SAN FRANCISCOWhile bone mineral density decreases with ovarian ablation via the leutinizing hormone releasing hormone (LHRH) analog goserelin(Drug information on goserelin) (Zoladex), the loss is partly recovered within a year after 2 years of treatment. Also, the loss may be minimized by the addition of tamoxifen(Drug information on tamoxifen) (Nolvadex), according to an analysis of ZIPP (Zoladex in Premenopausal Patients) trial data presented at the 37th Annual Meeting of the American Society of Clinical Oncology (ASCO abstract 96).
Ovarian ablation improves survival for premenopausal women with early breast cancer, said A. Sverrisdóttir, MD, Huddinge University Hospital, Stockholm, Sweden. The benefits of treatment with LHRH analogs have been comparable to the benefits of chemotherapy. Concerns remain, however, about inducing a premature menopause because of the known increased risk of bone mineral density loss with early menopause.
While it is known that tamoxifen has estrogen agonist effects, the potential adverse effects of LHRH analog treatment on bone are unknown, Dr. Sverrisdóttir said. Furthermore, the net effect of the combination of ovarian ablation and tamoxifen in premenopausal women is unknown.
In the ZIPP trial results presented at ASCO 2000, recurrence-free survival benefits for adjuvant therapy with goserelin were highly significant (P = .001) in premenopausal women with node-negative breast cancer who did not receive adjuvant chemotherapy.
Bone Mineral Density Data
For the current analysis, bone mineral density data from 73 Stockholm participants in the trial were evaluated. The patients received no adjuvant therapy (n = 22), tamoxifen (40 mg/d for 2 years, n = 19), goserelin alone (3.6 mg every 28 days for 2 years, n = 17), or tamoxifen plus goserelin (n = 15).