Ovarian Function Suppression in Premenopausal Hormone Receptor-Positive Early Breast Cancer: A Comprehensive Review

Area of Science:

• Oncology
• Endocrinology
• Reproductive Medicine

Background:

• Premenopausal hormone receptor-positive (HR+) breast cancer poses unique challenges due to ovarian estrogen production.
• Tamoxifen was the standard, but ovarian function suppression (OFS) integration has improved adjuvant therapy.
• Estrogen from the hypothalamic-pituitary-ovarian axis drives tumor growth in premenopausal women.

Purpose of the Study:

• To review landmark trials and biological rationale for OFS in premenopausal HR+ breast cancer.
• To guide personalized treatment strategies by synthesizing current evidence.
• To discuss benefits, toxicities, and special considerations for OFS.

Main Methods:

• Review of landmark clinical trials (e.g., SOFT, TANE, TEXT, HBE).
• Synthesis of biological rationales for estrogen's role.
• Analysis of emerging evidence on OFS efficacy and toxicity.

Main Results:

• OFS combined with aromatase inhibitors or tamoxifen is superior to tamoxifen alone in high-risk populations.
• Key toxicities include bone loss, menopausal symptoms, and sexual dysfunction.
• Specific subgroups (young women, lobular carcinoma, BRCA carriers) show distinct benefits from OFS.

Conclusions:

• Ovarian function suppression is a cornerstone for high-risk premenopausal HR+ breast cancer adjuvant therapy.
• Personalized management requires balancing oncologic outcomes with survivorship, considering genomic tools and duration.
• Emerging areas include managing ovarian escape and potential for chemotherapy de-escalation with OFS.