From the Guidelines
Zoladex (Goserelin) plays a crucial role in cancer treatment by inducing ovarian suppression or failure, which is often used in combination with other therapies such as aromatase inhibitors or bisphosphonates to prevent bone loss and reduce the risk of fractures in patients with breast or prostate cancer.
Key Points
- Goserelin is a gonadotropin-releasing hormone agonist that can cause bone loss due to its effect on hormone deprivation therapies 1.
- The combination of goserelin with bisphosphonates such as zoledronic acid (ZOL) can prevent bone loss in premenopausal women with breast cancer 1.
- ZOL has been shown to increase bone mineral density (BMD) in the lumbar spine and hip, and reduce the risk of fractures in patients with breast cancer 1.
- The use of ZOL in combination with goserelin and other therapies is well tolerated, with no reported cases of osteonecrosis of the jaw (ONJ) or significant effects on renal function 1.
- The European panel recommends the use of ZOL in premenopausal women with breast cancer who are at risk of bone loss due to ovarian suppression or failure, with a dose of 4 mg every 6 months 1.
Bisphosphonates and Bone Health
- Bisphosphonates such as ZOL, ibandronate, clodronate, risedronate, and alendronate have been shown to prevent bone loss and reduce the risk of fractures in patients with breast cancer 1.
- The choice of bisphosphonate depends on the individual patient's risk factors and medical history, with ZOL being the most potent available bisphosphonate 1.
- Denosumab, a more potent osteoclast inhibitor, has also been shown to halve the incidence and significantly extend the time to first clinical fracture in post-menopausal women receiving aromatase inhibitors 1.
From the Research
Role of Zoladex (Goserelin) in Cancer Treatment
- Zoladex (Goserelin) is a gonadotropin-releasing hormone analogue that reduces plasma/serum estrogen levels in pre- or perimenopausal women to postmenopausal levels 2
- It is indicated in hormone receptor-positive early breast cancer in pre- or perimenopausal women and has similar efficacy to adjuvant chemotherapy in this population group 2
- The addition of Goserelin to adjuvant chemotherapy appears to offer an advantage over chemotherapy alone in younger patients 2
- Goserelin has been shown to be effective in the treatment of metastatic breast cancer in pre- and perimenopausal women, with objective response rates comparable to those seen following oophorectomy 3
Benefits of Goserelin in Breast Cancer Treatment
- Goserelin provides a valuable addition to the currently available options for treating pre- or perimenopausal women with hormone therapy-responsive early breast cancer 2
- It offers a highly effective and reliable method of achieving amenorrhea, which has been associated with an improved prognosis in patients with hormone-sensitive, early breast cancer 4
- The reversibility of amenorrhea upon cessation of Goserelin treatment may confer long-term advantages compared with permanent methods of ovarian ablation 4
- Goserelin has been shown to be equivalent to cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) chemotherapy in patients with estrogen receptor-positive, node-positive early breast cancer 5
Combination Therapy with Goserelin
- The combination of Goserelin with the peripheral estrogen antagonist, tamoxifen, may be used to produce 'combined estrogen blockade' 6
- This regimen has been shown to prolong progression-free survival and increase both the response rate and duration relative to the use of a GnRH agonist alone in advanced breast cancer 6
- The addition of Goserelin to 'standard treatment' (i.e. surgery +/- tamoxifen, chemotherapy or radiotherapy) results in a significant benefit in recurrence-free survival and overall survival in patients with early breast cancer 6