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EDITORIALS Two interesting trials from the Adjuvant Breast Cancer (ABC) Trials Collaborative Group (1,2) are reported in this issue of the Journal. Although their interpretation is impeded by the lack of estrogen receptor (ER) measurements in more than 40% of patients , these trials provide important information regarding adju-vant therapy for women with breast cancer. The ABC Ovarian Ablation or Suppression (OAS) Trial examines women randomly allocated to receive ovarian ablation or suppression compared with no ovarian ablation or suppression, against a background of 5 years of tamoxifen treatment with or without chemotherapy. Among 2144 women who were randomly assigned between 1993 and 2000, there was no evidence of benefi t for relapse-free survival (hazard ratio [HR] = 0.95, 95% confi dence interval [CI] = 0. In a small, unplanned analysis of 56 women younger than 40 years who did not receive chemother-apy, there was a more suggestive but not statistically signifi cant effect (overall survival, HR = 0.55, 95% CI = 0.17 to 1.85). Patients in the trial were not preselected by ER status, and only two-thirds of those with ER data were ER positive. Not surprisingly, there was a trend toward a greater effect of ovarian ablation or suppression in those with ER-positive tumors but no statistically signifi cant evidence of heterogeneity for either relapse-free survival or overall survival among the subgroups. Two other studies support this paradigm (3,4). In the study by Davidson et al. (3), 1504 node-positive premenopausal women with ER-positive breast cancer were randomly assigned to six cycles of oral (cyclo-phosphamide, Adriamycin, and 5-fl uorouracil [CAF]) chemother-apy compared with CAF plus goserelin (Zoladex) (CAFZ) and to CAFZ plus 5 years of tamoxifen (CAFZT). Although median survival was superior for CAFZT compared with CAF, there was not suffi cient power to detect a signifi cant difference in the trend toward superiority for CAFZ over CAF alone. Hypothesis-generating subgroup analyses suggested, as in the ABC (OAS) study, that women younger than age 40 years at trial entry with premeno-pausal estradiol levels after chemotherapy or who retained menses after chemotherapy benefi ted most from goserelin. Similarly, the study by Arriagada et al. (4) showed no benefi t of ovarian ablation or suppression overall in subgroups based on ER status or in women who experienced amenorrhea following chemotherapy, but it did show that women aged 39 years and younger had a statistically signifi cant benefi t from goserelin following …

Adjuvant Therapy for Breast Cancer: We Are Solving the Puzzle, But Pieces Are Still Missing