The emerging role of hormonal ablation as adjuvant therapy in node+ and node- pre-/perimenopausal patients

Medical ovarian suppression with GnRH-analogues is effective in pre-/perimenopausal patients with advanced breast cancer. This was the rationale to investigate the GnRH analogue goserelin in early breast cancer patients. More than 9900 women aged under 50 have been treated in recent adjuvant trials. Medical ovarian suppression seems to be at least as effective as surgical ovariectomy. Adjuvant goserelin treatment for 2 years is similar to 6 cycles of CMF in premenopausal receptor-positive patients. CMF is superior to goserelin in receptor-negative patients. A combination of goserelin and tamoxifen leads to a longer disease-free survival than 6 cycles of CMF. Ovarian function is reversible after discontinuation of a 2 year treatment with goserelin in patients under 40 years, so that fertility can be preserved. Persistent amenorrhoea after CMF treatment is correlated with a positive prognosis. However, there is no proof that the use of GnRH-analogues in patients with no CMF-induced amenorrhoea is beneficial. (C) 2001 Harcourt Publishers Ltd.