Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA.
Department of Hematology and Medical Oncology, Houston Methodist Cancer Center, Houston, Texas, USA.
Oncologist. 2021 Jun;26(6):e936-e942. doi: 10.1002/onco.13722. Epub 2021 Mar 11.
This study evaluated the proportion of premenopausal women who experience persistent ovarian escape (OE) while receiving ovarian suppression (OS) therapy for estrogen receptor-positive (ER+) breast cancer treatment. The study also examined clinical factors that may predispose to higher risk of persistent OE.
This was a retrospective, "real-world" study to evaluate premenopausal women receiving adjuvant endocrine OS therapy. The primary objective was to measure the percentage of persistent OE within the first 3 months of OS injections (using either leuprolide or goserelin). The secondary objective was to associate baseline clinical data (age, body mass index [BMI], and previous chemotherapy) with the probability of OE.
Of the 46 patients included in this analysis, 11 (23.9%) women did not achieve OS within 3 months. Three women (6.5%) remained in OE at 12 months. Older age (odds ratio, 0.86; confidence interval, 0.76-0.98, p = .024) was associated with lower chance of developing OE. BMI, previous chemotherapy, and drug used (tamoxifen versus aromatase inhibitor) did not correlate with the likelihood of OE in this patient cohort.
Among the premenopausal women who did not attain complete ovarian suppression, young age was a significant risk factor for likelihood of OE. Although the clinical relevance of this finding is not yet known, it should prompt further studies to determine whether inadequate OS is associated with higher recurrence risk for patients with ER+ breast cancer.
Because up to a quarter of premenopausal women do not attain adequate ovarian suppression within the first 3 months of gonadotropin-releasing hormone (GnRH) agonist therapy, bloodwork should be checked to ascertain hormone levels prior to starting aromatase inhibitor therapy, and at regular intervals, for these women.
本研究评估了接受雌激素受体阳性（ER+）乳腺癌治疗的卵巢抑制（OS）治疗的绝经前妇女中持续卵巢逃逸（OE）的比例。该研究还检查了可能导致更高风险持续 OE 的临床因素。
这是一项回顾性的“真实世界”研究，评估了接受辅助内分泌 OS 治疗的绝经前妇女。主要目的是测量 OS 注射后前 3 个月内持续 OE 的百分比（使用亮丙瑞林或戈舍瑞林）。次要目的是将基线临床数据（年龄、体重指数[BMI]和既往化疗）与 OE 发生的概率相关联。
在这项分析中，46 名患者中有 11 名（23.9%）女性在 3 个月内未达到 OS。3 名女性（6.5%）在 12 个月时仍处于 OE 状态。年龄较大（优势比，0.86；置信区间，0.76-0.98，p =.024）与 OE 发生的可能性较低相关。BMI、既往化疗和所用药物（他莫昔芬与芳香化酶抑制剂）在该患者队列中与 OE 的可能性无关。
在未能达到完全卵巢抑制的绝经前妇女中，年轻是 OE 发生可能性的显著危险因素。尽管这一发现的临床意义尚不清楚，但它应该促使进一步的研究，以确定 ER+乳腺癌患者的 OS 不足是否与更高的复发风险相关。
由于多达四分之一的绝经前妇女在 GnRH 激动剂治疗的前 3 个月内未能达到足够的卵巢抑制，因此应在开始芳香化酶抑制剂治疗前以及定期检查这些妇女的激素水平。
