Adjuvant chemotherapy followed by goserelin compared with either modality alone

The impact on amenorrhea, hot flashes, and quality of life in premenopausal patients - The international breast cancer study group trial VIII

Jürg Bernhard, David Zahrieh, Monica Castiglione-Gertsch, Christoph Hürny, Richard D. Gelber, John F. Forbes, Elizabeth Murray, John Collins, Stefan Aebi, Beat Thürlimann, Karen N. Price, Aron Goldhirsch, Alan S. Coates

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Purpose: The purpose of this article is to compare quality of life (QOL) and menopausal symptoms among premenopausal patients with lymph node-negative breast cancer receiving chemotherapy, goserelin, or their sequential combination, and to investigate differential effects by age. Patients and Methods: We evaluated QOL data from 874 pre- and perimenopausal women with lymph node-negative breast cancer who were randomly assigned to receive six courses of classical cyclophosphamide, methotrexate, and fluorouracil (CMF) chemotherapy, ovarian suppression with goserelin for 24 months, or six courses of classical CMF followed by 18 months of goserelin. We report QOL data collected during 3 years after random assignment in patients without disease recurrence. Results: Overall, patients receiving goserelin alone showed a marked improvement or less deterioration in QOL measures over the first 6 months than those patients treated with CMF. There were no differences at 3 years after random assignment according to treatment except for hot flashes. As reflected in the hot flashes scores, patients in all three treatment groups experienced induced amenorrhea, but the onset of ovarian function suppression was slightly delayed for patients receiving chemotherapy. Younger patients (< 40 years) who received goserelin alone returned to their premenopausal status at 6 months after the cessation of therapy, while those who received CMF showed marginal changes from their baseline hot flashes scores. Conclusion: Age-adjusted risk profiles that consider patient-reported outcomes enable patients to adapt to their disease and treatment, such as considering the trade-offs between delayed endocrine symptoms, but higher risk of permanent menopause with chemotherapy, and immediate but reversible endocrine symptoms with goserelin, in younger premenopausal patients.

Original languageEnglish (US)
Pages (from-to)263-270
Number of pages8
JournalJournal of Clinical Oncology
Volume25
Issue number3
DOIs
StatePublished - Jan 20 2007
Externally publishedYes

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Goserelin
Hot Flashes
Amenorrhea
Adjuvant Chemotherapy
Quality of Life
Breast Neoplasms
Methotrexate
Fluorouracil
Cyclophosphamide
Drug Therapy
Lymph Nodes
Therapeutics
Menopause

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Adjuvant chemotherapy followed by goserelin compared with either modality alone : The impact on amenorrhea, hot flashes, and quality of life in premenopausal patients - The international breast cancer study group trial VIII. / Bernhard, Jürg; Zahrieh, David; Castiglione-Gertsch, Monica; Hürny, Christoph; Gelber, Richard D.; Forbes, John F.; Murray, Elizabeth; Collins, John; Aebi, Stefan; Thürlimann, Beat; Price, Karen N.; Goldhirsch, Aron; Coates, Alan S.

In: Journal of Clinical Oncology, Vol. 25, No. 3, 20.01.2007, p. 263-270.

Research output: Contribution to journalArticle

Bernhard, Jürg ; Zahrieh, David ; Castiglione-Gertsch, Monica ; Hürny, Christoph ; Gelber, Richard D. ; Forbes, John F. ; Murray, Elizabeth ; Collins, John ; Aebi, Stefan ; Thürlimann, Beat ; Price, Karen N. ; Goldhirsch, Aron ; Coates, Alan S. / Adjuvant chemotherapy followed by goserelin compared with either modality alone : The impact on amenorrhea, hot flashes, and quality of life in premenopausal patients - The international breast cancer study group trial VIII. In: Journal of Clinical Oncology. 2007 ; Vol. 25, No. 3. pp. 263-270.
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abstract = "Purpose: The purpose of this article is to compare quality of life (QOL) and menopausal symptoms among premenopausal patients with lymph node-negative breast cancer receiving chemotherapy, goserelin, or their sequential combination, and to investigate differential effects by age. Patients and Methods: We evaluated QOL data from 874 pre- and perimenopausal women with lymph node-negative breast cancer who were randomly assigned to receive six courses of classical cyclophosphamide, methotrexate, and fluorouracil (CMF) chemotherapy, ovarian suppression with goserelin for 24 months, or six courses of classical CMF followed by 18 months of goserelin. We report QOL data collected during 3 years after random assignment in patients without disease recurrence. Results: Overall, patients receiving goserelin alone showed a marked improvement or less deterioration in QOL measures over the first 6 months than those patients treated with CMF. There were no differences at 3 years after random assignment according to treatment except for hot flashes. As reflected in the hot flashes scores, patients in all three treatment groups experienced induced amenorrhea, but the onset of ovarian function suppression was slightly delayed for patients receiving chemotherapy. Younger patients (< 40 years) who received goserelin alone returned to their premenopausal status at 6 months after the cessation of therapy, while those who received CMF showed marginal changes from their baseline hot flashes scores. Conclusion: Age-adjusted risk profiles that consider patient-reported outcomes enable patients to adapt to their disease and treatment, such as considering the trade-offs between delayed endocrine symptoms, but higher risk of permanent menopause with chemotherapy, and immediate but reversible endocrine symptoms with goserelin, in younger premenopausal patients.",
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T2 - The impact on amenorrhea, hot flashes, and quality of life in premenopausal patients - The international breast cancer study group trial VIII

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AU - Zahrieh, David

AU - Castiglione-Gertsch, Monica

AU - Hürny, Christoph

AU - Gelber, Richard D.

AU - Forbes, John F.

AU - Murray, Elizabeth

AU - Collins, John

AU - Aebi, Stefan

AU - Thürlimann, Beat

AU - Price, Karen N.

AU - Goldhirsch, Aron

AU - Coates, Alan S.

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N2 - Purpose: The purpose of this article is to compare quality of life (QOL) and menopausal symptoms among premenopausal patients with lymph node-negative breast cancer receiving chemotherapy, goserelin, or their sequential combination, and to investigate differential effects by age. Patients and Methods: We evaluated QOL data from 874 pre- and perimenopausal women with lymph node-negative breast cancer who were randomly assigned to receive six courses of classical cyclophosphamide, methotrexate, and fluorouracil (CMF) chemotherapy, ovarian suppression with goserelin for 24 months, or six courses of classical CMF followed by 18 months of goserelin. We report QOL data collected during 3 years after random assignment in patients without disease recurrence. Results: Overall, patients receiving goserelin alone showed a marked improvement or less deterioration in QOL measures over the first 6 months than those patients treated with CMF. There were no differences at 3 years after random assignment according to treatment except for hot flashes. As reflected in the hot flashes scores, patients in all three treatment groups experienced induced amenorrhea, but the onset of ovarian function suppression was slightly delayed for patients receiving chemotherapy. Younger patients (< 40 years) who received goserelin alone returned to their premenopausal status at 6 months after the cessation of therapy, while those who received CMF showed marginal changes from their baseline hot flashes scores. Conclusion: Age-adjusted risk profiles that consider patient-reported outcomes enable patients to adapt to their disease and treatment, such as considering the trade-offs between delayed endocrine symptoms, but higher risk of permanent menopause with chemotherapy, and immediate but reversible endocrine symptoms with goserelin, in younger premenopausal patients.

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