Long-term results of International Breast Cancer Study Group Trial Viii: Adjuvant chemotherapy plus goserelin compared with either therapy alone for premenopausal patients with node-negative breast cancer

P. Karlsson, Z. Sun, D. Braun, K. N. Price, M. Castiglione-gertsch, M. Rabaglio, R. D. Gelber, D. Crivellari, J. Collins, E. Murray, K. Zaman, M. Colleoni, B. A. Gusterson, G. Viale, M. M. Regan, A. S. Coates, A. Goldhirsch

Research output: Contribution to journalArticle

Abstract

Background: The International Breast Cancer Study Group Trial VIII compared long-term efficacy of endocrine therapy (goserelin), chemotherapy [cyclophosphamide, methotrexate and fluorouracil (CMF)], and chemoendocrine therapy (CMF followed by goserelin) for pre/perimenopausal women with lymph-node-negative breast cancer. Patients and methods: From 1990 to 1999, 1063 patients were randomized to receive (i) goserelin for 24 months (n = 346), (ii) six courses of 'classical' CMF (cyclophosphamide, methotrexate, 5-fluorouracil) chemotherapy (n = 360), or (iii) six courses of CMF plus 18 months goserelin (CMF→ goserelin; n = 357). Tumors were classified as estrogen receptor (ER) negative (19%), ER positive (80%), or ER unknown (1%); 19% of patients were younger than 40. Median follow-up was 12.1 years. Results: For the ER-positive cohort, sequential therapy provided a statistically significant benefit in disease-free survival (DFS) (12-year DFS = 77%) compared with CMF alone (69%) and goserelin alone (68%) (P = 0.04 for each comparison), due largely to the effect in younger patients. Patients with ER-negative tumors whose treatment included CMF had similar DFS (12-year DFS CMF = 67%; 12-year DFS CMF→ goserelin = 69%) compared with goserelin alone (12-year DFS = 61%, P= NS). Conclusions: For pre/perimenopausal women with lymph-node-negative ER-positive breast cancer, CMF followed by goserelin improved DFS in comparison with either modality alone. The improvement was the most pronounced in those aged below 40, suggesting an endocrine effect of prolonged CMF-induced amenorrhea.

Original languageEnglish
Pages (from-to)2216-2226
Number of pages11
JournalAnnals of Oncology
Volume22
Issue number10
DOIs
Publication statusPublished - Oct 2011

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Goserelin
Adjuvant Chemotherapy
Methotrexate
Fluorouracil
Cyclophosphamide
Breast Neoplasms
Disease-Free Survival
Estrogen Receptors
Therapeutics
Lymph Nodes
Drug Therapy
Estrogen Receptor alpha
Amenorrhea
Neoplasms

Keywords

  • Amenorrhea
  • Breast cancer
  • Chemotherapy
  • Goserelin
  • Hormonal therapy
  • Node negative

ASJC Scopus subject areas

  • Oncology
  • Hematology

Cite this

Long-term results of International Breast Cancer Study Group Trial Viii : Adjuvant chemotherapy plus goserelin compared with either therapy alone for premenopausal patients with node-negative breast cancer. / Karlsson, P.; Sun, Z.; Braun, D.; Price, K. N.; Castiglione-gertsch, M.; Rabaglio, M.; Gelber, R. D.; Crivellari, D.; Collins, J.; Murray, E.; Zaman, K.; Colleoni, M.; Gusterson, B. A.; Viale, G.; Regan, M. M.; Coates, A. S.; Goldhirsch, A.

In: Annals of Oncology, Vol. 22, No. 10, 10.2011, p. 2216-2226.

Research output: Contribution to journalArticle

Karlsson, P, Sun, Z, Braun, D, Price, KN, Castiglione-gertsch, M, Rabaglio, M, Gelber, RD, Crivellari, D, Collins, J, Murray, E, Zaman, K, Colleoni, M, Gusterson, BA, Viale, G, Regan, MM, Coates, AS & Goldhirsch, A 2011, 'Long-term results of International Breast Cancer Study Group Trial Viii: Adjuvant chemotherapy plus goserelin compared with either therapy alone for premenopausal patients with node-negative breast cancer', Annals of Oncology, vol. 22, no. 10, pp. 2216-2226. https://doi.org/10.1093/annonc/mdq735
Karlsson, P. ; Sun, Z. ; Braun, D. ; Price, K. N. ; Castiglione-gertsch, M. ; Rabaglio, M. ; Gelber, R. D. ; Crivellari, D. ; Collins, J. ; Murray, E. ; Zaman, K. ; Colleoni, M. ; Gusterson, B. A. ; Viale, G. ; Regan, M. M. ; Coates, A. S. ; Goldhirsch, A. / Long-term results of International Breast Cancer Study Group Trial Viii : Adjuvant chemotherapy plus goserelin compared with either therapy alone for premenopausal patients with node-negative breast cancer. In: Annals of Oncology. 2011 ; Vol. 22, No. 10. pp. 2216-2226.
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title = "Long-term results of International Breast Cancer Study Group Trial Viii: Adjuvant chemotherapy plus goserelin compared with either therapy alone for premenopausal patients with node-negative breast cancer",
abstract = "Background: The International Breast Cancer Study Group Trial VIII compared long-term efficacy of endocrine therapy (goserelin), chemotherapy [cyclophosphamide, methotrexate and fluorouracil (CMF)], and chemoendocrine therapy (CMF followed by goserelin) for pre/perimenopausal women with lymph-node-negative breast cancer. Patients and methods: From 1990 to 1999, 1063 patients were randomized to receive (i) goserelin for 24 months (n = 346), (ii) six courses of 'classical' CMF (cyclophosphamide, methotrexate, 5-fluorouracil) chemotherapy (n = 360), or (iii) six courses of CMF plus 18 months goserelin (CMF→ goserelin; n = 357). Tumors were classified as estrogen receptor (ER) negative (19{\%}), ER positive (80{\%}), or ER unknown (1{\%}); 19{\%} of patients were younger than 40. Median follow-up was 12.1 years. Results: For the ER-positive cohort, sequential therapy provided a statistically significant benefit in disease-free survival (DFS) (12-year DFS = 77{\%}) compared with CMF alone (69{\%}) and goserelin alone (68{\%}) (P = 0.04 for each comparison), due largely to the effect in younger patients. Patients with ER-negative tumors whose treatment included CMF had similar DFS (12-year DFS CMF = 67{\%}; 12-year DFS CMF→ goserelin = 69{\%}) compared with goserelin alone (12-year DFS = 61{\%}, P= NS). Conclusions: For pre/perimenopausal women with lymph-node-negative ER-positive breast cancer, CMF followed by goserelin improved DFS in comparison with either modality alone. The improvement was the most pronounced in those aged below 40, suggesting an endocrine effect of prolonged CMF-induced amenorrhea.",
keywords = "Amenorrhea, Breast cancer, Chemotherapy, Goserelin, Hormonal therapy, Node negative",
author = "P. Karlsson and Z. Sun and D. Braun and Price, {K. N.} and M. Castiglione-gertsch and M. Rabaglio and Gelber, {R. D.} and D. Crivellari and J. Collins and E. Murray and K. Zaman and M. Colleoni and Gusterson, {B. A.} and G. Viale and Regan, {M. M.} and Coates, {A. S.} and A. Goldhirsch",
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T1 - Long-term results of International Breast Cancer Study Group Trial Viii

T2 - Adjuvant chemotherapy plus goserelin compared with either therapy alone for premenopausal patients with node-negative breast cancer

AU - Karlsson, P.

AU - Sun, Z.

AU - Braun, D.

AU - Price, K. N.

AU - Castiglione-gertsch, M.

AU - Rabaglio, M.

AU - Gelber, R. D.

AU - Crivellari, D.

AU - Collins, J.

AU - Murray, E.

AU - Zaman, K.

AU - Colleoni, M.

AU - Gusterson, B. A.

AU - Viale, G.

AU - Regan, M. M.

AU - Coates, A. S.

AU - Goldhirsch, A.

PY - 2011/10

Y1 - 2011/10

N2 - Background: The International Breast Cancer Study Group Trial VIII compared long-term efficacy of endocrine therapy (goserelin), chemotherapy [cyclophosphamide, methotrexate and fluorouracil (CMF)], and chemoendocrine therapy (CMF followed by goserelin) for pre/perimenopausal women with lymph-node-negative breast cancer. Patients and methods: From 1990 to 1999, 1063 patients were randomized to receive (i) goserelin for 24 months (n = 346), (ii) six courses of 'classical' CMF (cyclophosphamide, methotrexate, 5-fluorouracil) chemotherapy (n = 360), or (iii) six courses of CMF plus 18 months goserelin (CMF→ goserelin; n = 357). Tumors were classified as estrogen receptor (ER) negative (19%), ER positive (80%), or ER unknown (1%); 19% of patients were younger than 40. Median follow-up was 12.1 years. Results: For the ER-positive cohort, sequential therapy provided a statistically significant benefit in disease-free survival (DFS) (12-year DFS = 77%) compared with CMF alone (69%) and goserelin alone (68%) (P = 0.04 for each comparison), due largely to the effect in younger patients. Patients with ER-negative tumors whose treatment included CMF had similar DFS (12-year DFS CMF = 67%; 12-year DFS CMF→ goserelin = 69%) compared with goserelin alone (12-year DFS = 61%, P= NS). Conclusions: For pre/perimenopausal women with lymph-node-negative ER-positive breast cancer, CMF followed by goserelin improved DFS in comparison with either modality alone. The improvement was the most pronounced in those aged below 40, suggesting an endocrine effect of prolonged CMF-induced amenorrhea.

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KW - Amenorrhea

KW - Breast cancer

KW - Chemotherapy

KW - Goserelin

KW - Hormonal therapy

KW - Node negative

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