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Annals of Oncology 1:183-188, 1990
© 1990 European Society for Medical Oncology

research-article

The magnitude of endocrine effects of adjuvant chemotherapy for premenopausal breast cancer patients

A. Goldhirsch, R. D. Gelber and M. Castiglione

for the International Breast Cancer Study Group (see Appendix for Participants and Authors)

Correspondence to: Aron Goldhirsch, M.D. International Breast Cancer Study Group Konsumstrasse 13 3007 Bern, Switzerland

We analysed the incidence of amenorrhoea and its association with outcome in a cohort of 1127 premenopausal women with breast cancer randomized to International Trial V (formerly Ludwig V). For 552 patients without axillary lymph node involvement, one course of perioperative cytotoxic drugs was compared with no-adjuvant chemotherapy. For 575 patients with node-positive disease, a single course of cytotoxic chemotherapy was compared with a prolonged treatment (6 or 7 courses). Amenorrhoea was defined as having no menstrual bleeding for a 3-month interval within the first 9 months after surgery. Amenorrhoea was observed in21% of the 199 patients with node-negative breast cancer who received no adjuvant therapy, 31% of the 353 node-negative patients who had a single course of cytotoxic therapy, 31% of the 188 patients with node-positive disease who had the same short-duration therapy, and 68% of the 387 node-positive patients who had a prolonged adjuvant therapy. Amenorrhoea was associated with an increased disease-free survival (DFS) only in the patients with prolonged cytotoxic therapy: 4-year DFS % (± s.e.) was 68% ± 3% vs. 61% ± 5% for the amenorrhoea and the no-amenorrhoea groups, respectively, (p = 0.05). In contrast, the comparison between prolonged therapy and one single course among node-positive patients showed a much larger treatment effect (4-year DFS 66% vs. 38%, p < 0.0001). We conclude that although cytotoxics-induced amenorrhoea is associated with a better outcome, it is unlikely that this form of endocrine manipulation is the main mechanism of response to adjuvant systemic chemotherapy.

breast cancer, adjuvant chemotherapy, endocrine mechanism, cytotoxics-induced amenorrhoea, oophorectomy, perioperative therapy, node-negative, node-positive, premenopausal


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