Management of Young Patients With Breast Cancer

Compiled for you by PharmaWrite

Presented by Neelam Patel, PharmD, BCOP
University of Texas, MD Anderson Cancer Center, Houston, TX

Key Takeaways

• Adjuvant treatment with gonadotropin-releasing hormone agonists may provide a new option for premenopausal women undergoing chemotherapy
• More data are needed, however, because concerns still exist about long-term toxicities with adjuvant endocrine therapy in young breast cancer patients with longer life expectancies, toxicities that can affect long-term bone health, sexual health, cognition, and cardiovascular health
• Treatment-related concerns about potential toxicities should be discussed with patients before therapy initiation
• Several guidelines to assist with decision-making are available from ASCO and NCCN

This session focused on treatment-related concerns in young patients with breast cancer and the management of treatment-related toxicities compared with older women. Information from ASCO guidelines on endocrine adjuvant therapy for premenopausal women (Rugo 2016) and supporting studies were presented and treatment options were reviewed, including therapy sequencing, monitoring, and follow-up recommendations. Adjuvant endocrine therapy options have broadened for premenopausal women (ie, use of gonadotropin-releasing hormone agonists) and newer studies recommend longer durations of therapy beyond 5 years.

The speaker concluded that more data supporting ovarian suppression with gonadotropin-releasing hormone agonists in the adjuvant chemotherapy setting are needed, since this is still not recognized as a standard of care. Concerns still exist because of the inherent long-term toxicities with using adjuvant endocrine therapy in young breast cancer patients with longer life expectancy with regard to bone health, sexual health, cognition dysfunction, and cardiovascular health (lipid monitoring).

Several guidelines are available to assist with decision-making, including the ASCO breast cancer survivorship care guideline (Runowicz 2016), the National Comprehensive Cancer Network breast cancer guidelines, and the ASCO guideline on fertility preservation for patients with cancer (Loren 2013).

This session summary was prepared by Ginah Nightingale, PharmD, BCOP, a member of the PharmaWrite Oncology Working Group.

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