What is the role of endocrine therapy in the treatment of premenopausal women with stage IV breast cancer?

Updated: Apr 23, 2020
  • Author: Joseph A Sparano, MD; Chief Editor: John V Kiluk, MD, FACS  more...
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Answer

Answer

Recommended treatment is ovarian suppression plus endocrine therapy with tamoxifen or an AI. Gonadotropin-releasing hormone (GRH) analogues may be used to suppress ovarian estrogen production (as in the following regimens):

  • Goserelin 3.6 mg SC depot every 4 wk or

  • Leuprolide 7.5 mg IM depot every 4 wk or 22.5 mg IM every 3 mo or 30 mg IM every 4 mo

Treatment considerations are as follows:

  • Exercise caution when using GRH analogues in combination with AIs because of inconsistent inhibition of estrogen production.

  • Oophorectomy is preferred because it induces permanent menopause and obviates repeated injections.

  • Tamoxifen or AIs are used in the same doses and schedules commonly employed for adjuvant therapy.

  • Selected patients who have had prolonged response or periods of stability on AIs may be switched to one of the following: progestational agents (megestrol acetate 40 mg PO QID) or  androgens (fluoxymesterone 10-40 mg PO in divided doses) or  estradiol (10 mg PO TID).

  • In patients whose menopausal status is uncertain (eg, because of hysterectomy or chemotherapy-induced amenorrhea), confirmation of menopausal status may require documentation of an elevated serum follicle-stimulating hormone (FSH) level and a low estradiol level.


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