Premenopausal Women With Metastatic Breast Cancer

For premenopausal patients, we are left with three potential options for first-line therapy; tamoxifen monotherapy, treatment with an LH-RH analogue, or the two treatment options administered in concert.

The potential benefits with respect to each individual treatment approach, the combination as well as interactions with chemotherapy-induced amenorrhea in the adjuvant setting has recently been discussed in detail elsewhere (85). In the metastatic setting, first-line therapy with either tamoxifen or ovarian ablation is associated with similar response rates (86, 87).

Another interesting approach is to use the two treatment options in concert. Thus, Klijn et al. (88) have shown moderate superiority for combined treatment (TAM + LHRH-analogue) versus monotherapy with each individual approach. On the other hand, it is not fully clear whether a similar benefit may not be achieved through sequential application of the same treatment strategies.

Considering further treatment for premenopausal women, a natural choice should be treatment with a third-generation aromatase inhibitor. While we are left with an open question in adjuvant therapy regarding duration of treatment with an LH-RH analogue (85), based on the fact that metastatic breast cancer remains noncurable and, thus, patients responding to ovarian ablation may be candidates for subsequent aromatase inhibition, it seems reasonable to advocate permanent ovarian ablation (radiological or surgical) for those patients obtaining a clear response to treatment with an LH-RH analogue. Subsequently, such patients may be treated according to the principles outlined for postmenopausal women above.

Notably, there is currently much interest in exploring the concept of "total estrogen suppression," meaning to combine an LH-RH analogue with an aromatase inhibitor upfront, While this is a most interesting treatment approach, awaiting evidence from phase III studies this approach should be considered experimental, and not advocated outside clinical trials at this stage.

Natural Cures For Menopause

Natural Cures For Menopause

Are Menopause Symptoms Playing Havoc With Your Health and Relationships? Are you tired of the mood swings, dryness, hair loss and wrinkles that come with the change of life? Do you want to do something about it but are wary of taking the estrogen or antidepressants usually prescribed for menopause symptoms?

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