Cancer Res Treat.  2016 Oct;48(4):1351-1362. 10.4143/crt.2015.444.

Survival Outcome of Combined GnRH Agonist and Tamoxifen Is Comparable to That of Sequential Adriamycin and Cyclophosphamide Chemotherapy Plus Tamoxifen in Premenopausal Patients with Lymph-Node–Negative, Hormone-Responsive, HER2-Negative, T1-T2 Breast Cancer

• Sohn G
• Ahn SH
• Kim HJ
• Son BH
• Lee JW
• Ko BS
• Lee Y
• Lee SB
• Baek S

• KMID: 2356237
• DOI: http://doi.org/10.4143/crt.2015.444

Abstract

PURPOSE
The purpose of this study was to compare treatment outcomes between combined gonadotropin-releasing hormone agonist and tamoxifen (GnRHa+T) and sequential adriamycin and cyclophosphamide chemotherapy and tamoxifen (AC->T) in premenopausal patients with hormone-responsive, lymph-node-negative breast cancer.
MATERIALS AND METHODS
In total, 994 premenopausal women with T1-T2, lymph-node-negative, hormone-receptor-positive, HER2-negative breast cancer between January 2003 and December 2008 were included in this retrospective cohort study. GnRHa+T and AC->T were administered to 608 patients (61.2%) and 386 patients (38.8%), respectively. Propensity score matching and inverse probability weighting were applied to the original cohort, and 260 patients for each treatment arm were included in the final analysis. Recurrence-free, cancer-specific, and overall survival was compared between the two treatment groups.
RESULTS
A total of 994 patients were followed up for a median of 7.4 years (range, 0.5 to 11.4 years). The 5-year follow-up rate was 98.7%, and 13 patients were lost to follow-up. In propensity-matched cohorts (n=520), there was no difference in recurrence-free, cancer-specific, and overall survival rates between the two treatment groups (p=0.306, p=0.212, and p=0.102, respectively), and this was maintained after applying inverse probability weighting.
CONCLUSION
GnRHa+T is a reasonable alternative to AC->T in patients with premenopausal, hormone-responsive, HER2-negative, lymph-node-negative, T1-T2 breast cancer.

Keyword

Breast neoplasms; Premenopause; Chemotherapy; Drug therapy; Tamoxifen

MeSH Terms

Arm
Breast Neoplasms*
Breast*
Cohort Studies
Cyclophosphamide*
Doxorubicin*
Drug Therapy*
Female
Follow-Up Studies
Gonadotropin-Releasing Hormone*
Humans
Lost to Follow-Up
Premenopause
Propensity Score
Retrospective Studies
Survival Rate
Tamoxifen*
Cyclophosphamide
Doxorubicin
Gonadotropin-Releasing Hormone
Tamoxifen

Figure

• 

  Fig. 1. Inclusion and exclusion diagram. HR, hormone receptor; LN, lymph node; GnRHa+T, combined gonadotropin-releasing hormone agonist and tamoxifen; AC->T, sequential adriamycin and cyclophosphamide chemotherapy and tamoxifen; CTx->T, chemotherapy followed by tamoxifen; CMF->T, sequential cyclophosphamide, methotrexate, 5-fluorouracil chemotherapy, and tamoxifen; Tx, treatment; Premeno, premenopause; Postmeno, postmenopause.

• 

  Fig. 2. Recurrence-free survival (RFS) (A), cancer-specific survival (CSS) (B), and overall survival (OS) (C) curves according to treatment arm (combined gonadotropin-releasing hormone agonist and tamoxifen [GnRHa+T] vs. sequential adriamycin and cyclophosphamide chemotherapy and tamoxifen [AC->T]) in overall cohorts (n=994). RFS (D) and OS (E) curves according to treatment arm (GnRHa+T vs. AC->T) in the T1a+T1b group (n=115), RFS (F), CSS (G), and OS (H) curves according to treatment arm (GnRHa+T vs. AC->T) in the T1c group (n=559). RFS (I), CSS (J), and OS (K) curves according to treatment arm (GnRHa+T vs. AC->T) in T2 group (n=320).

• 

  Fig. 3. Recurrence-free survival (RFS) (A), cancer-specific survival (CSS) (B), and overall survival (OS) (C) curves according to treatment arm (combined gonadotropin-releasing hormone agonist and tamoxifen [GnRHa+T] vs. sequential adriamycin and cyclophosphamide chemotherapy and tamoxifen [AC->T]) in propensity-matched cohorts (n=520).

• 

  Fig. 4. Recurrence-free survival (RFS) (A), cancer-specific survival (CSS) (B), and overall survival (OS) (C) curves according to treatment arm (combined gonadotropin-releasing hormone agonist and tamoxifen [GnRHa+T] vs. sequential adriamycin and cyclophosphamide chemotherapy and tamoxifen [AC->T]) in inverse-probability-weighted cohorts (n=520).

Reference

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