Koung Jin Suh , MD 1 , Se Hyun Kim , MD 1 , Kyung-Hun Lee , MD 2 , 3 , Tae-Yong Kim , MD 2 , Yu Jung Kim , MD 1 , Sae-Won Han , MD 2 , 3 , Eunyoung Kang , MD 4 , Eun-Kyu Kim , MD 4 , Kidong Kim , MD 5 , Jae Hong No , MD 5 , Wonshik Han , MD 3 , 6 , Dong-Young Noh , MD 3 , 6 , Maria Lee , MD 7 , Hee Seung Kim , MD 6 , Seock-Ah Im , MD 2 , 3 , Jee Hyun Kim , MD 1
27 February 2017
Although combining aromatase inhibitors (AI) with gonadotropin-releasing hormone agonists (GnRHa) is becoming more common, it is still not clear if GnRHa is as effective as bilateral salpingo-oophorectomy (BSO).
We retrospectively analyzed data of 66 premenopausal patients with hormone receptor– positive, human epidermal growth factor receptor 2–negative recurrent and metastatic breast cancer who had been treated with AIs in combination with GnRHa or BSO between 2002 and 2015.
The median patient age was 44 years. Overall, 24 (36%) received BSO and 42 (64%) received GnRHa. The clinical benefit rate was higher in the BSO group than in the GnRHa group (88% vs. 69%, p=0.092). Median progression-free survival (PFS) was longer in the BSO group, although statistical significance was not reached (17.2 months vs. 13.3 months, p=0.245). When propensity score matching was performed, the median PFS was 17.2 months for the BSO group and 8.2 months for the GnRHa group (p=0.137). Multivariate analyses revealed that the luminal B subtype (hazard ratio, 1.67; 95% confidence interval [CI], 1.08 to 2.60; p=0.022) and later-line treatment (≥ third line vs. first line; hazard ratio, 3.24; 95% CI, 1.59 to 6.59; p=0.001) were independent predictive factors for a shorter PFS. Incomplete ovarian suppression was observed in a subset of GnRHa-treated patients whose disease showed progression, with E2 levels higher than 21 pg/mL.