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Review
. 2021 Nov;190(2):183-188.
doi: 10.1007/s10549-021-06368-4. Epub 2021 Sep 8.

Patient preferences and adherence to adjuvant GnRH analogs among premenopausal women with hormone receptor positive breast cancer

Jasmine S Sukumar  1 , Dionisia Quiroga  1 , Mahmoud Kassem  1 , Michael Grimm  1 , Namrata Vilas Shinde  1 , Leslie Appiah  2 , Marilly Palettas  3 , Julie Stephens  3 , Margaret E Gatti-Mays  1 , Ashley Pariser  1 , Mathew Cherian  1 , Daniel G Stover  1 , Nicole Williams  1 , Jeffrey Van Deusen  1 , Robert Wesolowski  1 , Maryam Lustberg  1 , Bhuvaneswari Ramaswamy  1 , Sagar Sardesai  4
Affiliations
Review

Patient preferences and adherence to adjuvant GnRH analogs among premenopausal women with hormone receptor positive breast cancer

Jasmine S Sukumar et al. Breast Cancer Res Treat. 2021 Nov.

Abstract

Purpose: Adjuvant ovarian function suppression (OFS) in premenopausal hormone receptor (HR) positive breast cancer (BC) improves survival. Adherence to adjuvant gonadotropin-releasing hormone analogs (GnRHa) remains a challenge and is associated with toxicities and inconvenient parenteral administration. The goal of this study was to describe real-world adherence patterns and patient preferences surrounding adjuvant GnRHa.

Methods: We analyzed the medical records of premenopausal women with non-metastatic HR positive BC from January 2000 to December 2017; participants received adjuvant monthly goserelin or leuprolide at The Ohio State University. Data collected included demographics, clinicopathologic characteristics, and OFS adherence/side effects. We defined non-adherence as discontinuation of GnRHa within 3 years for a reason other than switching to an alternate OFS, delay > 7 days from a dose, or a missed dose. Chi-square tests assessed associations between clinical characteristics and outcomes.

Results: A total of 325 patients met eligibility. Of these, 119 (37%) patients were non-adherent to GnRHa; 137 (42%) underwent elective bilateral salpingo-oophorectomy after initial GnRHa. Those opting for surgery reported significantly more hot flashes (74% vs 48%, p < 0.001), arthralgias (46% vs 30%, p = 0.003), and vaginal dryness (37% vs 21%, p = 0.001) compared with patients remaining on GnRHa.

Conclusion: Non-adherence to adjuvant GnRHa occurred in over a third of patients and almost half the patients initiating GnRHa underwent subsequent surgical ablation. These high frequencies highlight real-world patterns of OFS. Additionally, treatment toxicities may impact personal preference of OFS modality. Personalized practices to target predictors of adjuvant GnRHa non-adherence are critical to optimize symptoms, adherence, and survivorship.

Keywords: Breast cancer; Endocrine therapy; GnRH; Ovarian ablation; Ovarian suppression; Premenopausal.

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Conflict of interest statement

Conflict of interest The authors have no conflict of interest to disclose.

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