PMID-35862873 – Twenty-Year Benefit From Adjuvant Goserelin in Breast Cancer
Johansson A, Dar H, van 't Veer LJ, Tobin NP, Perez-Tenorio G, Nordenskjold A, Johansson U, Hartman J, Skoog L, Yau C, Benz CC, Esserman LJ, Stal O, Nordenskjold B, Fornander T, Lindstrom LS. Twenty-Year Benefit From Adjuvant Goserelin and Tamoxifen in Premenopausal Patients With Breast Cancer in a Controlled Randomized Clinical Trial. J Clin Oncol. 2022;40(35):4071-4082.
Quick Reference
| Property | Value |
|---|---|
| PMID | 35862873 |
| DOI | 10.1200/JCO.21.02844 |
| Year | 2022 |
| Journal | Journal of Clinical Oncology |
| Study Type | RCT (20-year follow-up) |
| Evidence Level | I |
| Sample | Premenopausal breast cancer patients |
| Peptide(s) Studied | Goserelin |
Key Findings
- Goserelin significantly improved long-term distant recurrence-free interval in ER-positive patients (HR 0.49)
- Genomic high-risk patients derived the greatest benefit from goserelin monotherapy (HR 0.24)
- Genomic low-risk patients responded better to tamoxifen alone
- Combining tamoxifen with goserelin paradoxically increased risk in genomic high-risk patients
- Twenty-year follow-up demonstrates durable, sustained benefit from ovarian suppression with goserelin
Study Design
Long-term follow-up (20 years) of a controlled randomized clinical trial evaluating adjuvant goserelin, tamoxifen, or their combination in premenopausal patients with ER-positive breast cancer. Genomic risk stratification was applied retrospectively to identify differential treatment responses.
Limitations
- Retrospective genomic risk analysis was not pre-specified
- Treatment paradigms have evolved significantly since the trial began
- Combination therapy results may reflect specific dosing/scheduling that differs from current practice
- No comparison with aromatase inhibitors or modern endocrine regimens
Clinical Relevance
This study provides the strongest long-term evidence for goserelin's role in premenopausal breast cancer, demonstrating that ovarian suppression alone can produce dramatic reductions in recurrence for genomic high-risk patients. The finding that combination therapy may be counterproductive in some subgroups challenges assumptions about escalating endocrine therapy and supports personalized treatment selection based on tumor genomics.
Related
#research #RCT #peptide #sexual-health #reproductive #evidence-level-I