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Evidence summaries

Ovarian Suppression for Adjuvant Treatment of Hormone Receptorpositive Early Breast Cancer

Adding hormonal ovarian suppression for premenopausal women with early, hormone receptor-positive breast cancer improves survival rate. Level of evidence: "A"

Summary

A Cochrane review [Abstract] 1 included 15 studies with a total of 11 538 subjects. Adjuvant endocrine therapy is used for hormone receptor-positive breast cancer and in premenopausal women by oestrogen receptor blockade with tamoxifen, temporary suppression of ovarian oestrogen synthesis by luteinising hormone releasing hormone (LHRH) agonists, and by permanent interruption of ovarian oestrogen synthesis with oophorectomy or radiotherapy. Adding ovarian function suppression (OFS) to treatment resulted in a reduction in mortality (table T1). This treatment effect was seen when OFS was added to observation, to tamoxifen, or to chemotherapy and tamoxifen.

Ovarian suppression compared to no ovarian suppression for adjuvant treatment of early breast cancer

OutcomesRelative effect(95% CI)Risk with control - No ovarian suppressionRisk with intervention - Ovarian suppressionof participants(studies)Certainty of the evidence
Overall survival (OS)5-year risk of deathMedian follow-up: range 5.3 to 12.1 yearsHR 0.86(0.78 to 0.94)110 per 100095 per 1000(87 to 104)10 374(11) High
Disease-free survival (DFS)5-year risk of recurrence Median follow-up: range 5.3 to 12.1 yearsHR 0.83(0.77 to 0.90)250 per 1000212 per 1000(199 to 228)8 899(10) High
Toxicity - hot flushes (a combination of "grade 3/4" and "any grade" toxicity)Follow-up: range 2 to 5 yearsRR 1.60(1.41 to 1.82)97 per 1000154 per 1000(136 to 176)5 581(6 ) Low
Contralateral breast cancerFollow-up: 4.75 to median 12.1 years3RR 0.75(0.57 to 0.97)1 per 100023 per 1000(18 to 30)7 856(8) Moderate

Clinical comments

Note

Date of latest search: 2020-08-05

    References

    • Bui KT, Willson ML, Goel S et al. Ovarian suppression for adjuvant treatment of hormone receptor-positive early breast cancer. Cochrane Database Syst Rev 2020;(3):CD013538. [PubMed]

Primary/Secondary Keywords