Halle Moore, MD, director, Breast Medical Oncology, Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Institute, co-director, Cleveland Clinic Comprehensive Breast Cancer Program, associate professor of medicine, Cleveland Clinic Lerner College of Medicine, discusses the use of preventive anastrozole (Arimidex) versus tamoxifen in ductal carcinoma in situ (DCIS). 

During the 2020 San Antonio Breast Cancer Symposium, the 12-year results of the IBIS-II trial were presented. The findings did not show any clear differences between anastrozole and tamoxifen when utilized as treatment for patients with locally excised hormone receptor–positive DCIS. 

The results reinforce the fact that patients with this disease have options for treatment, says Moore. For example, a patient with severe osteoporosis may prefer to receive tamoxifen because anastrozole was associated with an increased rate of fractures. Conversely, patients who are concerned about the risk of blood clots or uterine cancer may prefer anastrozole, which demonstrated lower rates of endometrial and ovarian cancers versus anastrozole. Ultimately, the data show that both drugs would be reasonable options for patients in this setting, concludes Moore. 

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Halle Moore, MD, discusses the use of preventive anastrozole versus tamoxifen in ductal carcinoma in situ.  



Dr. Moore on the Use of Preventive Anastrozole Versus Tamoxifen in DCIS 

Halle Moore, MD, medical oncologist, the Cleveland Clinic, discusses the use of GnRH agonists to preserve ovarian function and fertility in women with breast cancer.

Moore presented the results of the POEMS study at the 2017 San Antonio Breast Cancer Symposium (SABCS), which demonstrated that when given alongside chemotherapy, goserelin, a gonadotropin-releasing hormone (GnRH) agonist, improved pregnancy outcomes, disease-free survival, and overall survival outcomes in women with early-stage hormone receptor (HR)-negative breast cancer.

GnRH agonists work by putting women into temporary menopause, stopping ovarian cycling and estrogen production. While researchers are currently not entirely sure about why these agents prevent toxicity on the ovaries, one theory, Moore said, is that by preventing ovarian cycling, the ovaries get less blood flow for chemotherapy to impose negative effects—similar to how cooling caps work to prevent chemotherapy-related alopecia.

The POEMS study was also part of a larger meta-analysis, which was also presented at SABCS. This analysis included individual patient data from 5 different studies. Again, results displayed that drugs such as goserelin and other GnRH agonists can improve both pregnancy and survival outcomes, confirming the safety of this class of agents.

Moving forward, Moore mentioned that these findings suggest that physicians should more routinely be offering these agents to young women with breast cancer, especially if they one day hope to have children.

Dr. Moore Discusses Ovarian Preservation in Breast Cancer

Halle Moore, MD, medical oncologist, Cleveland Clinic, discusses the results of the phase III POEMS study, which was presented at the 2014 ASCO Annual Meeting.

This study looked at whether suppressing ovarian function during adjuvant or neoadjuvant chemotherapy could reduce the risk for long term ovarian failure in premenopausal women with ER-negative breast cancer. Patients were randomized to receive standard cyclophosphamide-containing chemotherapy with or without monthly goserelin.

Results showed a significant reduction (about 70%) in the ovarian failure rate observed in the group treated with goserelin. Further, at 2 years, women who received goserelin had better preserved ovarian function.

There was a higher rate of achieving pregnancy and having successful births among women who received goserelin, Moore says. There was no evidence that goserelin increased the risk of miscarriage, need for elective termination, or other adverse pregnancy events.

Halle Moore, MD

Articles

Dr. Moore on the Use of Preventive Anastrozole Versus Tamoxifen in DCIS

Dr. Moore Discusses Ovarian Preservation in Breast Cancer

Dr. Halle Moore Discusses Results of the Phase III POEMS Study in Breast Cancer