Ovarian suppression in breast cancer management


  • O.S. Zotov Bogomolets National Medical University, Kyiv, Ukraines




breast cancer, endocrine therapy, ovarian suppression, review


The review summarizes current data about the role of ovarian suppression/ablation in endocrine therapy for breast cancer. Information of the indications and methods of ovarian suppression is given; the characteristics of modern drugs used for this purpose — gonadotropin-releasing hormone agonist — are presented, including their advantages and possible side effects. The review contains a description of the evolution of views on the indications for ovarian suppression based on the data from the most authoritative and reliable clinical trials. The latest data from leading international guidelines on the scope of ovarian suppression/ablation in the palliative, adjuvant and neoadjuvant modes are discussed.


4rd ESO–ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC 4) / F. Cardoso, E. Senkus, A. Costa // Annals of Oncology. — 2018. — 29. — 1634-1658. doi: 10.1093/annonc/mdy192.

ASCO Endorsement of the CCO Practice Guideline on Adjuvant Ovarian Ablation in the Treatment of Premenopausal Women with Early Stage Invasive Breast Cancer // Journal of Clinical Onco­logy. — 2011. — Vol. 29, Issue 29. — 3939-3942.

Charehbili A., Fontein D., Kroep J. et al. Neoadjuvant hormonal therapy for endocrine sensitive breast cancer: A systematic review // Cancer Treatment Reviews Volume. — 2014. — 40, 1. — 86-92.

Crump M., Sawka C.A., DeBoer G. et al. An individual patient-based meta-analysis of tamoxifen versus ovarian ablation as first line endocrine therapy for premenopausal women with metastatic breast cance // Breast Cancer Res. Treat. — 1997. — 44. — 201-210.

EBCТCG. Ovarian ablation in early breast cancer: overview of the randomised trials // Lancet. — 1996. — 348. — 1189-1196.

Eisen A., Messersmith H., Franek J., Trudeau M. Breast Cancer Disease Site Group. Adjuvant ovarian ablation in the treatment of premenopausal women with early stage invasive breast cancer // Cancer Care Ontario. — 2010 Jul 6. Program in Evidence-based Care Evidence-based Series.

Elective and risk-reducing salpingo-oophorectomy / American College of Obstetricians and Gynecologists practice bulletin // Obstet. Gynecol. — 2008. — 111 (1). — 231-41.

Emons G., Grundker C., Gunthert A.R. et al. GnRH antagonists in the treatment of gynecological and breast cancers Endocrine-Related // Cancer. — 2003. — 10291-299.

Endocrine Therapy for Hormone Receptor-Positive Metastatic Breast Cancer: American Society of Clinical Oncology Guideline / Rugo H.S., Rumble R.B., Macrae E. et al. // J. Clin. Oncol. — 2016. — 34 (25). — 3069-103. doi: 10.1200/JCO.2016.67.1487.

Fleming G., Francis P.A., Láng I. et al. Randomized comparison of adjuvant tamoxifen (T) plus ovarian function suppression (OFS) versus tamoxifen in premenopausal women with hormone receptor-positive (HR+) early breast cancer (BC): Update of the SOFT trial // SABCS Publication Number: GS4-03. https://www.sabcs.org/Portals/SABCS2016/Documents/SABCS-2017-Abstracts.pdf

Gnant M., Harbeck N., Thomssen C. A Brief Summary of the Consensus Discussion about Escalation and De-Escalation of Primary Breast // Cancer Treatment Breast Care. — 2017. — 12. — 102-107. doi: 10.1159/000475698.

Jackischa C., Harbeckb N., Huoberc J. et al. 14th St. Gallen International Breast Cancer Conference 2015: Evidence, Controversies, Consensus — Primary Therapy of Early Breast Cancer: Opinions Expressed by German Experts Breast Care // 2015. — 10. — 211-219. doi: 10.1159/000433590.

Klijn J.G.M., Blamey R.W., Boccardo F. et al. Сombined tamoxifen and luteinizing hormone-releasing hormone (LHRH) agonist versus LHRH agonist alone in premenopausal advanced breast cancer: a meta-analysis of four randomized trials // J. Clin. Oncol. — 2001. — 19 (2). — 343-53.

Locally recurrent or metastatic breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up clinical practice guidelines / F. Cardoso, N. Harbeck, L. Fallowfield, S. Kyriakides, E. Senkus // Annals of Oncology 23 (Suppl. 7). — 2012. —11-19. doi: 10.1093/annonc/mds232.

National Comprehensive Cancer Network: NCCN Clinical Practice Guidelines in Oncology: Breast Cancer. Version 2.2018. https://www.nccn.org/store/login/login.aspx?Return URL = https://www.nccn.org/professionals/physician_gls/pdf/breast_blocks.pdf

Pagani O., Regan M.M., Fleming G.F. et al. Randomized comparison of adjuvant aromatase inhibitor exemestane (E) plus ovarian function suppression (OFS) vs tamoxifen (T) plus OFS in premenopausal women with hormone receptor positive (HR+) early breast cancer (BC): Update of the combined TEXT and SOFT trials // 2017 SABCS Publication Number: GS4-02. https://www.sabcs.org/Portals/SABCS2016/Documents/SABCS-2017-Abstracts.pdf

Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up / Senkus E., Kyriakides S., Ohno S. et al. ESMO Guidelines Working Group // Ann. Oncol. — 2015. — 26 (suppl. 5). — 8-30. doi: 10.1093/annonc/mdv29.

Pritchard K.I. Current and future directions in medical the­rapy for breast carcinoma: endocrine treatment // Cancer. — 2000. — 88. — 3065-3072.

Regan M.M., Pagani O., Francis P.A. et al. Absolute improvements in freedom from distant recurrence with adjuvant endocrine therapies for premenopausal women with hormone receptor-po­sitive (HR+) HER2-negative breast cancer (BC): Results from TEXT and SOFT. ASCO Abstract #503 https://meetinglibrary.asco.org/record/160255/abstract

Robertson J.F., Blamey R.W. The use of gonadotrophin-releasing hormone (GnRH) agonists in early and advanced breast cancer in pre- and perimenopausal women // Eur. J. Cancer. — 2003. — 39. — 861-869.

Woo Chul Noh, Jong Won Lee, Seok Jin Nam et al. The role of the addition of ovarian suppression to tamoxifen in young women with hormone-sensitive breast cancer who remain premenopausal or regain menstruation after chemotherapy (ASTRRA): Study protocol for a randomized controlled trial and progress // J. Clin. Oncol. — 2018. — 36 (suppl; abstr 502).

Щепотин И.Б., Зотов А.С., Лебедева О.И. Рак грудной железы и репродуктивная функция женщины: рак грудной железы у беременных и вопросы сохранения фертильности после лечения // Клиническая онкология. — 2012. — № 5 (1). — С. 59-63.

Щепотин И.Б., Зотов А.С., Любота Р.В. и др. Роль подавления функции яичников в комплексной терапии больных раком молочной железы в пременопаузе (обзор литературы) // Вопр. онкологии. — 2013. — Т. 59, № 3. — С. 397-404.

Щепотін І.Б., Зотов О.С., Любота Р.В. та ін. Індукована хіміотерапією аменорея у хворих на рак молочної залози: основні механізми та діагностичні критерії порушення функції яєчників (огляд літератури) // Клін. ендокр. та ендокр. хірургія. — 2013. — № 2 (43). — С. 3-9.

Щепотін І.Б., Зотов О.С., Любота Р.В., Любота І.І. Значення супресії функції яєчників у лікуванні хворих на рак молочної залози в пременопаузі (огляд літератури) // Клін. ендокр. та ендокр. хірургія. — 2013. — № 1 (42). — С. 26-33.