Ovarian suppression (OS) |
IBCSG VIII (IBCSG, 2003) |
N
=1063
Pre‐ or peri
ER+/−
Node (−)
|
CMF×6 (oral) vs. Goserelin vs. CMF×6→Goserelin |
For ER+: CMF→G vs. CMF:
RR for DFS 0.80, P=0.26
|
In ER+ group as whole, no difference between 3 treatment arms;
If ER+ and ≤39 years old:
5 year DFS:
Goserelin 62%
CMF 64%
CMF→Goserelin 85% (P=0.02)
|
|
INT 0101 (Davidson et al., 2005) |
N
=1503
Premenopausal
Node (+)
ER and/or PR+
|
CAF vs. CAF‐Z vs. CAF‐ZT |
CAF‐Z vs. CAF:
HR for DFS 0.93, P=0.22
HR for survival 0.88, P=0.14
CAF‐ZT vs. CAF‐Z:
HR for DFS 0.74, P=<0.01
HR for survival 0.91, P=0.21
|
Trend toward benefit with ovarian suppression after chemo if <40 years |
|
Arriagada et al., 2005
|
N
=926
Premenopausal
ER/PR+ or −
Grade II/III or node (+)
|
Chemo (FAC, FEC, or CMF) vs. Chemo+OS |
For all patients:
RR for recurrence or death 1.1, P=0.51
RR for death 1.2, P=0.19
For ER+ and <40 years:
RR recurrence or death 0.49, P=0.005
|
Benefit to ovarian suppression after chemo only if ER+ and <50 |
|
EBCTCG, 2005
|
N
=7601
Age<50 at diagnosis
47% ER unknown
61% node+
|
Ovarian suppression by surgery, XRT, or LHRH inhibitor |
Benefit on recurrence
15‐year gain 4.3%
HR 0.83 favoring
Ovarian suppression
Benefit on breast cancer mortality
15‐year gain 3.2%
HR 0.87 favoring OS
|
Benefit in node (+) and (−)
More benefit if no chemo given
Numbers too small for other subgroup analysis
|