Tesch Megan E, Zheng Yue, Rosenberg Shoshana M, Poorvu Philip D, Ruddy Kathryn J, Tamimi Rulla, Schapira Lidia, Peppercorn Jeffrey, Borges Virginia, Come Steven E, Snow Craig, Bhasin Shalender, Partridge Ann H
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
NPJ Breast Cancer. 2024 Aug 1;10(1):67. doi: 10.1038/s41523-024-00680-0.
Ovarian function suppression (OFS) benefits young women with hormone receptor (HR)-positive breast cancer but they are at risk for ovarian function breakthrough. We assessed endocrine effects of gonadotropin-releasing hormone agonist (GnRHa) treatment in a prospective cohort of patients aged ≤ 40 years with HR-positive breast cancer. Plasma estradiol (E2), estrone, and follicule-stimulating hormone (FSH) levels were measured from blood samples drawn 1 and 4 years after diagnosis. Patient characteristics, invasive breast cancer-free survival (iBCFS), and overall survival (OS) were compared between those with and without E2 > 2.72 pg/mL during GnRHa treatment. Among eligible patients, 54.7% (46/84) and 60% (15/25) had E2 > 2.72 pg/mL at 1 and 4 years, respectively. Factors associated with E2 > 2.72 pg/mL at 1 year were no prior chemotherapy (P = 0.045) and tamoxifen use (P = 0.009). After a median follow-up of 7 years, among patients with stage I-III breast cancer (N = 74), iBCFS events were seen in 6 (8.1%) with E2 > 2.72 pg/mL and 5 (6.8%) with E2 ≤ 2.72 pg/mL (P = 0.893). Among patients with de novo metastatic breast cancer (N = 12), 6 (50%) with E2 > 2.72 pg/mL and 3 (25%) with E2 ≤ 2.72 pg/mL died during follow-up (P = 0.052). Larger studies exploring the clinical implications of incomplete E2 suppression by GnRHa are needed to ensure optimal OFS treatment strategies are being employed for this population.
卵巢功能抑制（OFS）对激素受体（HR）阳性的年轻乳腺癌女性有益，但她们存在卵巢功能突破的风险。我们在一个年龄≤40岁的HR阳性乳腺癌患者前瞻性队列中评估了促性腺激素释放激素激动剂（GnRHa）治疗的内分泌效应。在诊断后1年和4年采集的血样中测量血浆雌二醇（E2）、雌酮和促卵泡生成素（FSH）水平。比较了GnRHa治疗期间E2>2.72 pg/mL和E2≤2.72 pg/mL的患者的患者特征、无浸润性乳腺癌生存期（iBCFS）和总生存期（OS）。在符合条件的患者中，分别有54.7%（46/84）和60%（15/25）在1年和4年时E2>2.72 pg/mL。与1年时E2>2.72 pg/mL相关的因素是未接受过化疗（P = 0.045）和使用他莫昔芬（P = 0.009）。中位随访7年后，在I-III期乳腺癌患者（N = 74）中，E2>2.72 pg/mL的患者中有6例（8.1%）发生iBCFS事件，E2≤2.72 pg/mL的患者中有5例（6.8%）发生iBCFS事件（P = 0.893）。在初发转移性乳腺癌患者（N = 12）中，E2>2.72 pg/mL的患者中有6例（50%）在随访期间死亡，E2≤2.72 pg/mL的患者中有3例（25%）在随访期间死亡（P = 0.052）。需要开展更大规模的研究来探索GnRHa不完全抑制E2的临床意义，以确保为该人群采用最佳的OFS治疗策略。
