For premenopausal women with estrogen receptor (ER)-positive breast cancer who are undergoing adjuvant therapy, combining tamoxifen with ovarian suppression can be an effective treatment strategy. This approach is particularly beneficial for those at higher risk of recurrence.
Regimen and Dosing
- Tamoxifen:
– Dosage: 20 mg orally once daily.
– Duration: Typically prescribed for 5 to 10 years, depending on the patient’s risk factors and response to treatment.
- Ovarian Suppression:
– Methods: Ovarian suppression can be achieved through medication or surgical intervention.
– Gonadotropin-Releasing Hormone (GnRH) Agonists: These are commonly used for ovarian suppression. Triptorelin, goserelin, or leuprolide are examples of GnRH agonists administered via injection, usually every 1 to 3 months.
– Surgical Options: Bilateral oophorectomy or ovarian irradiation are alternatives for permanent ovarian suppression.
– Duration: Ovarian suppression is typically administered for 5 years in conjunction with tamoxifen[2][6].
Clinical Benefits
– The combination of tamoxifen and ovarian suppression has been shown to improve disease-free survival and overall survival in premenopausal women with hormone receptor-positive breast cancer, especially those with high-risk features such as younger age or prior chemotherapy[4][6].
– Ovarian suppression is particularly recommended for women with stage II or III breast cancers or those at higher risk of recurrence[3].
Considerations
– Side Effects: Combining tamoxifen with ovarian suppression can increase side effects related to estrogen deprivation, such as hot flashes, mood changes, and potential impacts on bone density. It is important to discuss these with healthcare providers to manage them effectively[6].
– Individualized Treatment: The decision to use ovarian suppression alongside tamoxifen should be based on individual risk factors, patient preferences, and discussions with healthcare providers[3][6].
Citations:
[1] https://emedicine.medscape.com/article/1946040-overview
[2] https://pubmed.ncbi.nlm.nih.gov/31518174/
[3] https://emedicine.medscape.com/article/2247407-overview
[4] https://ascopost.com/news/january-2023/adjuvant-endocrine-therapy-and-ovarian-suppression-for-premenopausal-patients-with-hr-positive-breast-cancer/
[5] https://ascopubs.org/doi/10.1200/JCO.2015.65.9573
[6] https://www.komen.org/breast-cancer/treatment/type/hormone-therapy/ovarian-suppression/