AIs and chemical ovarian ablation?
Meet the Experts
Hope S. Rugo, M.D. is a clinical professor of medicine in the division of hematology and oncology at the University of California San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center, where she directs the Breast Oncology Clinical Trials Program.
Jennifer Armstrong, M.D. is a breast cancer oncologist at Paoli Hematology-Oncology Associates in Paoli, Pa., with a special interest in physicians' communication skills.
Question from Jastafford: Can you talk about the use of aromatase inhibitors in premenopausal women who have received chemical ovarian ablation?
- Answers —Hope Rugo, M.D.: There are two settings where this could be discussed and considered for treatment - one is for the treatment of metastatic breast cancer and there have been data published that suggest if patients receive chemical ovarian ablation (ovary shutdown) and truly have suppression of estrogen production, that aromatase inhibitors can be very effective. In premenopausal women who have early stage breast cancer, this is a research question.
There are three large international trials looking at ovarian suppression with either tamoxifen or an aromatase inhibitor or in one trial, tamoxifen alone. At the moment, the standard of treatment in terms of hormone therapy for premenopausal women with early stage breast cancer is tamoxifen. However, these trials are very important and will help us answer the question about how much additional benefit might be gained when ovarian suppression is added to standard chemotherapy and hormone therapy.
There is a trial ongoing in Austria that is looking at ovarian suppression for three years with either an aromatase inhibitor or tamoxifen. They're also following bone density to look for osteoporosis. They have already shown that ovarian suppression with either tamoxifen or an aromatase inhibitor causes significant loss of bone mineral density. However, this can be prevented with the use of the bisphosphonates or medication that helps to preserve bone density. For an individual woman who is on ovarian suppression, the choice of tamoxifen or an aromatase inhibitor should be made in discussion with her oncologist.
It is very important that ovarian suppression is confirmed by serial testing of the blood for estrogen as, in particular for young women, even monthly injections may fail to sufficiently suppress the ovaries or it may take more time than expected to suppress the ovaries. - Jennifer Armstrong, M.D.: I just want to review some of the terminology we're discussing. As Dr. Rugo just elegantly described, premenopausal women with hormone receptor positive breast cancer are candidates for one type of hormonal therapy now, and that is tamoxifen. Postmenopausal women with hormone receptor positive breast cancer can benefit from several different types of hormonal therapy which includes either tamoxifen or aromatase inhibitors.
There are ongoing investigations to see if premenopausal women are made postmenopausal by suppressing their ovarian function, whether these women receive similar benefit with aromatase inhibitors as women who have gone through menopause naturally. This is what is called “chemical ovarian ablation.”
On Wednesday, June 15, 2005 our Ask-the-Expert Online Conference was called Updates from the 2005 ASCO Annual Meeting. Hope Rugo, M.D. and moderator Jennifer Armstrong, M.D. answered your questions on the latest research advances presented at the 2005 American Society of Clinical Oncology meeting in Orlando, FL.
The materials presented in these conferences do not necessarily reflect the views of breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.
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