13th Asia-Pacific Oncologists Annual Meeting
Khulna Medical College and Hospital, Bangladesh
Title: Luteal versus folicular phase surgical oophorectomy plus tamoxifen in premenopausal women with metastatic hormone receptor-positive breast cancer
Biography: Syed Mozammel Hossain
In premenopausal women with metastatic hormone receptor-positive breast cancer, hormonal therapy is the first-line therapy. Gonadotropin-releasing hormone analogue+tamoxifen therapies have been found to be more effective. The pattern of recurrence risk over time after primary surgery suggests that peri-operative factors impact recurrence. Secondary analyses of an adjuvant trial suggested that the luteal phase timing of surgical oophorectomy in the menstrual cycle simultaneous with primary breast surgery favourably influenced long-term outcomes. 249 premenopausal women with incurable or metastatic hormone receptor-positive breast cancer entered a trial in which they were randomised to historical mid-luteal or mid-follicular phase surgical oophorectomy followed by oral tamoxifen treatment. Kaplane Meier methods, the log-rank test and multivariable cox regression models were used to assess overall and progression-free survival (PFS) in the two randomised groups and by hormone-confirmed menstrual cycle phase. Overall survival (OS) and PFS were not demonstrated to be different in the two ran- domised groups. In a secondary analysis, OS appeared worse in luteal phase surgery patients with progesterone levels <2 ng/ml (anovulatory patients; adjusted hazard ratio 1.46, 95% confidence interval [CI]: 0.89-2.41, p=0.14) compared with those in luteal phase with progesterone level of 2 ng/ml or higher. Median OS was two years (95% CI: 1.7e2.3) and OS at four years was 26%. The history-based timing of surgical oophorectomy in the menstrual cycle did not influence outcomes in this trial of metastatic patients.