This Journal of Clinical Oncology article concerns the use of hormone replacement therapy in ovarian cancer patients.
The surgical treatment of epithelial ovarian cancer (EOC) results in the abrupt induction of menopause in pre- and perimenopausal women, who account for approximately 20% of all patients with ovarian cancer. The loss of ovarian estrogen results in disruptive vasomotor symptoms, which can negatively affect quality of life, increases the risk of bone loss and fractures, and increases the risk of coronary heart disease (CHD). These adverse effects of the loss of ovarian function can be readily treated with hormone replacement therapy (HRT). However, many physicians treating patients with ovarian cancer have been reluctant to use HRT.
Adjuvant Hormone Therapy May Improve Survival in Epithelial Ovarian Cancer: Results of the AHT Randomized Trial
Purpose To assess the effects of adjuvant hormone therapy (AHT) on survival and disease outcome in women with epithelial ovarian cancer.
Patients and Methods Participants were premenopausal and postmenopausal women who had been diagnosed with epithelial ovarian cancer (any International Federation of Gynecology and Obstetrics stage) 9 or fewer months previously. Ineligible patients included those with deliberately preserved ovarian function, with a history of a hormone-dependent malignancy, or with any contraindications to hormone-replacement therapy. Patients were centrally randomly assigned in a 1:1 ratio to either AHT for 5 years after random assignment or no AHT (control). Main outcome measures were overall survival (OS), defined as time from random assignment to death (any cause), and relapse-free survival, defined as time from random assignment to relapse or death (any cause). Patients who continued, alive and relapse free, were censored at their last known follow-up.
Results A total of 150 patients (n = 75, AHT; n = 75, control) were randomly assigned from 1990 to 1995 from 19 centers in the United Kingdom, Spain, and Hungary; all patients were included in intention-to-treat analyses. The median follow-up in alive patients is currently 19.1 years. Of the 75 patients with AHT, 53 (71%) have died compared with 68 (91%) of 75 patients in the control group. OS was significantly improved in patients who were receiving AHT (hazard ratio, 0.63; 95% CI, 0.44 to 0.90; P = .011). A similar effect was seen for relapse-free survival (hazard ratio, 0.67; 95% CI, 0.47 to 0.97; P = .032). Effects remained after adjustment for known prognostic factors.
Conclusion These results show that women who have severe menopausal symptoms after ovarian cancer treatment can safely take hormone-replacement therapy, and this may, in fact, infer benefits in terms of OS in addition to known advantages in terms of quality of life.
Eeles RA, Morden JP, Gore M, et al. Adjuvant hormone therapy may improve survival in epithelial ovarian cancer: Results of the adjuvant hormone therapy randomized trial. J Clin Oncol, doi: 10.1200/JCO.2015.60.9719.
Content updated 16 October 2015