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Although young women with newly diagnosed breast cancer are at increased risk of developing more aggressive tumour subtypes as compared with older patients, most of them are diagnosed with hormone receptor-positive (ie, luminal-like) disease.1 Hence, the majority of premenopausal women with early stage breast cancer are candidates to receive adjuvant endocrine therapy. Young age is considered a risk factor for breast cancer recurrence and death, particularly in women with luminal-like breast cancer.2 Hence, the choice of the most appropriate adjuvant endocrine therapy is of crucial importance particularly in premenopausal patients.
For more than two decades, tamoxifen alone has been considered the standard of care as adjuvant endocrine therapy for all premenopausal patients with hormone receptor-positive breast cancer.3 4 Nevertheless, in the last few years, the adjuvant endocrine treatment landscape of premenopausal patients with breast cancer has dramatically changed and the choice of the best approach to be used in this setting has become particularly complex. In fact, important new data on the role of ovarian function suppression (OFS) in addition to tamoxifen or its possible combination with an aromatase inhibitor (AI) have recently become available and should now be discussed with all premenopausal women candidates to receive adjuvant endocrine therapy.5
Two studies (the E-3193, INT-01426 trials and the Suppression of Ovarian Function Trial (SOFT)7 8) provided evidence on the role of OFS in addition to tamoxifen in these patients. In the E-3193, INT-0142 trial, 345 premenopausal women at low clinical risk of recurrence (use of chemotherapy was not allowed) were randomised to receive tamoxifen alone or tamoxifen plus OFS for 5 years.6 The SOFT randomly assigned 3066 premenopausal women to receive 5 years of tamoxifen alone, tamoxifen plus OFS or the AI exemestane plus OFS.7 8 In the primary analysis of the …
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