Support for LHRH agonists for breast cancer
Addition of luteinising-hormone-releasing hormone agonists (such as goserelin) to treatment regimens for pre-menopausal women with hormone-receptor-positive breast cancer can reduce the risk of disease recurrence by more than an eighth, a meta-analysis published in The Lancet claims
(2007;369:1711).
Researchers analysed data from 16 randomised studies of 11,906 pre-menopausal
women with early breast cancer. Women taking LHRH agonists as a single
treatment did not experience significant reductions in cancer recurrence
or death after recurrence compared with no systemic treatment. However,
addition of an LHRH agonist to treatment with tamoxifen, chemotherapy
or both, resulted in a 12.7 per cent relative reduction in hazard rate
for disease recurrence (95 per cent confidence interval 2.4–21.9;
P=0.02) and a 15.1 per cent relative reduction in hazard rate for death
after recurrence (CI 1.8–26.7; P=0.03).
The authors say: “Some trials have shown a worse outcome after
chemotherapy in women who did not experience amenorrhoea after chemotherapy
and these women could be the ones who benefit most from the addition
of an LHRH agonist.” They say that more detailed assessment is
needed in terms of LHRH agonist value according to oestrogen and progesterone
receptor status.
None of the trials assessed LHRH agonist treatment versus chemotherapy,
with tamoxifen given in both study arms — the authors say that
this premise needs to be addressed. They conclude that LHRH agonists
provide an additional class of agents for treating pre-menopausal women
with hormone-receptor-positive breast cancer but the optimal duration
of treatment is unknown.
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