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Final Analysis of SWOG POEMS: Goserelin and Chemotherapy in Breast Cancer

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Key Points

  • On average, 23% of women who took goserelin became pregnant compared with 12% treated with standard therapy.
  • Five years after treatment, 88% of women who took goserelin were alive and disease-free compared with 79% of women who got standard treatment.
  • While differences in survival were not statistically significant, 92% of women who took goserelin were alive at 5 years compared to 83% of control patients.

Final results of SWOG Cancer Research Network’s international Prevention of Early Menopause Study (POEMS) showed continued evidence that women who get injections of the hormone drug goserelin along with standard breast cancer chemotherapy are more likely to become pregnant, without developing negative side effects or shortening their lives. These findings were published by Moore et al in the Journal of the National Cancer Institute.

“These 5-year follow-up results confirm our initial findings,” said SWOG investigator Halle Moore, MD, lead researcher on the POEMS study and Associate Professor of Medicine at the Cleveland Clinic, in a statement. “Goserelin protects the ovaries from the effects of chemotherapy, reducing the risk for early menopause. By getting these injections, more women became pregnant without negatively affecting their health or their chances of surviving their cancer.”

Initial Results

Ovarian failure is one side effect of chemotherapy, one that carries a heavy burden for women, including infertility, sexual dysfunction, and unpleasant symptoms. To determine whether ovarian failure could be prevented, the POEMS team launched their trial. Between 2004 and 2011, investigators randomly assigned 218 premenopausal women with hormone receptor–negative breast cancer to receive either standard cyclophosphamide-containing chemotherapy or standard chemotherapy plus goserelin.

The POEMS team announced their initial study results at the 2014 ASCO Annual Meeting (Abstract LBA505). Those initial results showed that 22% of patients on standard therapy experienced ovarian failure, whereas only 8% who received goserelin did. In addition, the 2014 results also showed that 12% of patients on the standard arm got pregnant, compared with 22% who received goserelin.

Final Analysis

The new results, which include 5 years of follow-up, show similar effects. On average, 23% [95% confidence interval [CI] = 15.3%–31.9%] of women who took goserelin became pregnant, compared with 12% [95% CI = 6.8%–19.2%] treated with standard therapy. Importantly, women who took goserelin experienced similar, or even better, survival rates compared with women who received standard chemotherapy.

Five years after treatment, 88% of women who took goserelin were alive and disease-free, compared with 79% of women who got standard treatment. Although differences in survival were not statistically significant, 92% of women who took goserelin were alive at 5 years, compared to 83% of control patients.

When the POEMS results were first issued, SWOG senior investigator Kathy Albain, MD, FACP, FASCO, of the Cardinal Bernardin Cancer Center of Loyola University Chicago, predicted they would change the standard of care for breast cancer. The National Comprehensive Cancer Network Clinical Practice Guidelines for Oncology and the St. Gallen Consensus Conference guidelines already reflect the use of goserelin for younger women who hope to protect ovarian function during chemotherapy for breast cancer.

“Cancer researchers set out to change the standard of care in order to improve, or lengthen, people’s lives,” Dr. Moore said. “Our final results show a means to improve quality of life for young women with hormone receptor­–negative breast cancer. If they want to be mothers, they can improve their chances safely and effectively. I’m proud of this result, and our international team.”

The National Institutes of Health funded the study through National Cancer Institute grant awards CA189974, CA180888, and CA180819. The Australia and New Zealand Breast Cancer Trials Group, the Breast Cancer Institute of Australia, and AstraZeneca also supported the trial.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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