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Published on: April 17, 2012
Use of goserelin in the treatment of breast cancer
Achim Rody1, Sibylle Loibl, Gunter von Minckwitz
1Department of Obstetrics and Gynecology, JW Goethe-University, Theodor-Stern-Kai 7, D-60590 Frankfurt, Germany. achim.rody@em.uni-frankfurt.de
Abstract:
Gonadotropin-releasing hormone analogs are, alongside tamoxifen, one of the most commonly used drugs in the treatment of pre-/perimenopausal endocrine-responsive breast cancer. Goserelin, as a principal agent of this class of drugs, is mainly investigated in clinical trials. The indirect comparison of goserelin with tamoxifen as a single drug in the adjuvant setting showed similar efficacy. Furthermore, goserelin is as effective as cyclophosphamide, methotrexate and 5-fluorouracil chemotherapy, and total endocrine blockade as a combination of gonadotropin-releasing hormone analog and tamoxifen showed a comparable benefit with anthracycline-containing adjuvant chemotherapy. Goserelin administered after cessation of chemotherapy leads to a further improvement and may be equieffective as tamoxifen or a combination of both. Data concerning taxane-based and dose-dense chemotherapy as well as combination of gonadotropin-releasing hormone analogs with third-generation aromatase inhibitors are still lacking (ongoing suppression of ovarian function, tamoxifen and exemestane, and premenopausal endocrine-responsive chemotherapy trials). Moreover, duration of therapy with gonadotropin-releasing hormone analogs (2-3 years or longer) is still a matter of debate. Palliative endocrine treatment is standard in the first-line therapy of patients without life-threatening disease and endocrine-responsive breast cancer. Treatment decisions depend upon adjuvant endocrine pretreatment. Clinical data regarding ovarian protection by synchronous use of gonadotropin-releasing hormone in young breast cancer patients receiving chemotherapy are incoherent.
Insights
Gonadotropin-releasing hormone analogs like goserelin are effective for premenopausal breast cancer, showing similar efficacy to tamoxifen and chemotherapy. Further research is needed on combinations and optimal treatment duration.
Area of Science:
- Endocrinology
- Oncology
- Pharmacology
Background:
- Gonadotropin-releasing hormone (GnRH) analogs and tamoxifen are key treatments for pre/perimenopausal endocrine-responsive breast cancer.
- Goserelin is a principal GnRH analog frequently studied in clinical trials.
Purpose of the Study:
- To review the efficacy of GnRH analogs, particularly goserelin, in breast cancer treatment.
- To compare GnRH analogs with other therapies like tamoxifen, chemotherapy, and aromatase inhibitors.
- To identify gaps in current research regarding GnRH analog use.
Main Methods:
- Indirect comparison of goserelin versus tamoxifen in the adjuvant setting.
- Evaluation of goserelin's efficacy against chemotherapy regimens (CMF).
- Assessment of total endocrine blockade (GnRH analog + tamoxifen) versus anthracycline chemotherapy.
- Review of data on GnRH analogs combined with taxanes, dose-dense chemotherapy, and aromatase inhibitors.
Main Results:
- Goserelin demonstrates similar efficacy to tamoxifen as a single agent in the adjuvant setting.
- Goserelin is as effective as cyclophosphamide, methotrexate, and 5-fluorouracil chemotherapy.
- Total endocrine blockade shows comparable benefits to anthracycline-containing adjuvant chemotherapy.
- Goserelin after chemotherapy may offer further improvement, potentially equieffective to tamoxifen or combination therapy.
Conclusions:
- GnRH analogs are established treatments for premenopausal endocrine-responsive breast cancer.
- Data on combinations of GnRH analogs with newer chemotherapies and aromatase inhibitors are limited.
- Optimal duration of GnRH analog therapy and ovarian protection strategies require further investigation.
