Adjuvant Endocrine therapy for women with hormone receptor-positive breast cancer: American society of clinical oncology clinical practice guideline update on ovarian suppression

Harold J. Burstein, Christina Lacchetti, Holly Anderson, Thomas A. Buchholz, Nancy E. Davidson, Karen E. Gelmon, Sharon H. Giordano, Clifford A. Hudis, Alexander J. Solky, Vered Stearns, Eric P. Winer, Jennifer J. Griggs

Research output: Contribution to journalArticle

Abstract

Purpose To update the ASCO adjuvant endocrine therapy guideline based on emerging data concerning the benefits and risks of ovarian suppression in addition to standard adjuvant therapy in premenopausal women with estrogen receptor-positive breast cancer. Methods ASCO convened an Update Panel and conducted a systematic review of randomized clinical trials investigating ovarian suppression. Results Two trials investigating the addition of ovarian suppression to tamoxifen did not show an overall clinical benefit for ovarian suppression. Nonetheless, the addition of ovarian suppression to standard adjuvant therapy with tamoxifen or with an aromatase inhibitor improved disease-free survival and improved freedom from breast cancer and distant recurrence compared with tamoxifen alone among the subset of patients who were at sufficient risk for recurrence such that adjuvant chemotherapy was warranted. Compared with tamoxifen alone, ovarian suppression was associated with a substantial increase in menopausal symptoms, sexual dysfunction, and diminished quality of life. Recommendations The Panel recommends that higher-risk patients should receive ovarian suppression in addition to adjuvant endocrine therapy, whereas lower-risk patients should not. Women with stage II or III breast cancers who would ordinarily be advised to receive adjuvant chemotherapy should receive ovarian suppression with endocrine therapy. The panel recommends that some women with stage I or II breast cancers at higher risk of recurrence who might consider chemotherapy may also be offered ovarian suppression with endocrine therapy. Women with stage I breast cancers not warranting chemotherapy should not receive ovarian suppression, nor should women with nodenegative cancers 1 cm or less. Ovarian suppression may be administered with either tamoxifen or an aromatase inhibitor.

Original languageEnglish (US)
Pages (from-to)1689-1701
Number of pages13
JournalJournal of Clinical Oncology
Volume34
Issue number14
DOIs
StatePublished - May 10 2016

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Medical Oncology
Practice Guidelines
Tamoxifen
Hormones
Breast Neoplasms
Aromatase Inhibitors
Adjuvant Chemotherapy
Recurrence
Therapeutics
Drug Therapy
Estrogen Receptors
Disease-Free Survival
Randomized Controlled Trials
Quality of Life
Guidelines
Neoplasms

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Adjuvant Endocrine therapy for women with hormone receptor-positive breast cancer : American society of clinical oncology clinical practice guideline update on ovarian suppression. / Burstein, Harold J.; Lacchetti, Christina; Anderson, Holly; Buchholz, Thomas A.; Davidson, Nancy E.; Gelmon, Karen E.; Giordano, Sharon H.; Hudis, Clifford A.; Solky, Alexander J.; Stearns, Vered; Winer, Eric P.; Griggs, Jennifer J.

In: Journal of Clinical Oncology, Vol. 34, No. 14, 10.05.2016, p. 1689-1701.

Research output: Contribution to journalArticle

Burstein, HJ, Lacchetti, C, Anderson, H, Buchholz, TA, Davidson, NE, Gelmon, KE, Giordano, SH, Hudis, CA, Solky, AJ, Stearns, V, Winer, EP & Griggs, JJ 2016, 'Adjuvant Endocrine therapy for women with hormone receptor-positive breast cancer: American society of clinical oncology clinical practice guideline update on ovarian suppression', Journal of Clinical Oncology, vol. 34, no. 14, pp. 1689-1701. https://doi.org/10.1200/JCO.2015.65.9573
Burstein, Harold J. ; Lacchetti, Christina ; Anderson, Holly ; Buchholz, Thomas A. ; Davidson, Nancy E. ; Gelmon, Karen E. ; Giordano, Sharon H. ; Hudis, Clifford A. ; Solky, Alexander J. ; Stearns, Vered ; Winer, Eric P. ; Griggs, Jennifer J. / Adjuvant Endocrine therapy for women with hormone receptor-positive breast cancer : American society of clinical oncology clinical practice guideline update on ovarian suppression. In: Journal of Clinical Oncology. 2016 ; Vol. 34, No. 14. pp. 1689-1701.
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