AGO Recommendations for Diagnosis and Treatment of Patients with Primary and Metastatic Breast Cancer. Update 2011

Regarding adjuvant endocrine therapy for premenopausal patients with endocrine sensitive disease, the AGO recommendations have not changed substantially in 2011. Assessment of the menopausal status is best done by menstruation history and follicle-stimulating hormone (FSH) and estradiol (E2) measurements. Low anti-muellerian hormone (AMH) levels seem to be indicative for reduced ovarian reserve and chemotherapy-related amenorrhea (CRA) in chemotherapytreated breast cancer patients [177, 213]. AMH measurements may thus help to assess the ovarian reserve after chemotherapy (AGO +/–). Tamoxifen alone is the preferred endocrine therapy in young women (AGO ++; EBCTCG 2005), in cases of tamoxifen contraindications, gonadotropin-releasing hormone analogues (GnRHa) alone may be an alternative in patients with low (and intermediate) risk of recurrence as the long-term results of the ZIPP trial suggest [99]. Due to the side effect profile and remaining uncertainties when looking at the individual (and overall low) event number in the ABCSG 12 trial, GnRHa and aromatase inhibitors (AI) are not considered a regular therapeutic option in premenopausal patients with endocrine sensitive disease (AGO –). Yet, the experts feel that GnRHa and AI may be considered in patients with severe contraindications against tamoxifen (AGO +/–). Based on the convincing data from MA17 [96], extended adjuvant therapy with an AI is a valid option for premenopausal patients that have become postmenopausal during Introduction