Winnie Yeo1, Takayuki Ueno2, Ching-Hung Lin3, Qiang Liu4, Kyung-Hun Lee5, Roland Leung6, Yoichi Naito7, Yeon Hee Park8, Seock-Ah Im5, Huiping Li9, Yoon Sim Yap10, Yen-Shen Lu11. 1. State Key Laboratory of Translational Oncology, Department of Clinical Oncology, Faculty of Medicine, Prince of Wales Hospital, Hong Kong Cancer Institute, Chinese University of Hong Kong, 30-32 Ngan Shing St., Shatin, NT, Hong Kong SAR, China. 2. Breast Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake Koto-ku, Tokyo, 135-8550, Japan. 3. Department of Oncology, National Taiwan University Hospital, 7 Chung-Shan South Rd., Taipei, 10016, Taiwan. 4. Breast Tumor Center, Sun-Yat Sen Memorial Hospital, Sun-Yat Sen University, 107 Yanjiang West Rd., Guangzhou, 510120, China. 5. Department of Internal Medicine, Cancer Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. 6. Division of Haematology, Medical Oncology and BMT, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Rd., Hong Kong SAR, China. 7. Department of Breast and Medical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan. 8. Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, 81 Irwon-ro, Seoul, 06351, Republic of Korea. 9. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, 52 Fucheng Rd., Beijing, 100142, China. 10. Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore. 11. Department of Oncology, National Taiwan University Hospital, 7 Chung-Shan South Rd., Taipei, 10016, Taiwan. yslu@ntu.edu.tw.
Abstract
PURPOSE: Breast cancer in young Asian women has distinctive clinicopathological characteristics; hence, we question the universal generalizability of treatment recommendations based on data from predominantly non-Asian postmenopausal women. METHODS: The Asian Breast Cancer Cooperative Group (ABCCG) reviewed current ESO-ESMO and St. Gallen recommendations for treating hormone receptor positive/human epidermal growth factor receptor 2 negative (HR+/HER2-) breast cancer in premenopausal women. Points disputed by ≥ 3/12 members were discussed, and statements on contentious issues formulated for anonymous voting; consensus required a ≥ 75% majority. RESULTS: The ABCCG contends that: (1) Trials in premenopausal women are not only necessary, but also worthwhile if performed separately from others that also enroll postmenopausal participants. (2) Not all premenopausal women with HR+ early breast cancer need adjuvant ovarian function suppression (OFS). (3) Certain clinical factors might influence decision-making about prescribing OFS. (4) For early HR+/HER2- breast cancer in premenopausal patients with OFS, tamoxifen is preferred for intermediate-risk cases; for high risk, near-consensus supported aromatase inhibitor, despite no clear overall survival benefit versus tamoxifen. (5) Oncotype DX Breast Recurrence Score® has different treatment implications in patients aged ≤ 50 versus > 50 years. (6) High-risk patients (if premenopausal after chemotherapy) should receive adjuvant chemotherapy and OFS plus aromatase inhibitor. (7) For patients with advanced disease receiving OFS on a backbone of tamoxifen, gonadotrophin-releasing hormone agonists may be given 12-weekly. (8) For premenopausal women who decline OFS or oophorectomy, tamoxifen alone is still an option but is considered less effective; other monotherapies are also less effective than OFS plus such treatments. CONCLUSION: Premenopausal Asian women with breast cancer have unique disease characteristics and may benefit from treatment that differs somewhat from international guidelines. Given the great diversity of patients and clinical settings worldwide, the ABCCG advocates evidence-based yet flexible and individualized use of all potential options to improve breast cancer outcomes.
PURPOSE:Breast cancer in young Asian women has distinctive clinicopathological characteristics; hence, we question the universal generalizability of treatment recommendations based on data from predominantly non-Asian postmenopausal women. METHODS: The Asian Breast Cancer Cooperative Group (ABCCG) reviewed current ESO-ESMO and St. Gallen recommendations for treating hormone receptor positive/human epidermal growth factor receptor 2 negative (HR+/HER2-) breast cancer in premenopausal women. Points disputed by ≥ 3/12 members were discussed, and statements on contentious issues formulated for anonymous voting; consensus required a ≥ 75% majority. RESULTS: The ABCCG contends that: (1) Trials in premenopausal women are not only necessary, but also worthwhile if performed separately from others that also enroll postmenopausal participants. (2) Not all premenopausal women with HR+ early breast cancer need adjuvant ovarian function suppression (OFS). (3) Certain clinical factors might influence decision-making about prescribing OFS. (4) For early HR+/HER2- breast cancer in premenopausal patients with OFS, tamoxifen is preferred for intermediate-risk cases; for high risk, near-consensus supported aromatase inhibitor, despite no clear overall survival benefit versus tamoxifen. (5) Oncotype DX Breast Recurrence Score® has different treatment implications in patients aged ≤ 50 versus > 50 years. (6) High-risk patients (if premenopausal after chemotherapy) should receive adjuvant chemotherapy and OFS plus aromatase inhibitor. (7) For patients with advanced disease receiving OFS on a backbone of tamoxifen, gonadotrophin-releasing hormone agonists may be given 12-weekly. (8) For premenopausal women who decline OFS or oophorectomy, tamoxifen alone is still an option but is considered less effective; other monotherapies are also less effective than OFS plus such treatments. CONCLUSION: Premenopausal Asian women with breast cancer have unique disease characteristics and may benefit from treatment that differs somewhat from international guidelines. Given the great diversity of patients and clinical settings worldwide, the ABCCG advocates evidence-based yet flexible and individualized use of all potential options to improve breast cancer outcomes.
Authors: Peh Joo Ho; Alex R Cook; Nur Khaliesah Binte Mohamed Ri; Jenny Liu; Jingmei Li; Mikael Hartman Journal: Cancer Med Date: 2020-02-13 Impact factor: 4.452
Authors: Jiyun Lee; Seock-Ah Im; Gun Min Kim; Kyung Hae Jung; Seok Yun Kang; In Hae Park; Jee Hyun Kim; Hee Kyung Ahn; Yeon Hee Park Journal: Cancer Res Treat Date: 2020-12-17 Impact factor: 4.679