In an accompanying Comment, Drs Nicholas Wilcken and Martin Stockler, Department of Medical Oncology, Westmead and Napean Hosptials andUniversity of Sydney, NSW, Australia and NHMRC Clinical Trials Centre, University of Sydney and Sydney Cancer Centre, Royal Prince Alfred and Concord Hospitals, NSW, Australia, say: "In women with higher-risk disease, chemotherapy followed by tamoxifen should still be the standard approach, with the addition of an LH-RH analogue a reasonable consideration for those who remain premenopausal.

"A century of research has taught us much about endocrine therapy for breast cancer, but the most important lessons about adjuvant ovarian suppression will be learnt over the next decade."

Read Dr. Alvaro Pereira-Rico's Response:

First, let me make a point regarding the title of this news story. The word alternative might imply for some patients a non-standard, “integrative medicine approach”.

This article refers to a well-known but not precisely defined approach (as with phase III randomized clinical trials) for pre-menopausal hormone receptor positive breast cancer. LH-RH for breast cancer is used mostly in Europe and Australia, but rarely in the USA. The rationale for its use is very clear: inhibit the hormones (in the brain) that stimulate the production of estrogen, and the main driving force of breast cancer growth will be severely diminished.

As with all the hormonal agents in breast cancer, it only works in tumors that have hormone receptors. And it is not surprising that it works best in pre-menopausal women, who have higher estrogen levels than post-menopausal women. And since breast cancer is more aggressive in younger women, it makes sense that adding a different line of therapy to the standard of care benefits this group of patients. Although I have not read the original paper it seems to me that using LH-RH agonists in addition to chemotherapy and tamoxifen (“peripheric” antiestrogen) MIGHT give a pre-meopausal woman with hormone receptor positive breast cancer the best chance for permanent cure. But as stated in the last paragraph, this approach is not yet a standard of care. There are a large number of on-going adjuvant trials using hormonal agents, which for sure will change how we use LH-RH agonists in breast cancer.

I hope you find this informative and implore you to speak with your physician about your specific situation.