Combining ovarian suppression and an aromatase inhibitor is an efficacious treatment method for premenopausal women with breast cancer. However, the regimen (which is given long-term) can cause some major adverse events, explained Dawn L. Hershman, MD, MS, professor of medicine and epidemiology at the Columbia University Irving Medical Center.

Several trials were published, one the SOFT trial, the other the TEXT trial. Both of them were very similar in a lot of ways, looking at premenopausal women and the effect of ovarian suppression. We discovered that there actually is a benefit to suppressing a woman's ovaries and giving her an aromatase inhibitor along with it, compared to giving tamoxifen alone.

But the biggest problem with doing that is that it's very toxic. We always think about the toxicities of chemotherapy, but the toxicities from endocrine therapy can be far worse, and they go on much longer. We give these treatment for 5, sometimes even 10 years. It's super challenging to keep people on their therapy. We've done research showing that just even with 5 years of tamoxifen, by the end of the 5 years, only about 50% of patients are taking it more than 80% of the time. The reason why people stop their medications is complicated. But one of the most common reasons why people stop taking their medications is side effects. We know that when we take a young woman and we suppress her ovarian function and we give them an aromatase inhibitor, close to 100% have side effects. It can cause depression, hot flashes, difficulty sleeping, severe bone pain, and problems with their mood. It can increase their risk for osteoporosis, and sometimes even cardiovascular disease. So it's not without significant consequences.

In order to better treat young women, we need better risk prediction models to figure out exactly who are the people at highest risk, so that we can target those women and give them more intensive treatment, and spare women who maybe don't have such high risk cancer.

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Ovarian Suppression Plus AI Treatment Can Have Major Adverse Events

  Dawn L. Hershman, MD, MS, Columbia University Medical Center, discusses preventing chemotherapy-induced peripheral neuropathy (CIPN) in diabetic patients with cancer.

Clinicians treating patients who already have diabetes-related neuropathy need to be careful in prescribing certain chemotherapy drugs that may worsen the neuropathy, especially in the palliative care setting where there may not be much benefit. For patients who may see a marginal benefit with chemotherapy, perhaps clinicians would consider prescribing docetaxel instead of paclitaxel to reduce CIPN risk.

Dawn L. Hershman, MD, MS, Columbia University Medical Center, discusses preventing chemotherapy-induced peripheral neuropathy (CIPN) in diabetic patients with cancer. 

Dawn L. Hershman on Preventing CIPN in Patients With Diabetes

Dawn L. Hershman, MD, MS, Columbia University Medical Center, discusses the results of a recent study that found diabetes, age, and certain treatment regimens are contributing factors to developing chemotherapy-induced peripheral neuropathy (CIPN).

The study, which examined more than 1400 patients over the age of 65, reports that CIPN rates increase with age, and patients with diabetes treated with a taxane had nearly a twofold risk of developing CIPN, as were those treated with paclitaxel versus docetaxel.

Conversely, patients who had an autoimmune disease actually showed lower rates of CIPN, which, Hershman notes, raises intriguing questions for further study.

Dawn L. Hershman, MD, MS

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Ovarian Suppression Plus AI Treatment Can Have Major Adverse Events

Dawn L. Hershman on Preventing CIPN in Patients With Diabetes

Dawn L. Hershman on Factors Contributing to CIPN