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Treating HR+/HER2− breast cancer in premenopausal Asian women: Asian Breast Cancer Cooperative Group 2019 Consensus and position on ovarian suppression

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Abstract

Purpose

Breast cancer in young Asian women has distinctive clinicopathological characteristics; hence, we question the universal generalizability of treatment recommendations based on data from predominantly non-Asian postmenopausal women.

Methods

The Asian Breast Cancer Cooperative Group (ABCCG) reviewed current ESO-ESMO and St. Gallen recommendations for treating hormone receptor positive/human epidermal growth factor receptor 2 negative (HR+/HER2−) breast cancer in premenopausal women. Points disputed by ≥ 3/12 members were discussed, and statements on contentious issues formulated for anonymous voting; consensus required a ≥ 75% majority.

Results

The ABCCG contends that: (1) Trials in premenopausal women are not only necessary, but also worthwhile if performed separately from others that also enroll postmenopausal participants. (2) Not all premenopausal women with HR+ early breast cancer need adjuvant ovarian function suppression (OFS). (3) Certain clinical factors might influence decision-making about prescribing OFS. (4) For early HR+/HER2− breast cancer in premenopausal patients with OFS, tamoxifen is preferred for intermediate-risk cases; for high risk, near-consensus supported aromatase inhibitor, despite no clear overall survival benefit versus tamoxifen. (5) Oncotype DX Breast Recurrence Score® has different treatment implications in patients aged ≤ 50 versus > 50 years. (6) High-risk patients (if premenopausal after chemotherapy) should receive adjuvant chemotherapy and OFS plus aromatase inhibitor. (7) For patients with advanced disease receiving OFS on a backbone of tamoxifen, gonadotrophin-releasing hormone agonists may be given 12-weekly. (8) For premenopausal women who decline OFS or oophorectomy, tamoxifen alone is still an option but is considered less effective; other monotherapies are also less effective than OFS plus such treatments.

Conclusion

Premenopausal Asian women with breast cancer have unique disease characteristics and may benefit from treatment that differs somewhat from international guidelines. Given the great diversity of patients and clinical settings worldwide, the ABCCG advocates evidence-based yet flexible and individualized use of all potential options to improve breast cancer outcomes.

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Notes

  1. This consensus statement largely represents evidence from East Asian countries/regions, including China, Hong Kong, Japan, Singapore, Taiwan, and South Korea, for which robust epidemiologic data and expert knowledge of ABCCG members are available.

Abbreviations

ABCCG:

Asian Breast Cancer Cooperative Group

ESO-ESMO:

European School of Oncology and European Society for Medical Oncology

ABC 4:

ESO-ESMO International Consensus Guidelines for Advanced Breast Cancer, fourth edition

HR+:

Hormone receptor positive

HER2−:

Human epidermal growth factor receptor 2 negative

OFS:

Ovarian function suppression

OFA:

Ovarian function ablation

GnRHa:

Gonadotrophin releasing hormone agonist

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Acknowledgements

Novartis supported administrative organization of the ABCCG consensus survey and meeting, and third-party assistance with manuscript development. However, Novartis took no direct role in developing this Consensus Statement; the ABCCG members independently agreed each consensus point, wrote the manuscript, and decided to publish the final version. Dr. David Neil (PhD), of Full Universe Integrated Marketing, Taiwan, provided professional editorial and medical writing services, and his colleague Ms. Anabelle Huang assisted with manuscript preparation project management; these contributions were supported by funding from Novartis.

Author information

Authors and Affiliations

  1. State Key Laboratory of Translational Oncology, Department of Clinical Oncology, Faculty of Medicine, Prince of Wales Hospital, Hong Kong Cancer Institute, Chinese University of Hong Kong, 30–32 Ngan Shing St., Shatin, NT, Hong Kong SAR, China

    Winnie Yeo

  2. Breast Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake Koto-ku, Tokyo, 135-8550, Japan

    Takayuki Ueno

  3. Department of Oncology, National Taiwan University Hospital, 7 Chung-Shan South Rd., Taipei, 10016, Taiwan

    Ching-Hung Lin & Yen-Shen Lu

  4. Breast Tumor Center, Sun-Yat Sen Memorial Hospital, Sun-Yat Sen University, 107 Yanjiang West Rd., Guangzhou, 510120, China

    Qiang Liu

  5. Department of Internal Medicine, Cancer Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Kyung-Hun Lee & Seock-Ah Im

  6. Division of Haematology, Medical Oncology and BMT, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Rd., Hong Kong SAR, China

    Roland Leung

  7. Department of Breast and Medical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Yoichi Naito

  8. Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, 81 Irwon-ro, Seoul, 06351, Republic of Korea

    Yeon Hee Park

  9. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, 52 Fucheng Rd., Beijing, 100142, China

    Huiping Li

  10. Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore

    Yoon Sim Yap

Authors
  1. Winnie Yeo
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  2. Takayuki Ueno
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  3. Ching-Hung Lin
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  4. Qiang Liu
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  5. Kyung-Hun Lee
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  6. Roland Leung
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  7. Yoichi Naito
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  8. Yeon Hee Park
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  9. Seock-Ah Im
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  10. Huiping Li
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  11. Yoon Sim Yap
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  12. Yen-Shen Lu
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Consortia

The Asian Breast Cancer Cooperative Group

Corresponding author

Correspondence to Yen-Shen Lu.

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Conflict of interest

The authors have all participated as faculty members of Novartis Breast Cancer Advisory Boards, and received personal fees, reimbursement of travel expenses, and/or hospitality for their service in this capacity. However, the ABCCG is a professional association that was constituted and operates independently of Novartis and which sets its own research agenda. The article discusses specific Novartis products within the context of the current breast cancer therapeutic landscape, which the authors strove to review impartially. All views expressed are the authors’ own, and do not necessarily represent those of Novartis. The authors declare competing interests. WY reports consultancy/advisory roles and receipt of personal fees for Novartis, Pfizer, AstraZeneca, Eli Lilly, Roche, and Amgen. TU reports receiving personal fees and non-financial support from Novartis KK, and personal fees from Chugai, Eisai, AstraZeneca KK, and Taiho. CHL reports a consultancy/advisory role for Novartis. QL reports a consultancy/advisory role and personal fees for Novartis, and receipt of personal fees from Pfizer, Roche, AstraZeneca, and Eisai. KHL reports consultancy/advisory roles with Novartis, AstraZeneca, Roche, Ono, Eisai, Bayer, and Samsung Bioepis. RL reports a consultancy/advisory role with Novartis. YN reports research funding and a consultancy/advisory role for Roche Diagnostics, and consultancy/advisory roles for Novartis, Pfizer, Taiho, Nippon Kayaku, Eli Lilly, AstraZeneca, Merck Serono, Bayer, Meiji Seika, Chugai, and Eisai. YHP reports research funding and consultancy/advisory roles for Novartis, Pfizer, Eisai, and research funds from AstraZeneca, and Roche. SAI reports research funding from AstraZeneca, research funds and a consultancy/advisory role for Pfizer, and consultancy/advisory roles with Novartis, Hanmi, Roche, Pfizer, Amgen, and Eisai. HL reports research funding and a consultancy/advisory role for Roche Diagnostics, and consultancy/advisory roles with Novartis, Pfizer, Eli Lilly, and AstraZeneca. YSY reports personal fees and a consultancy/advisory role for Novartis, receiving personal fees and non-financial support from Pfizer, AstraZeneca, Lilly, and non-financial support from Eisai, and Roche. YSL reports receiving research funds and personal fees from Novartis, Pfizer, Roche, and Merck Sharp & Dohme, and personal fees from Boehringer Ingelheim.

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This work did not entail studies of human participants by any of the authors.

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Yeo, W., Ueno, T., Lin, CH. et al. Treating HR+/HER2− breast cancer in premenopausal Asian women: Asian Breast Cancer Cooperative Group 2019 Consensus and position on ovarian suppression. Breast Cancer Res Treat 177, 549–559 (2019). https://doi.org/10.1007/s10549-019-05318-5

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