Focus on domestic and foreign guidelines/consensus, explore the best course of OFS treatment

*For medical professionals for reading reference

The standard treatment for GNRHA auxiliary endocrine therapy should be 5 years.

Endocrine therapy occupies an irreplaceable position in the treatment of pre -menopausal breast cancer treatment. With the continuous deepening of research, selective estrogen receptor regulators (SERM) ushered in the status of early breast cancer treatment cornerstone. Enzyme inhibitors (AI) gradually reflect their advantages, and the status of ovarian functional suppression (OFS) in patients with breast cancer in the early days of menopause is increasingly significant. Not only that, based on the emergence of new evidence -based evidence, the endocrine therapy strategy of combined with OFS has become an important trend in the field of early breast cancer treatment in predecessor. The following series of issues such as OFS and selection, the best time to benefit the people, the best time to benefit the people, the best time and the best course of the drug OFS have also received more attention from scholars. This Weite discussed the best course of OFS for exchanges and studies for the major scholars.

OFS's action mechanism

Before menopause, gonadotrophoplasm release hormones (GNRH), gonadotropin hormone (GNRH), combined with the corresponding receptor on the pituitary cell membrane, so that the pituitary formation (LH) and follicle stimulus (FolLLICLICE-Stimulating Hormone ( FSH), which acts on the ovarian and releases estrogen, and estrogen can promote the growth of breast tumors [10-11]. OFS refers to inhibiting ovarian estrogen through surgery, radiotherapy or drugs. Commonly used drugs are Gonadotropin Release Hormone Agonist (GNRHA). GNRHA is common in Gosherin, Toperin and Liang Bingrein. GNRHA has continuously stimulated the pituitary gland to inhibit the secretion of the pituitary secretion LH and FSH, and the secretion of estrogen is down to achieve the purpose of lowering the estrogen level [1,2].

OFS method and choice

The OFS method mainly includes bilateral ovarian surgery, ovarian radiotherapy, and drug trends.

Surgical trend includes traditional surgical resection and laparoscopic surgical resection, which is creative and irreversible. Although ovarian dehumidation can rapidly reduce the concentration of serum estradiol (E2), patients also permanently lose their ovaries.

Related ovarian radiotherapy shows that 20%to 30%of patients cannot successfully achieve the effect of ovarian momentum after radiotherapy, and the level of deduction of estrogen decline is significantly worse than ovarian resection, so clinical use is limited.

Destroyer GNRHA can inhibit the level of estrogen in serum, and its degree of inhibition is similar to surgery. Intergroup studies conducted in patients with positive metastatic breast cancer patients with hormone receptors show that Gosherelin's objective and efficient treatment of breast cancer treatment is equivalent to surgery, and the safety and tolerance of patients with Gosherein patients are good [3].

2021OFS Consensus: GNRHA can quickly reduce the level of female serum estrogen, reach a postmenopausal state, and the effect after stopping the drug. Because ovarian function inhibitors have now entered medical insurance, considering the creativeness and irreversibility of surgery, and limited radiotherapy effects, it is recommended to use gnrha as the first choice for pre -menstrual hormone receptor -positive breast cancer OFS.

GNRHA best treatment

1. GNRHA's standard treatment

Regarding the best course of GNRHA in the treatment of pre -menopamental breast cancer treatment, there is no clear theory at present because there is no comparative study of different treatment courses of GNRHA. The previous important clinical study of GNRHA for the treatment of pre-menopamental breast cancer has been used for 2, 3 or 5 years of OFS treatment. For example, GNRHA's treatment in ZIPP Study [4] is 2 years, ABCSG-12 Study [5] GnRha The course of treatment is 3 years, and the GNRHA treatment in Soft and Text [6] is 5 years. The above treatments have confirmed the good security and tolerance of GNRHA.

Soft research [7] shows that the 5 -year DFS, breast cancer survival rate and OS of the Gnrha with his Moqifen group reached 86.6%, 88.4%, and 96.7%, respectively. 83.2%, 89.4%and 93.3%.

The results of HOBOE-2 Study [8] show that 5 years of azolic acid combined with aromatic enzyme inhibitors and OFS, 5-year aromatase inhibitors combined with OFS, and 5 years of 5 years of his Modifen combined with OFS. 93.3%, 93.2%and 85.4%.

CDK4/6 inhibitors In the early HR-positive high-risk breast cancer patients (including pre-menopause and after menopause), Monarche Studies [9], Pallas Studies [10] and Penelope-B Study [11] selected standard endocrine therapy control group The length of treatment is at least 5 years.

"Early breast cancer ovarian function inhibits clinical application expert consensus (2021)" [12]: Because there is no comparative study of different treatment courses of GNRHA, the concept of extension of endocrine therapy and long -term follow -up results of SOFT/Text tests are recommended The standard treatment of GNRHA is 5 years.

2. Patients who have been treated for 5 years of OFS standard treatment for the subsequent extension of GNRHA, and lack of subsequent research on the treatment of extended treatment.

A figurine analysis published by NEJM in 2017 [13] was included in 88 tests, a total of 62923 women with ER -positive breast cancer. The evaluation received 5 years of setting endocrine therapy, and the absolute risk of follow -up in the distance to determine whether it was extended. Among them, about 46%of patients <55 years old, and about 54%of patients with age ≥55 years old. The 20 -year -old recurrence risk of patients with T1N0 is 13%, and the risk of 20 years of T2N2 patients is as high as 41%. The risk of recurrence in the distance continues to exist, and extending endocrine therapy is imperative.

Third, guide recommendation

In 2015, "ESMO Primary Breast Cancer Diagnosis, Treatment and follow -up clinical practice guidelines" [14] and "China Anti -Cancer Association Breast Cancer Diagnosis and Treatment Guide and Specification (2021)" [15] GNRHA treatment is 2 ~ 5 years Essence In 2021, St.Gallen expert consensus [16], 2016 ASCO's guideline update [17], and 2020 BCY4 guide [18] recommended treatment for 5 years.

"2021OFS Consensus" [12] pointed out that the standard treatment for GNRHA auxiliary endocrine therapy should be 5 years. After completing the five -year endocrine therapy of OFS, if you have not menopause and good tolerance, it is recommended to continue the 5 -year endocrine therapy or 5 -year SERM treatment for 5 years. Patients with low -risk selection of OFS for chemotherapy can consider OFS combined with endocrine therapy for 2 years.

"China Clinical Oncology Society (CSCO) Breast Cancer Diagnosis and Treatment Guidelines (2022 Edition)" [19] pointed out: For patients with HR positive pre -breast cancer, patients with 4 or more lymph nodes recommend OFS+AI 5 years or OFS +TAM 5 years or tam. Those who meet the following risk factors: 1.G2 or G3; 2. 1-3 positive lymph nodes; 3.T ＞ 2cm patients, recommend OFS+TAM 5 years or OFS+AI 5 years or TAM. And in 2022, the CSCO guide For those who have been treated with OFS+AI for the initial five years of the treatment and good tolerance, it is recommended to use SERM 5 years or OFS+AI 5 years.

OFS treatment best treatment summary

In summary, the standard treatment for GNRHA auxiliary endocrine therapy should be 5 years. After completing endocrine therapy for 5 years, if the patient is not menopause and has good tolerance, it is recommended to continue endocrine therapy for 5 years or 5 -year SERM therapy.

Expert Introduction

Deng Rong

The Breast Center of Jiangsu Cancer Hospital, deputy chief physician

Assistant Director of General Surgery

Standing Committee of the Chinese Society of Elderly and Elderly Medical Society

Member of the Breast Science Group of the Micro -Unsecured Medicine Commission of the Chinese Medical Association

Member of the China Anti -Cancer Association Rehabilitation Association

Youth Member of the Cancer Rehabilitation Branch of Chinese Elderly and Senior Medical Society

Youth Member of the Nail Milk Branch of the China Anti -Cancer Association Rehabilitation Association

Member of the Breast Surgery Group of the Jiangsu Medical Association Surgeon Branch

Secretary of the Surgery Group of the Breast Cancer Quality Control Specialist Committee of Jiangsu Cancer Professional Quality Control Center

Good at good (mammary cancer improvement treatment and first/second phase reconstruction, breast cancer preservation, laparoscopy and other surgery, breast cancer systemic treatment, etc.)

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Approval number CN-98044

Expired Date 2023-6-17

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