Case: Premenopausal HR and young patients with moderate-risk breast cancer endocrine treatment thinking.

!---- Case Profile 1 Basic Situation: Patient, Female, Unmenopausal.was born in 1982, personal history, past history, tumor family history are not special.2 medical history introduction: patients due to "discovery of left breast lump more than 3 months later" in October 2017 in my hospital outpatient mammograms, the results suggest: left breast 10 o'clock direction from the nipple 2 cm found the size of about 3.5 cm x 2.0 cm low weak echo group, the boundary is not clear, the shape is more regular, the inner visible weakness echo, no visible blood flow signal significantly increased.left breast puncture results show: left leachate detection of immersive catheter cancer, estrogen receptor (ER, strong, 95%), progesterone receptor (PR, medium, 80%), HER2 (-), Ki-67 (plus, about 10%).3 surgical treatment after: November 2017 patients due to "left breast cancer" in our hospital line "left breast skin under the simple removal of the left breast post-left mastion leg removal biopsy . . . left armpit 1, 2 level sly lymph nodes cleaning and left breast muscle after the prosthesis implanted breast reconstruction", postoperative pathology: "left breast-soaked catheter izedomyoma (level 3), left armpit outpost lymph nodes 1/4 detection macro metastasis, left armpit 1, 2 horizontal lymph nodes 10 unmet metastasis; left breast tumor 3.4 cm x 1.4 cm x 1.6 cm, immunohistyization show: ER (plus, strong, 90%), PR (medium, 50%), HER2 (--Ki), Ki-67 (plus, about 30-40%).was diagnosed with left breast-soaked catheter cancer (pT2N1M0, Phase II.B, molecular distype: Luminal B, HER2-).4 postoperative assisted therapy after: 6 cycles of chemotherapy in December 2017 with TC (dossitaande and cycloamide), chemotherapy with gosherrylin, which began two weeks prior to chemotherapy, assisted endocrine therapy after chemotherapy in June 2018, and end-of-surgery follow-up.think about the beneficiaries of OFS on treatment options? In the ASTRRA study, the TREATMENT of TAM 5 years combined with ovarian function inhibition (OFS) was 2 years compared with TAM treatment for 5 years, significantly improving the 5-year disease-free survival (DFS) rate, with an absolute benefit rate of 3.6%, while significantly improving total survival (OS), reducing the risk of death by 69%, so the benefits of OFS joint endocrine therapy were more pronounced for patients with premenopausal HR plus high-risk patients.8 years of follow-up studies of SOFT, of ofs combined endocrine therapy significantly improved the DFS rate (83.2% vs. 78.9%, P-0.009) and OS (93.3% vs. 91.5%, P-0.01); the results of theHOBOE-2 study showed that the use of OFS plus aromatase inhibitors (AI) for patients with premenopausal HR plus aromatase (AI) was 93.2%, and the 5-year DFS of OFS-AI-slysic acid was 93.3%, compared with the significant improvement of DFS (HR-0.52, P-003) in patients with POSTmenopausal HR-s.comm.based on evidence-based medical evidence and combined with national conditions, put forward in the consensus of Chinese experts: for premenopausal HR-plus early breast cancer risk and high risk patients, or steep analysis of higher-risk patients, recommended OFS joint AI treatment, OFS combined TAM treatment is also a reasonable choice.recommend of OFS joint AI treatment for any risk level patient with A TAM taboo certificate.St. Gallen Consensus recommends the following: For the choice of ovarian function inhibition in endocrine therapy, experts in the St. Gallen Consensus assess risk factors and, in numerous indications, suggest that patients with risk seis recommend joint OFS treatment.of OFS's ways and choices? The ways of ovary function inhibition are radiation deposition, surgical de-potential, drug deposition.no matter what ovarian function inhibition, the goal is to control the body's estrogen levels within the required range.radiation deposition does not reduce serum estradiol levels by 100%, failure rate is as high as 40%, there is a potential risk of permanent removal of ovarian function, therefore, clinically less used.the advantage of surgery de-egoing is to reduce serum estradiol immediately after surgery and enter menopause, but there are other risks of anesthesia and surgery, and permanent removal of the ovaries.drug-deprecation gonadotropin release hormone agonisant (GnRHa) inhibits estrogen levels in the serum to a degree comparable to surgical de-ative effectiveness, and has a reversible effect that preserves fertility.Intergroup study in patients with metastatic breast cancer, which was positive for premenopausal hormone receptors, showed that Goscherin was as effective as surgery in the treatment of breast cancer, and was safe and well tolerated.IBCSG VIII study found that goschererin's action was reversible after discontinuation, retaining fertility, and after 24 months of Goschererin treatment, 90 percent of patients aged 39 and older resumemens within 1 year, and 50 percent of patients aged 40 and older resume menstrual in 1 year. CanOFS be used in sync with chemotherapy? The order, sequence or synchronization of chemotherapy and OFS treatment? The SOFT/TEXT study provides some discussion.TEXT study, patients planning chemotherapy were treated with OFS-synchronous chemotherapy.results show that of OFS Joint AI and OFS Joint TAM, the five-year disease-free survival rate was 89.8% and 84.6%, respectively, and the 8-year disease-free survival rate was 86.8% and 82.8%, respectively.PATIENTs in the SOFT study group who underwent chemotherapy were given OFS within 8 months of the final chemotherapy confirmation.results show that the five-year disease-free survival rate of OFS Joint AI and OFS Joint TAM was 84.3% and 80.6%, respectively, and the 8-year disease-free survival rate was 85.9% and 83.2%, respectively.8 years of OS subgroup analysis, chemotherapy at the same time to OFS endocrine therapy (TEXT study) than after chemotherapy sequence OFS endocrine therapy (SOFT study) OS benefit.released a study by Professor Lin Ying of Sun Yat-sen University's First Hospital at the 2019 annual meeting of the American Society of Clinical Oncology (ASCO), based on the Bayesian Network Meta analysis to evaluate the choice of three endocrine therapy options (TAM, OFS,TAM, OFS-AI) for chemotherapy synchronization or serialisation.results showed no statistical differences in the benefits of DFS and OS between the three treatment regimens.however, using Bayesian algorithm to sequence the treatment effect data of different treatment options, DFS and OS benefit, found that TAM sequential chemotherapy ranked higher than synchronous treatment, while endocrine therapy with OFS program in DFS and OS benefit ranking, synchronous chemotherapy effect is relatively better than sequential treatment.therefore, it is recommended that treatment containing OFS should be treated with simultaneous chemotherapy.Lu Qing, Professor, Doctoral Tutor, Chief Physician, Director of Breast Surgery, Sichuan University Huaxi Hospital, Deputy Director of The Clinical Research Center for Breast Diseases, 11th batch of academic and technical leaders of the Sichuan Provincial Committee, Sichuan Provincial People's Government, and Director of the 2nd Sichuan Breast Medical Association Member, Member of the Standing Committee of the 2nd China Physicians Association Breast Disease Training Committee, Chairman of the First Sichuan Physicians Association Breast Disease Committee, Deputy Chairman of the 1st and 2nd Sichuan Cancer Association Breast Cancer Committee, and Deputy Chairman of the 1st and 2nd Sichuan Preventive Medical Association Breast Cancer Prevention and Control Committee.Lu Qing Source: Igriny !-- Content Presentation Ends - !-- Determine signed-up ends.