1. Combined Tamoxifen and Luteinizing Hormone-Releasing Hormone (LHRH) Agonist Versus LHRH Agonist Alone in Premenopausal Advanced Breast Cancer: A Meta-Analysis of Four Randomized Trials
- Author
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Klijn, J. G. M., Blamey, R. W., Boccardo, F., Tominaga, T., Duchateau, L., Sylvester, R., Beex, L. V. A. M., Mauriac, L., Zijl, J. A., Veyret, C., Wildiers, J., Jassem, J., Piccart, M., Burghouts, J., Becqaert, D., Seynaeve, C., Mignolet, F., Namer, M., Julien, J. P., Garcia Conde, J., Dunser, M., Margreiter, R., Tjabbes, T., Roozendaal, K. J., Velden, P. C., Nortier, J. W. R., Blamey, R., Howell, A., Forbes, J., Kaufmann, M., Nordenskjold, B., Kvinnsland, S., Wilson, R. G., Jonat, W., Kleeberg, U. R., Eiermann, W., Hilfrich, J., Weitzel, H. K., Glas, U., Rutqvist, L. E., Rudenstam, C., Sander, S., Ryden, S., Honsson, P., Lonning, P. E., Loven, L., Russell, I. S., Olweny, C., Byrne, J. J., Snyder, R. D., Coates, A. S., Lowenthal, R. M., Jeal, P. N., Dalley, D. N., Janicke, F., Kleine, W., Michel, R. Th, Canobbio, L., Amoroso, D., Rubagotti, A., Bumma, C., D Aprile, M., Matteis, A., Di Carlo, A., Francini, G., Petrioli, R., Folco, U., Calligioni, E., Gallotti, P., Lopez, M., Mesiti, M., Pacini, P., Sassi, M., Sismondi, P., Paolo Zola, Ogita, M., Okazaki, M., Watanabe, T., Satomi, T., Hatazawa, C., Okuyama, N., Koyama, T., Kobayashi, M., Shimizu, T., Tabei, T., Sano, M., Makino, H., Ando, J., Kimura, M., Takeuchi, T., Aoyama, H., Koyama, H., Shin, E., Chou, G., and Medical Oncology
- Subjects
Agonist ,Oncology ,endocrine system ,Cancer Research ,medicine.medical_specialty ,Neoplasms, Hormone-Dependent ,Antineoplastic Agents, Hormonal ,medicine.drug_class ,medicine.medical_treatment ,Antineoplastic Agents ,Breast Neoplasms ,Buserelin ,Gonadotropin-Releasing Hormone ,Drug Therapy ,SDG 3 - Good Health and Well-being ,Neoplasms ,Internal medicine ,medicine ,Humans ,Neoplasm Metastasis ,Hormone-Dependent ,Randomized Controlled Trials as Topic ,Hormonal ,business.industry ,Standard treatment ,Goserelin ,Oophorectomy ,Cancer ,Antiestrogen ,medicine.disease ,Survival Analysis ,Drug Therapy, Combination ,Female ,Premenopause ,Tamoxifen ,Endocrinology ,Combination ,business ,hormones, hormone substitutes, and hormone antagonists ,medicine.drug - Abstract
PURPOSE: The logic behind the application of luteinizing hormone-releasing hormone (LHRH) agonists in combination with tamoxifen in premenopausal women is that LHRH agonists on the one hand suppress the tamoxifen-induced stimulation of the pituitary-ovarian function and, on the other hand, seem as effective as surgical castration. This meta-analysis combines all randomized evidence to compare the combined treatment with LHRH agonist alone with respect to overall survival, progression-free survival, and objective response in premenopausal women with advanced breast cancer. PATIENTS AND METHODS: Four clinical trials randomizing a total of 506 premenopausal women with advanced breast cancer to LHRH agonist alone or to the combined treatment of LHRH agonist plus tamoxifen were identified. Meta-analytic techniques were used to analyze individual patient data from these trials. RESULTS: With a median follow-up of 6.8 years, there was a significant survival benefit (stratified log-rank test, P = .02; hazards ratio [HR] = 0.78) and progression-free survival benefit (stratified log-rank test, P = .0003; HR = 0.70) in favor of the combined treatment. The overall response rate was significantly higher on combined endocrine treatment (stratified Mantel Haenszel test, P = .03; odds ratio = 0.67). CONCLUSION: The combination of LHRH agonist plus tamoxifen is superior to LHRH agonist alone in premenopausal women with advanced breast cancer. Therefore, if a premenopausal woman with advanced breast cancer is thought to be suitable for endocrine treatment, it is proposed that the combination of a LHRH agonist plus tamoxifen be considered as the new standard treatment.
- Published
- 2001