There is increasing use of luteinising
hormone-releasing
hormone (
LHRH) agonists in the adjuvant treatment of
breast cancer (J. Clin. Oncol. 19(2) (2001) 343). However, few mature studies are available and there is uncertainty regarding the optimal use of these agents. We performed a systematic review to address the role of
LHRH agonists in the adjuvant treatment of pre-menopausal women with early
breast cancer. As ovarian suppression is unlikely to benefit women with ER-negative tumours, the review is limited to women with ER-positive disease. The objectives of this review were to address the following issues; the role of
LHRH agonists compared to
tamoxifen (TAM),
LHRH agonists in place of
chemotherapy and
LHRH agonists integrated into chemo-hormonal regimens. We identified 11 randomised trials. In three trials, adjuvant suppression of ovarian function using
LHRH agonists, with or without TAM, had similar benefits at 5-6 years follow-up in terms of disease-free survival (DFS) and overall survival (OS) to adjuvant CMF
chemotherapy (J. Clin. Oncol 20(24) (2002) 4628; J. Natl.
Cancer Inst. 95(24) (2003) 1833; Anticancer Res. 22 (2002) 2325; In: San Antonio
Breast Cancer Symposium, San Antonio, TX, 2003, Abstr 40). These findings suggest that ovarian suppression using
LHRH agonists (+/-TAM) is a reasonable alternative to CMF
chemotherapy in women with oestrogen receptor (ER) positive tumours. The role of
chemotherapy in addition to
LHRH agonists is not clearly defined and mature results of four trials are awaited (J. Clin. Oncol. 20(24) (2002) 4621; J. Clin. Oncol. 18(14) (2000) 2718; Proc. Am. Soc. Clin. Oncol. 2000, Abstr 279; Proc. Am. Soc. Clin. Oncol. 20 (2001) Abstr 104; Proc. Am. Soc. Clin. Oncol. 2001, Abstr. 1777). Data is also inadequate at the time of publication to inform decisions about the efficacy of
LHRH agonists in comparison with TAM for the treatment of ER-positive early
breast cancer (Proc. Am. Soc. Clin. Oncol. 21 (2001) Abstr. 103; Eur. J. Surg. Oncol. 28(5) (2002) 505; Proc. Am. Soc. Clin. Oncol. 22 (2003), Abstr. 15).