Adjuvant therapy for premenopausal patients with early breast cancer

Current topics on adjuvant therapy for premenopausal patients with breast cancer are reviewed.

The Early Breast Cancer Trialists' Collaborative Group overview showed that women under 50 received a remarkable benefit from postoperative chemotherapy and endocrine therapy. The impact of chemotherapy-induced amenorrhea on patient outcome remains to be defined. The addition of luteinizing-hormone-releasing hormone agonists to tamoxifen, chemotherapy or both significantly reduced both recurrence and death in premenopausal patients with endocrine-responsive breast cancer. Exploratory trials are investigating the use of more complete estrogen suppression with luteinizing-hormone-releasing hormone agonists with aromatase inhibitors. There is no consensus on how long these agonists should be used in the adjuvant setting. Chemotherapy-induced ovarian failure is frequently associated with infertility. The suppression of ovarian function using luteinizing-hormone-releasing hormone agonists during chemotherapy seems promising for preserving ovarian function. Chemotherapy-induced ovarian failure and prolonged luteinizing-hormone-releasing hormone agonist therapy cause premature menopausal symptoms. To minimize the menopausal symptoms, intervention strategies should be investigated.

There are a number of unresolved issues in terms of the optimal use of chemotherapy and endocrine therapy in premenopausal patients with breast cancer. Well-designed and well-organized randomized clinical trials are essential to resolve these issues.