Today we shift our focus to premenopausal women with early stage breast cancer. The SOFT trial reported with over 5 years of follow up. This trial randomized early stage breast cancer patients to one of the following for a 5 year course:
Tamoxifen OR
Tamoxifen + Ovarian suppression OR
Exemestane + Ovarian suppression
Ovarian suppression = either monthly injections, surgical removal or radiation to the ovaries
The main question they were trying to answer in this study was what is the optimal hormonal therapy for premenopausal women with hormone receptor positive breast cancer.
The results were interesting. They found that women with higher risk breast cancer, particularly those who required chemotherapy and regained their periods, benefitted from ovarian suppression. Whereas, those with lower risk tumors, mainly those who did not require chemotherapy, did exceptionally well with tamoxifen alone.
The most striking results were found in patients who were under the age of 35 and required chemotherapy (which was most of that age group). There was a fairly striking benefit of adding ovarian suppression to tamoxifen (11.2% decrease in the risk of breast cancer recurrence) over using tamoxifen alone. Adding ovarian suppression to an aromatase inhibitor offered even more benefit over tamoxifen alone (15.7% decrease in the risk of breast cancer recurrence).
However, the potential side effects are sobering. We worry about the long-term effects of ovarian suppression with regard to sexual dysfunction, mood issues, late cardiac effects including high blood pressure, bone aches, and bone density, especially in this very young patient population. Aromatase inhibitors can exacerbate many of these symptoms and health issues.
So, the hormonal therapy options have become increasingly complicated and our discussions with patients who fit these criteria are likely to get a whole lot more complicated. However, the end goal is to individualize care as much as possible and with this data, we should be able to do this a little better…even if it does mean some more intensive treatment for our young patients.
Side note: All premenopausal women with hormone receptor positive breast cancer should be discussing this data with their medical oncologist. You can reference the SOFT and TEXT trials and ask how these trials will impact your care. Breast Cancer Consultants can also help apply this information specifically to your breast cancer diagnosis and treatment plan.