Goserelin a Good Alternative to Chemotherapy.

SAN ANTONIO -- Goserelin is an attractive alternative to adjunctive chemotherapy in many women with early breast cancer, Dr. Walter Jonat said at a breast cancer symposium sponsored by the San Antonio Cancer Institute.

Monotherapy with the GnRH agonist analogue goserelin (Zoladex) displayed therapeutic efficacy equal to that of triple-drug chemotherapy but with substantially fewer side effects and better quality of life in peri- or premenopausal patients with estrogen receptor--positive, lymph node--positive breast cancer in the Zoladex Early Breast Cancer Research Association (ZEBRA) trial, reported Dr. Jonat of the University of Kiel, Germany.

ZEBRA was a 102-center controlled trial in which 1,614 pre- or perimenopausal patients underwent breast cancer surgery and were then randomized to 2 years of goserelin monotherapy or 6 months of adjunctive chemotherapy with cyclophosphamide, methotrexate, and 5-fluorouracil.

After 3 years of follow-up in the Astra-Zeneca-sponsored trial, disease-free survival in the 1,189 patients with estrogen receptor--positive tumors was identical regardless of whether they received goserelin or chemotherapy. But adverse effects were much fewer with goserelin therapy.

Goserelin also proved more convenient, being given by monthly injection, while combination chemotherapy required frequent lengthy visits to the hospital or clinic.

During the 6 months that the patients were on chemotherapy, their overall quality-of-life scores, activity level, physical distress score, and effort to cope with illness were significantly worse than in the goserelin group, Dr. Jonat said.

Side effects of chemotherapy consisted chiefly of nausea, vomiting, and hair loss, while goserelin-treated patients complained of hot flashes and vaginal dryness during the 2 years that they were on the medication.