NEW YORK (Reuters Health) – A Canadian guideline on ovarian ablation in premenopausal women with breast cancer has been endorsed by the American Society of Clinical Oncology (ASCO), including the recommendation that ovarian ablation should not be routinely added to systemic therapy.

The authors of the report in the Journal of Clinical Oncology online September 5 explain that ASCO reviews and endorses clinical practice guidelines developed by other organizations to expand the number of high-quality guidelines available.

In this instance, an ad hoc ASCO panel reviewed the Cancer Care Ontario (CCO) Guideline on Adjuvant Ovarian Ablation in the Treatment of Premenopausal Women With Early-Stage Invasive Breast Cancer – specifically, hormone receptor-positive cancer.

The CCO guideline is based on evidence derived from 22 unique randomized clinical trials, according to the paper, as well as two individual patient data meta-analyses, one trial-based meta-analysis, and three additional systematic reviews.

The ASCO review panel found that the CCO recommendations “are clear, thorough, based on the most relevant scientific evidence in this content area, and present options that will be acceptable to patients.”

Lead author Dr. Jennifer J. Griggs, with the University of Michigan Health System, Ann Arbor, and colleagues say the key recommendations are:*Ovarian ablation should not be routinely added to systemic therapy or used as an alternative to systemic therapy.*Ovarian ablation should only be considered for women who cannot tolerate or decline systemic therapy.*When ovarian ablation is considered using LHRH agonists, monthly injections are recommended.

The CCO guideline does point out that there is no evidence to choose between surgical oophorectomy, ovarian irradiation, or medical suppression for ovarian ablation. The ASCO group adds a caveat that ovarian suppression is not always successful using LHRH agonists.

Overall, the authors conclude, “The ASCO review panel agrees with the recommendations as stated in the CCO guideline, with the qualification that ongoing research studies may alter the recommendations of the panel.”

Reference:
American Society of Clinical Oncology Endorsement of the Cancer Care Ontario Practice Guideline on Adjuvant Ovarian Ablation in the Treatment of Premenopausal Women With Early-Stage Invasive Breast Cancer
J Clin Oncol 2011;29.