Recently, the optimal management of endocrine-responsive therapy early breast cancer in premenopausal women is controversial remains. Numerous benefits came from aromatase inhibitors beyond those of tamoxifen in postmenopausal women, but in premenopausal women their benefits among whom endocrine-responsive disease accounts for 62% of early breast cancers are unknown. It is still a combination of ovarian suppression with the use of gonadotropin-releasing hormone analogues and tamoxifen had been used as standard care for premenopausal women due to its effectiveness in establishing cytotoxic chemotherapy regiments and is better tolerated than chemotherapy.
Here, the experts examined the effect of adding zoledronic acid to a combination of goserelin and tamoxifen or goserelin and anastrozole in premenopausal women with endocrine-responsive early breast cancer. The aim was disease-free survival, recurrence-free survival and overall survival were secondary end point.
Many retrospective studies involving premenopausal women with advanced breast cancer, the combination of ovarian suppression and an aromatase inhibitor reduced circulating estrogen levels by an additional 76% as compared with ovarian suppression plus tamoxifen. Thus, it could increase treatment’s efficacy and aromatase inhibitors could be under investigation as alternatives to tamoxifen in premenopausal women with early breast cancer.
Zoledronic acid prevents bone loss associated with aromatase inhibitors in postmenopausal women with early breast cancer as stated that preclinical data suggest that zoledronic acid has antitumor and antimetastatic properties. It also has the inhibition of angiogenesis, tumor-cell invasion, the induction of apoptosis, antitumor synergy with cytotoxic chemotherapy, and immunomodulatory effects through induction of tetta or gamma T cells.
As the results of the experiment that describe in the article, it showed that the treatment with anastrozole and with tamoxifen were associated with similar rates of disease-free survival. The rate of this disease-free survival increased in addition of zoledronic acid to adjuvant endocrine therapy as compared with endocrine therapy alone.
The authors said that in patients who were receiving adjuvant therapy, zoledronic acid with 4 mg every 6 months prevented bone loss caused by aromatase inhibitors as early several studies stated a reduced incidence of micrometastases in the bone marrow of patients with breast cancer who have received zoledronic acid. If taken together, it siggest that zoledronic acid may asses antitumor effect both in and outside of bones.
Now it is believed that premenopausal women with endocrine-responsive early breast cancer, goserelin plus anastrazole yielded clinical results that were similar to those with goserelin plus tamoxifen, and the administered of zoledronic acid to endocrine therapy significantly improved disease-free survival.
This medical journal is authorized by Michael Gnant, M.D., Brigitte Mlineritsch, M.D., Walter Schippinger, M.D., Gero Luschin-Ebengreuth, M.D., Sabine Pöstlberger, M.D., Christian Menzel, M.D., Raimund Jakesz, M.D., Michael Seifert, M.D., Michael Hubalek, M.D., Vesna Bjelic-Radisic, M.D., Hellmut Samonigg, M.D., Christoph Tausch, M.D., Holger Eidtmann, M.D., Günther Steger, M.D., Werner Kwasny, M.D., Peter Dubsky, M.D., Michael Fridrik, M.D., Florian Fitzal, M.D., Michael Stierer, M.D., Ernst Rücklinger, Ph.D., Richard Greil, M.D., for the ABCSG-12 Trial Investigators.
As i found this article in New England Medical Journal Volume 360:679-691, you can fully read the report in a Full Text Article or PDF Format.
