Sponsored By
Cynthia Villarreal-Garza, MD, DSc
In Latin American countries, the onset of breast cancer is approximately 10 years earlier than in high-income countries. Moreover, the incidence rate of breast cancer in individuals aged <40 years is close to 11%, which is higher than the rates in developed regions such as the United States and the European Union. Additionally, most of these young women are diagnosed with advanced-stage disease.1,2
Gonadotropin-releasing hormone (GnRH) agonist therapy is generally preferred over oophorectomy or ovarian irradiation for several reasons, including fewer short-term side effects (which translates to better quality of life and improved treatment adherence), reversibility, proven efficacy, and reduced burden on healthcare systems. In Latin American countries, because there are delays in scheduling surgical and radiotherapy procedures, GnRH agonist therapy represents a more readily accessible option for ovarian function suppression (OFS).3
Several factors, including patient clinicopathologic risk, dosage and administration procedure, availability, cost, guideline recommendations, and physician and patient preferences, influence the selection of a specific GnRH agonist for OFS. Although criteria for identifying higher-risk patients are not well defined, this group of patients encompasses those requiring treatment with chemotherapy due to the presence of involved lymph nodes, large tumor size, high risk of recurrence, and patients diagnosed at a younger age (≤35 years) who will benefit from OFS.4 The Regan Composite Risk Score can be utilized to identify high-risk patients with breast cancer; however, there are no recommendations for the selection of a specific GnRH agonist based on risk.5
Based on a recent survey, disease and route of administration also impact GnRH agonist selection. Patients generally prefer intramuscular injections as they are associated with less pain compared with a subcutaneous implant.6 Familiarity and experience with GnRH agonists used in prostate cancer may play a key role in treatment selection.7 In Latin American countries, where resources can be limited and out-of-pocket expenditures are high, availability and cost are significant factors in the selection process of GnRH agonists.8
Goserelin and triptorelin have been used in pivotal clinical trials, demonstrating the benefit of adjuvant OFS. However, although the European Society for Medical Oncology, 5th International Consensus Symposium for Breast Cancer in Young Women, and the American Society of Clinical Oncology recommend adjuvant OFS in premenopausal women with early breast cancer, they do not provide recommendations for a specific drug.9-11 A recent survey aimed at defining physician perspectives on GnRH agonist selection revealed that age is an important criterion that drives the use of GnRH agonists in patients with early breast cancer. The majority of respondents in the public sector (61.1%) chose goserelin, followed by leuprolide (33.3%) and triptorelin (5.6%). In the private sector, 42.5% of responders chose goserelin, followed by triptorelin (35%) and leuprolide (22.5%). The primary reason for choosing goserelin and leuprolide was availability.6 However, in a scenario of complete availability, goserelin was still the top choice, followed by triptorelin and leuprolide.
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