Dr Fariba behnamfar Associate Prof.Annual Isfahan University of
Medical Sciences
1394 Annual Scientific Meeting Of Obstetricians and
GynecologistsIn The Name of GodAdjuvant endocrine therapy for
non-metastatic, hormone receptor-positive breast cancer
Adjuvant endocrine therapy for non-metastatic, hormone
receptor-positive breast cancerThe selective estrogen receptor
modulator (SERM)tamoxifenAromatase inhibitors, which block the
peripheral conversion of androgens to estrogens.Ovarian suppression
or ablation, which inhibits endogenous estrogen production from the
ovaries, which can be done on a temporary basis (ovarian
suppression) or permanently through oophorectomy or radiation
therapy ,ablationEndocrine therapyFor women who appear to not be at
a high risk of recurrence, we administer tamoxifenas single-agent
therapy.
For women with high-risk breast cancer, we offer ovarian
suppression plus exemestanerather thantamoxifenas single-agent
therapy
SOFT trialIn the SOFT trial, over 3000 premenopausal women were
randomly assigned to one of three arms:tamoxifenalone, tamoxifen
plus ovarian suppression, orexemestaneplus ovarian suppression
Women were allowed to enter following surgery alone (in which case
they were randomized within 12 weeks of surgery) or within eight
months of the end of chemotherapy, provided they had biochemical
proof they were not menopausal. With a median follow-up of 67
months, compared with tamoxifen alone, tamoxifen plus ovarian
suppression resulted in:No statistically significant difference in
DFS at five years (HR 0.83, 95% CI 0.66-1.04)A higher rate of
serious (grade 3) toxicities (31 versus 23.7 percent,
respectively). These included menopausal symptoms and
depression
SOFT trialpatients with a higher risk of relapse may derive a
benefit from ovarian suppression plus either aromatase inhibition
ortamoxifen These include:Patients who were treated with
chemotherapyPatients
