Tailor the adjuvant hormonal manipulation for premenopausal breast cancer patients

The 2016 publication titled “The hormonal manipulation 5-Fluoro-uracil Epirubicin Cyclophosphamide (HMFEC) trial” in the European Journal of Cancer provided an opportunity to revisit the adjuvant HM of premenopausal breast cancer (BC) patients (1). In the HMFEC study, premenopausal BC patients with positive lymph node involvement were randomized in a 2×2 factorial fashion to groups either administered FE50C vs. FE75C followed by HM or no HM. Gonadotrophin-releasing hormone agonists (GnRHa) were used for HM if patients retained menstrual cycle after chemotherapy; for patients became amenorrhea after chemotherapy, tamoxifen was administered. As expected, HM benefit was not seen in ER-negative population. In the ER-positive/ER-unknown subpopulation, the HM provided modest and nonsignificant recurrence reduction [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.62–1.17, P=0.32] (1).