER2-negative breast cancer, sequential A+T regimen was associated with increased risk of toxicities and no clear survival benefit as compared to 6 cycles of TC. Higher-risk patients may benefit the most from A+T, whilst TC may be an efficacious and less toxic alternative for lower-risk patients.
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Affiliation(s)
- Rafael Caparica
- Department of Medical Oncology, Institut Jules Bordet and Université Libre de Bruxelles (ULB), Boulevard de Waterloo 121, 1000, Brussels, Belgium
| | - Marco Bruzzone
- Clinical Epidemiology Unit, Ospedale Policlinico San Martino, Genova, Italy
| | - Francesca Poggio
- Department of Medical Oncology, U.O. Oncologia Medica 2, Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Marcello Ceppi
- Clinical Epidemiology Unit, Ospedale Policlinico San Martino, Genova, Italy
| | - Evandro de Azambuja
- Department of Medical Oncology, Institut Jules Bordet and Université Libre de Bruxelles (ULB), Boulevard de Waterloo 121, 1000, Brussels, Belgium
| | - Matteo Lambertini
- Department of Medical Oncology, Institut Jules Bordet and Université Libre de Bruxelles (ULB), Boulevard de Waterloo 121, 1000, Brussels, Belgium.
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Poggio F, Lambertini M, Bighin C, Conte B, Blondeaux E, D'Alonzo A, Dellepiane C, Boccardo F, Del Mastro L. Management of young women with early breast cancer. ESMO Open 2018; 3:e000458. [PMID: 30559981 PMCID: PMC6267460 DOI: 10.1136/esmoopen-2018-000458] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 10/18/2018] [Indexed: 12/31/2022] Open
Abstract
Breast cancer is still the most frequent cancer diagnosed in women aged ≤40 years and the primary cause of death in this age group. The management of these patients needs a dedicated approach involving a multidisciplinary team that takes into account their treatment and survivorship issues. The present review aims to provide a perspective on the many challenges associated with treatment of young women with early breast cancer. We will focus on the standard (neo)adjuvant treatment, highlighting the paucity of age-specific results about the available genomic signatures, the groundbreaking landscape of adjuvant endocrine therapy and the relevant issue of the fertility preservation.
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Affiliation(s)
- Francesca Poggio
- Department of Medical Oncology, UO Oncologia Medica 2, Policlinico San Martino-IST, Genova, Italy
| | - Matteo Lambertini
- Department of Medical Oncology, Institut Jules Bordet and Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Claudia Bighin
- Department of Medical Oncology, UO Oncologia Medica 2, Policlinico San Martino-IST, Genova, Italy
| | - Benedetta Conte
- Department of Medical Oncology, UO Oncologia Medica 2, Policlinico San Martino-IST, Genova, Italy
| | - Eva Blondeaux
- Department of Medical Oncology, UO Oncologia Medica 2, Policlinico San Martino-IST, Genova, Italy
| | - Alessia D'Alonzo
- Department of Medical Oncology, UO Oncologia Medica 2, Policlinico San Martino-IST, Genova, Italy
| | - Chiara Dellepiane
- Department of Medical Oncology, UO Oncologia Medica 2, Policlinico San Martino-IST, Genova, Italy
| | - Francesco Boccardo
- Department of Medical Oncology, Clinica di Oncologia Medica, Policlinico San Martino-IST, Genova, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
| | - Lucia Del Mastro
- Department of Medical Oncology, UO Oncologia Medica 2, Policlinico San Martino-IST, Genova, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy.
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