GnRH agonist was given via subcutaneous injection 1 week before the initiation of chemotherapy and administered every 28 days until completion of chemotherapy.
Patients with HER2-positive breast cancer who received neoadjuvant trastuzumab treatment were excluded from this study. The HR-positive group comprised ER-positive and/or PR-positive patients. Positive staining for the ER or PR was defined as a score of more than 3+ and HER2/ neu positivity was defined as a score of 3+ by immunohistochemical staining or HER2/ neu gene amplification by fluorescence in situ hybridization. Neoadjuvant chemotherapy was recommended for patients who had positive lymph node involvement, and/or who were expected to benefit from surgery. For evaluation of neoadjuvant responses, a surgical oncologist reviewed all medical records.Īll patients had received neoadjuvant chemotherapy according to the tumor factor. Two treatment groups were analyzed for the study, one received goserelin concurrent with neoadjuvant chemotherapy (goserelin group) for fertility preservation and the other received neoadjuvant chemotherapy alone (neochemotherapy-alone group).
Inclusion criteria in this study were as follows: (1) newly diagnosed breast cancer from December 2010 to September 2014 (2) patient age under 40 years (3) a diagnosis of invasive nonmetastatic breast cancer and (4) having received neoadjuvant chemotherapy. Patient consent is not necessary for a retrospective study. The AMCBCC database is a prospectively maintained, web-based system that includes information on all patients who have undergone operations for breast cancer at the Asan Medical Center in Korea since 1989. Data were obtained from the Asan Medical Center Breast Cancer Center (AMCBCC) database. The protocol of the study was approved by the Institutional Review Board of Asan Medical Center (approval number: 2015-0579). Therefore, we retrospectively evaluated neoadjuvant responses to determine the oncologic effects of GnRH agonist administration concurrent with chemotherapy in this patient population. GnRH agonist administration is a promising therapy for fertility preservation, and the oncologic efficacy of GnRH agonist administration with concurrent chemotherapy is an important concern for young premenopausal breast cancer patients. However, although a survival benefit was observed, it was not significant. A retrospective study suggested that GnRH agonist treatment concurrent with chemotherapy can be effective, especially against hormone receptor (HR)-positive tumors. However, an adjustment for breast cancer stage did not alter disease-free survival or overall survival rates. Disease risk factors were not stratified in the study, making it difficult to draw conclusions about the oncologic effects of the GnRH agonist. The POEMS/S0230 trial, which included only estrogen receptor (ER) and progesterone receptor (PR) negative tumors, indicated that women treated with GnRH agonists had improved disease-free survival and overall survival rates.
The results of the POEMS/S0230 trial will lead to important changes in treatment strategies for young breast cancer patients who are considering chemotherapy. Recently, the Prevention of Early Menopause Study (POEMS/S0230) reported that administration of a GnRH agonist with chemotherapy appeared to protect against ovarian failure, reducing the risk of early menopause and improving prospects for fertility preservation. However, in negative trials and in trials with a strict primary endpoint, a small number of patients, and patients from different age groups, results have differed. Trials of gonadotropin-releasing hormone (GnRH) agonists coadministered with adjuvant chemotherapy for the purpose of protecting ovarian function have shown mixed results. The desire for fertility preservation and for better survival outcomes may at times conflict, but it is nonetheless a significant issue among these patients. Early ovarian failure after chemotherapy is an important issue for young breast cancer patients.