Ovarian escape in premenopausal breast cancer: Challenges and strategies for optimizing hormone suppression

Ovarian function suppression (OFS) is extensively acknowledged for its efficacy and benefits in the management of breast cancer among premenopausal women. While gonadotropin-releasing hormone agonists (GnRHa) serve as the fundamental component of OFS, a subset of patients experience incomplete estrogen suppression, leading to potential treatment failure and adverse outcomes. This review systematically examines ovarian escape (OE) during GnRHa treatment in premenopausal women with hormone receptor-positive (HR+) breast cancer and explores potential risk factors along with the underlying mechanisms. Discrepancies in defining menopausal status and assay variability complicate OE diagnosis; however, early detection and intervention can mitigate the risk of treatment failure. Current guidelines lack standardized guidelines for hormone monitoring, underscoring the need for personalized strategies to optimize OFS efficacy and mitigate risks. Further research is warranted to elucidate OE mechanisms and refine therapeutic approaches. By proposing evidence-based management strategies, this work advances personalized OFS approaches tailored to high-risk populations.