[17] The impact of treatment-induced amenorrhea on survival of premenopausal patients with endocrine-responsive breast cancer: 10-year results of ABCSG-05 (CMF vs. goserelin+tamoxifen). Gnant M, Greil R, Kubista E, Menzel C, Schippinger W, Seifert M, Haider K, Mlineritsch B, Samonigg H, Kwasny W, Fridrik M, Steger G, Steindorfer P, Tschmelitsch J, Poetter R, Jakesz R.. Medical University of Vienna, Vienna, Austria Background: Treatment-induced amenorrhea (TIA) is considered one of the mechanisms of action of cytostatic chemotherapy for adjuvant treatment of premenopausal patients with endocrine-responsive breast cancer. In a prospective randomized trial of 1,037 patients (ABCSG-05) we have shown that adjuvant treatment with goserelin and tamoxifen is superior to CMF treatment with respect to 5-year relapse-free-survival (Jakesz et al, JCO 2002). With 10 years of follow-up, we now present mature survival results of ABCSG-05 with particular emphasis on the impact of TIA in CMF-treated patients. Patients and Methods: 1,037 premenopausal patients with endocrine-responsive breast cancer were randomized to receive either 6 cycles of cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) or 3 years of goserelin plus 5 years of tamoxifen (GosTam). Data on amenorrhea were recorded prospectively. Patient and tumor characteristics (T, N, Grading, age, ER, PR, HER-2, adjuvant treatment, TIA) were analyzed in uni- and multivariate analyses including interaction analyses. Overall survival (OS) and relapse-free survival (RFS) were used as end points. Results: Median follow-up in the trial was 120.6 months (181.3 mo max.). Actual ten-year and actuarial 15-year overall survival (OS) in the trial cohort was 82.0% and 74.6%, respectively. RFS at 10 years was 81.7% in the GosTam group, and 78.6% in the CMF group (HR 1.21, p=0.2). TIA occurred in 62.8% of CMF patients, and all GosTam patients. Among CMF patients, TIA was a significant prognostic factor for improved RFS (HR 0.656 (0.477-0.901) p=0.0093) and OS (HR 0.569 (0.387-0.837) p=0.0042). Furthermore, nodal status and HER-2 over expression were significant prognostic factors: Nodal status for RFS: HR 2.150 (1.883-2.455), p<.0001, for OS HR 2.282 (1.950-2.670) p<0.0001. HER-2/neu over expression was associated with increased risk of relapse (HR 1.889 (1.135-3.145) p=0.0144 and death (HR 1.858 (1.082-3.190) p=0.0247). In the subgroups of CMF patients with HER-2 over expressing or low hormone receptor expression tumors, TIA had no significant impact on RFS or OS. Discussion: Treatment-induced amenorrhea after adjuvant CMF chemotherapy of premenopausal breast cancer patients is a strong prognostic factor indicating improving RFS and OS. This is particularly true for patients with tumors expressing high estrogen and progesterone receptors and negative HER-2/neu status. In contrast, recovery of ovarian function after 3 years of adjuvant LHRH agonist does not adversely impact long-term survival. Additional ovarian suppression treatment may be advisable for premenopausal patients with endocrine-responsive disease who receive adjuvant chemotherapy without achieving treatment-induced amenorrhea. San Antonio Breast Cancer, 12/06 Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.