Significance of Ovarian Function Suppression in Endocrine Therapy for Breast Cancer in Pre-Menopausal Women.

Abstract:

:Ovarian function suppression (OFS) for treating breast cancer in pre-menopausal women was introduced for the first time in the late 19th century as bilateral oophorectomy. It was not until the 1960s that the oestrogen receptor was identified and a test for detecting endocrine sensitivity of the breast cancer was developed. A weakness of early trials on OFS for breast cancer treatment is therefore their failure to take receptor sensitivity into account when selecting participants. A meta-analysis performed in the early 1990s first proved that adjuvant OFS significantly improved the cure rate of oestrogen receptor-positive breast cancer in pre-menopausal women regardless of whether it was carried out through oophorectomy, radiation-induced ablation or drug therapy. In the 1970s, tamoxifen was synthesized. It became one of the most important cancer drugs and today constitutes the gold standard for endocrine adjuvant therapy. Taking tamoxifen for a five-year period lowers mortality by 30 % over 15 years. Ten years of tamoxifen therapy reduces mortality even further, with increased side effects, however. Research over the past ten years has proven that for post-menopausal women, aromatase inhibitors have benefits over tamoxifen. Current trial results have rekindled the debate about the combination of OFS with tamoxifen or with aromatase inhibitors for adjuvant breast cancer treatment of pre-menopausal women. These trials have reported an improvement in disease-free survival in patients with a high risk of recurrence when they are treated with a combination of OFS plus tamoxifen or aromatase inhibitors, especially in women younger than 35. However, combination therapy causes significantly more side effects, which could negatively impact compliance. Endocrine treatments administered over a period of many years show waning compliance, which tends to be only around 50 % after five years. Inadequate compliance compromises efficacy and increases the risk of mortality. For this reason, when indicating and supporting endocrine adjuvant therapy, physicians must ensure that compliance will be good. To prevent recurrence in the long run, it is much more effective to prescribe a somewhat less effective therapy that will actually be carried out than to prescribe one that is theoretically more effective, but is not adhered to consistently. ZUSAMMENFASSUNG:Die Ovarialsuppression als Therapie des Mammakarzinoms der prämenopausalen Frau wurde erstmals Ende des 19. Jahrhunderts als bilaterale Ovarektomie durchgeführt. Erst in den 1960er-Jahren wurde der Östrogenrezeptor identifiziert und ein Test zum Nachweis der endokrinen Sensitivität des Mammakarzinoms entwickelt. Die frühen Studien zur OFS beim Mammakarzinom leiden daher darunter, dass keine Selektion nach Rezeptorpositivität des Tumors erfolgte. Erst eine Metaanalyse Anfang der 1990er-Jahre konnte nachweisen, dass die adjuvante Ovarialsuppression zu einer deutlichen Verbesserung der Heilungsrate des rezeptorpositiven Mammakarzinoms der prämenopausalen Frau führt, unabhängig davon, ob sie durch Ovarektomie, Radiokastration oder medikamentös erfolgt. In den 1970er-Jahren wurde Tamoxifen synthetisiert. Durch glückliche Zufälle wurde es zu einem der wichtigsten onkologischen Medikamente und ist heute der Goldstandard der endokrinen adjuvanten Therapie. Eine 5-jährige Einnahme senkt die Mortalität über 15 Jahre um 30 %; die 10-jährige Tamoxifentherapie ermöglicht eine zusätzliche Mortalitätssenkung allerdings bei Zunahme der Nebenwirkungen. Für postmenopausale Frauen wurde im letzten Jahrzehnt nachgewiesen, dass Aromatasehemmer gegenüber Tamoxifen Vorteile aufweisen. Aktuelle Studienergebnisse entfachten die Diskussion über die Kombination von Ovarialsuppression mit Tamoxifen oder mit Aromatasehemmern zur adjuvanten Therapie prämenopausaler Patientinnen neu. Sie hatten eine Verbesserung des krankheitsfreien Überlebens bei Patientinnen mit hohem Rezidivrisiko durch Kombination von Ovarialsuppression mit Tamoxifen oder Aromatasehemmern v. a. bei Frauen unter 35 Jahren gezeigt. Allerdings hat die Kombinationstherapie deutlich mehr Nebenwirkungen, was die Compliance negativ beeinflussen könnte. Die jahrelangen endokrinen Therapien leiden unter einer abnehmenden Compliance, die nach 5 Jahren in der Regel nur noch bei 50 % liegt. Eine unzureichende Compliance vermindert den Effekt und erhöht das Mortalitätsrisiko. Daher muss bei der Indikationsstellung und Begleitung der endokrinen adjuvanten Therapie auf eine gute Compliance geachtet werden. Eine tatsächlich durchgeführte Therapie, mit evtl. etwas geringerer Wirkung kann onkologisch sinnvoller sein als eine prinzipiell wirksamere Behandlung, die aber nicht konsequent durchgeführt wird.

authors

Scharl A,Salterberg A

doi

10.1055/s-0042-106389

subject

Has Abstract

pub_date

2016-05-01 00:00:00

pages

516-524

issue

5

eissn

0016-5751

issn

1438-8804

journal_volume

76

pub_type

杂志文章,评审
  • [Initial experiences with a levonorgestrel-ethinyl estradiol combination for interception].

    abstract::Several authors have reported on reliable postcoital contraception, using an estrogen/gestagen combination. These studies in more than a hundred women showed, that the unprotected intercourse in less than 50% took place around ovulation. Pregnancy rates from 0.7 to 2.6% were observed. From October 1987 to July 88, 50 ...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章

    doi:10.1055/s-2008-1036294

    authors: Fitz R,Grünberger W,Vytiska-Binstorfer E

    更新日期:1989-12-01 00:00:00

  • [The prognostic value of lymphangiosis carcinomatosa and malignancy grading in T1/T2-N0 cancers of the breast using 10 or fewer examined axillary lymph nodes].

    abstract::In 270 cases of T1 and T2 carcinomas of the breast with ten or less axillary lymph nodes having been examined, the prognostic relevance of the histopathological statement of nodal negativity was assessed in a retrospective study. In this collective study, the mean number of lymph nodes examined was 4.1 +/- 1.9 for the...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章

    doi:10.1055/s-2008-1035755

    authors: Stauch G,Szulfer CC,Hilfrich J,Georgii A

    更新日期:1989-03-01 00:00:00

  • [Histopathological findings in incidental appendectomies during gynecologic laparotomies and their significance for the patient].

    abstract::Incidental appendectomy is a more and more frequent part of gynaecological laparotomies. Doubts about the increased post-operative morbidity and mortality have been shown to be unfounded in numerous series. Opinions on contra-indications to incidental appendectomy are divided. German language authors do not do inciden...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章

    doi:10.1055/s-2008-1036892

    authors: von Rechenberg KN

    更新日期:1983-05-01 00:00:00

  • [Flow cytometry detected S-phase fraction and ploidy as prognostic parameters in primary, node-negative breast cancer].

    abstract::100 specimens of patients with primary node-negative breast cancer were examined by flow cytometry. 64 tumours were shown to be diploid and 36 tumours were aneuploid. The median was the cut-off level for tumours with low S-phase (< or = 10.9%) and high S-phase values (> 10.9%). Aneuploid tumours were associated with h...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章

    doi:10.1055/s-2007-1022842

    authors: Winter K,Eidtmann H,Jonat W

    更新日期:1994-05-01 00:00:00

  • [Hormonal contraception and substitution therapy: the importance of progestogen for cardiovascular diseases].

    abstract::Epidemiological data have demonstrated, that the progestogen component of oral contraceptives is involved in the development of hypertension, ischaemic heart diseases and stroke. It had been suggested, that atherosclerotic lesions due to the unfavourable effect on lipid metabolism of progestogens with androgenic prope...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章,评审

    doi:10.1055/s-2007-1026140

    authors: Kuhl H

    更新日期:1992-11-01 00:00:00

  • [Residual ovary syndrome--significance of medical therapy (author's transl)].

    abstract::Today, hysterectomy internationally is nearly as frequent as appendectomy. In approx. 1% of all hysterectomies (vaginal or abdominal) where one or both ovaries are left, the residual ovary syndrome is found after an average period of slightly over five years. Predominant symptoms are diffused abdominal pain and palpab...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章

    doi:10.1055/s-2008-1037016

    authors: Hauser GA

    更新日期:1980-01-01 00:00:00

  • Epidemiological Follow-up 15 Years after the Breast Cancer Scandal in Essen.

    abstract::Purpose: In the years 1993-1996 a number of presumably false-positive breast cancer diagnoses were made by a pathologist in Essen. A follow-up, undertaken 15 years later, investigated how many women had tumour recurrence and/or metastasis or had died from breast cancer. Material and Methods: A total of 151 (68 %) out ...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章

    doi:10.1055/s-0031-1298541

    authors: Hauth EA,Berkemeyer S,Jaeger H,Forsting M,Hoffmann B,Jöckel KH

    更新日期:2012-06-01 00:00:00

  • Twenty-five-year-old Woman with Bilateral Borderline Ovarian Tumour Desiring to Preserve Fertility - Case Report and Literature Review on the Current State of Fertility Preservation in Women with Borderline Ovarian Tumours.

    abstract::Borderline ovarian tumours are semimalignant tumours occurring unilaterally or bilaterally with a peak incidence among women of reproductive age. Since the affected women often wish to preserve fertility, particular precautions must be taken when counselling the patient and obtaining consent prior to planning an indiv...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章

    doi:10.1055/s-0042-109267

    authors: Findeklee S,Lotz L,Heusinger K,Hoffmann I,Dittrich R,Beckmann MW

    更新日期:2016-11-01 00:00:00

  • [Uterus septus with adenocarcinoma of one half of the uterus].

    abstract::The authors demonstrate a rare case of an adenocarcinoma of the uterus associated with a uterus septus. The concomitance of carcinoma and congenital uterine anomalies is coincidental and has no causal connection. Congenital anomalies of the uterus which remain undetected can be responsible for serious delay in diagnos...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章

    doi:10.1055/s-2008-1036708

    authors: Beyer WF,Freissler G,Schlotter CM,Kühn H

    更新日期:1984-08-01 00:00:00

  • "Pregnant and Operating": Evaluation of a Germany-wide Survey Among Female Gynaecologists and Surgeons.

    abstract::The current law on the protection of expectant and nursing mothers largely rules out surgical activities during pregnancy for female doctors who perform surgical roles in hospitals. The proportion of female junior staff in gynaecology amounts to 80 %, and, for many of these women, surgical further training is not poss...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章

    doi:10.1055/s-0034-1383065

    authors: Knieper C,Ramsauer B,Hancke K,Woeckel A,Ismail L,Bühren A,Toth B

    更新日期:2014-09-01 00:00:00

  • [Endoscopically assisted construction of a neovagina--surgical technique and experience].

    abstract::The specific disadvantage of the Vecchietti technique for construction of a vagina in cases of vaginal agenesis is the need for laparotomy. We describe an endoscopically assisted construction of a vagina by a variation of this method and report on the first five cases operated on without any complications and with goo...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章

    doi:10.1055/s-2007-1023676

    authors: Gauwerky JF,Wallwiener D,Bastert G

    更新日期:1993-04-01 00:00:00

  • [Abortion induction in the 2d pregnancy trimester. Endocervical PGE2 gel administration, intramuscular sulprostone administration and combined (endocervical PGE2 gel/intramuscular sulprostone) treatment].

    abstract::In 74 patients with normal pregnancy, termination of pregnancy was induced during 1980-1983 for medical reasons (12%) or for eugenic reasons (88%) in the second trimenon of pregnancy. We compared endocervical PG-E2 gel application (if necessary, several doses of 0.5 mg PG-E2 gel every 4-6 hours in 25 cases) with intra...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章

    doi:10.1055/s-2008-1036456

    authors: Schmidt W,Rabe D,Hendrik HJ

    更新日期:1985-04-01 00:00:00

  • [4 decades of surgery of cervix cancer].

    abstract::An impressive breakthrough of Wertheim's original intentions became evident on analysing the observations, experiences and results obtained from the early 'forties right up to the 'eighties of this century in various hospitals such as the Pathological Institute of the famous Berlin "Charité" Hospital and the Departmen...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章,评审

    doi:10.1055/s-2008-1036397

    authors: Ober KG

    更新日期:1989-05-01 00:00:00

  • [The rational application of endocrinological and radiological methods in the differential diagnosis of hirsutism in women (author's transl)].

    abstract::The intensity and duration of the clinical symptoms and signs determine the type and spectrum of the necessary and essential diagnostic measures in women with signs of hirsutism. Women with specific disease entities and women who desire pregnancy are in a different category. When severe signs of adrogenization (virili...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章,评审

    doi:10.1055/s-2008-1036771

    authors: Moltz L

    更新日期:1982-04-01 00:00:00

  • Psychosocial Stress, Course of Pregnancy and Pregnancy Outcomes in the Context of the Provision of Sexual Services.

    abstract::Introduction There has been very little medical research into pregnancies which occur in the context of prostitution, even though the associated health risks for mother and child, e.g. violence or maternal drug abuse, are well known. The aim of this study was to compile and summarize what is known (inter-)nationally a...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章

    doi:10.1055/s-0042-124045

    authors: Simoes E,Gostomzyk J,Brucker SY,Graf J

    更新日期:2017-04-01 00:00:00

  • [The activity of L-cystine-aminopeptidase (oxytocinase) in the serum of pregnant women during intravenous application of oxytocin (author's transl)].

    abstract::The oxytocinase levels have been tested prior to, during and after oxytocin challenge tests in 42 pregnant women. There was no relation between labour and the activity of the enzyme. There was no change in the activity during and after oxytocin infusion. Repeated challenge tests did not change these results. The use o...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章

    doi:

    authors: Schumann K,Fährmann M

    更新日期:1978-12-01 00:00:00

  • [Recurrent functional ovarian cysts following laparoscopy fenestration].

    abstract::The laparoscopic fenestration of functional ovarian cysts with a benign appearance is well known. After aspiration of the contents of the cyst, a window is cut in the cyst wall for an endocystic inspection. In this way, samples for cytology as well as histopathology are obtained. A laparoscopic fenestration was perfor...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章

    doi:10.1055/s-2008-1036293

    authors: De Wilde R,Mohr B,Hesseling M,Aschoff J

    更新日期:1989-12-01 00:00:00

  • [Obstetric prognostic factors of newborn infants with very low birth weight (< or = 1,500 gram) with reference to survival rate and early childhood development].

    abstract::Prognostic factors influencing survival in 235 very low birthweight prematures (< or = 1500 g) born between 1986 and 15.11. 1993 at the Department of Obstetrics and Gynaecology, University Hospital of Cologne, were retrospectively evaluated. Chromosomal anomalies and severe congenital malformations were excluded. Of 1...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章

    doi:10.1055/s-2007-1022794

    authors: Hamm W,Göhring UJ,Günther M,Kribs A,Neuhaus W,Roth B,Bolte A

    更新日期:1995-03-01 00:00:00

  • [Endoscopic diagnosis preceding reconstructive surgery of the fallopian tube].

    abstract::Between October 1978 and December 1980 165 diagnostic laparoscopies were carried out because of the suspected diagnosis of primary tubal infertility. In this preselected series 27.9% of the cases had normal findings. It was remarkable that the previous diagnosis was not confirmed in 21 cases which had a prior infertil...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章

    doi:10.1055/s-2008-1037166

    authors: Scheidel P,Hepp H

    更新日期:1982-11-01 00:00:00

  • [Clinical significance of the tumor marker CA-125 for the preoperative diagnosis and postoperative management of patients with malignant ovarian cancers].

    abstract::The ovarian carcinoma-associated antigen CA-125 was determined in 144 women with various gynecological tumors (ovarian, breast, uterine), by using the heterologous monoclonal antibody OC-125. In 90% of the malignant ovarian tumors positive CA-125 values were correct, whereas their negative values were correct in 88% o...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章

    doi:10.1055/s-2008-1036133

    authors: Sevelda P,Salzer H,Dittrich C,Spona J

    更新日期:1985-11-01 00:00:00

  • [Endometrioid carcinoma of the spinal canal (author's transl)].

    abstract::A woman, born in 1923, suffered since menarche of pain of the vertebra and has had a headache during menstrual periods. 1963 she developed a transverse lesion of the cord with an incomplete paraplegia because of an endometriosis externa of spinal canal. After a 12 years symptomless interval, she complained again of a ...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章

    doi:

    authors: Richter K

    更新日期:1977-09-01 00:00:00

  • [Physical performance in pregnancy].

    abstract::To evaluate their physical efficiency, 14 healthy untrained women were examined during pregnancy weeks 16-20, 25-29 and 34-38 and 5 to 10 weeks post partum, by spiroergometry at various exercise levels on the bicycle ergometer. Besides the spiroergometric values, circulatory parameters were measured and serum analyses...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章

    doi:10.1055/s-2008-1036184

    authors: Kusche M,Bolte A,Hollmann W,Roemer D

    更新日期:1986-03-01 00:00:00

  • Cervical Cancer Screening: Defining the Need for Research.

    abstract::With the development of a National Cancer Plan published in 2012, Germany has followed the recommendations of the WHO and the EU. The first area of action listed in Germany's National Cancer Plan is improving the early detection of cancer. Both citizens and medical specialists are encouraged to take responsibility the...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章

    doi:10.1055/s-0032-1328303

    authors: Simoes E,Brucker S,Beckmann MW,Ortmann O,Albring C,Wallwiener D

    更新日期:2013-03-01 00:00:00

  • The Prognostic Impact of Grading in FIGO IB and IIB Squamous Cell Cervical Carcinomas.

    abstract::Background Tumor grade is one of the more controversial factors, and the data regarding its prognostic impact in squamous cell carcinoma (SCC) of the uterine cervix are controversial. Methods The histological slides of 467 surgically treated FIGO stage IB1 to IIB cervical SCC were re-examined regarding the prognostic ...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章

    doi:10.1055/a-0828-7681

    authors: Brambs CE,Höhn AK,Hentschel B,Fischer U,Bilek K,Horn LC

    更新日期:2019-02-01 00:00:00

  • [Sickle cell disease and pregnancy].

    abstract::Three million out of 4.5 million foreigners in Germany are from countries, where sickle cell anaemia is found. Today, this disease occurs in Germany with sufficient frequency and this makes it imperative for every physician to be familiar with it. Most of the sickle cell patients today attain the reproductive age. Dur...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章,评审

    doi:10.1055/s-2008-1026275

    authors: Dickerhoff R

    更新日期:1990-06-01 00:00:00

  • [Ranking of hysterosalpingography (HSG) in the physician's consultation-room practice concerning sterility problems (author's transl)].

    abstract::In the following up of the diagnosis of the female sterility we practised 123 hysterosalpingographies (HSG) from 1972--1978. Presupposition was the proof of the ovulation by base temperature. The HSG is the beginning of the diagnosis to recognize the intracanalicular changes of the uterus and to avoid senseless treatm...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章

    doi:10.1055/s-2008-1037290

    authors: Fettig O,Heilmann R

    更新日期:1981-07-01 00:00:00

  • [Comparison between intra and para cervical anaesthesia in therapeutic abortion (author's transl)].

    abstract::Therapeutic abortion during the first trimester of pregnancy was carried out as an out-patient procedure under local anaesthesia in 40 women. The intracervical injection of 1% mepivacaine resulted in satisfactory freedom from pain just as the paracervical injection. There was no dignificant difference in the intensity...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章

    doi:

    authors: Peters FD,Hirsch HA

    更新日期:1978-11-01 00:00:00

  • [Psycho-oncologic after-care--is there a need in a tumor center? Results of a survey of 200 patients of the Heidelberg University Gynecologic Clinic].

    abstract::In an ongoing study at the department of gynaecology and obstetrics of Heidelberg University Hospital, 200 patients of the oncological outpatient department have so far been interviewed about how they experienced their illness, their therapy, the success of treatment and the after-care. An interim analysis of the ques...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章

    doi:10.1055/s-2007-1022852

    authors: Kirstgen C,Bastert G

    更新日期:1994-06-01 00:00:00

  • [Again: juriprudence problems in voluntary sterilization].

    abstract::Various legal aspects of voluntary sterilization in West Germany are discussed. Legal precedents have established the right of any person over 25 to undergo voluntary sterilization; those under 25 may undergo sterilization only in the case of a medical, genetic, or criminological indication. The German Physicians' C...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章

    doi:

    authors: Schlund GH

    更新日期:1978-08-01 00:00:00

  • [Primary pulmonary hypertension and pregnancy].

    abstract::Primary pulmonary hypertension (PPH) is an uncommon disease with a poor prognosis. Most patients with PPH are young women of child-bearing age. We report on such a case of PPH during pregnancy, discuss the aetiology, pathophysiology, morphological characteristics and the management in pregnancy and delivery. ...

    journal_title:Geburtshilfe und Frauenheilkunde

    pub_type: 杂志文章

    doi:10.1055/s-2007-1023711

    authors: Pfisterer J,Runge HM,Kommoss F,Herbst EW,Hillemanns HG

    更新日期:1991-03-01 00:00:00