The Year in Breast Cancer: The Top Five Under-appreciated Developments of 2008

Conleth Murphy, MD, and Andrew Seidman, MD
Published: Monday, Dec 29, 2008
2008 was a busy year in the field of breast cancer medicine, with thousands of abstracts presented at the ASCO, ASCO breast, and ESMO meetings and the San Antonio Breast Cancer Symposium in December, in addition to the many papers published over the course of the year (a PubMed search reveals that 5,252 papers published in the last year contained the words “breast cancer” in the title). Some of these developments rightly attracted considerable attention. Issues such as the potential impact of adjuvant bisphosphonates on breast cancer outcomes and the impact of the addition of bevacizumab to chemotherapy for metastatic disease garnered extensive coverage in both the oncology and the mainstream media. Yet, some stories, for one reason or another, passed under the radar and failed to get the attention they deserved. Perhaps they concerned the less glamorous topic of supportive medications rather than the “big-hitters,” the cytotoxics themselves. Perhaps they explored the schedule of treatment administration rather than novel treatment agents. Regardless, they contributed something to our knowledge of this disease. We have selected five of these developments that we think merit a closer look. Our criteria are simple: any story that potentially impacts our day-to-day practice, but which failed to make the news.

GnRH Analogues

The first story concerns the use of gonadotrophin releasing hormone (GnRH) analogues in premenopausal women to preserve fertility. Motivated by promising evidence from animal models, non-randomized studies have been performed and have suggested an improvement in fertility preservation for patients undergoing cytotoxic chemotherapy who received GnRH analogues throughout their treatment course. Consequently, the use of GnRH analogues has entered clinical practice, despite a lack of randomized clinical trial data to support their use. An abstract at this year’s ASCO meeting detailed the first prospective randomized trial to examine this issue. In the study, 49 pre-menopausal women receiving (neo)adjuvant chemotherapy for breast cancer were randomized to receive goserelin versus no goserelin. Patients were stratified by age, ER status, and treatment type. Menstrual status, FSH, and Inhibin levels were monitored every six months. One of the salient points of this trial was the high rate of recovery of menstrual function in both the goserelin and the control group: 88% and 84%, respectively, at 18 months. This is in keeping with a previous analysis reporting an 85% recovery of menstrual function among patients age 40 years and younger who were treated with adjuvant anthracycline and taxane. No significant difference between the groups was observed in the current study. The major limitation of this trial is its small sample size. Nevertheless, it raises concerns regarding the widespread adoption of GnRH analogues as a means of preserving ovarian function in the face of chemotherapy treatment in pre-menopausal women. Several larger phase III trials are accruing or have recently completed accrual (Sidebar). The emerging data from these trials will help to clarify the role of GnRH analogues in fertility preservation for young women with breast cancer.

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