Expert Consensus Standardizes Long-Term GnRHa Management for Premenopausal HR+ Breast Cancer

Premenopausal patients with hormone receptor-positive (HR+) breast cancer face a higher tumor heterogeneity, greater invasiveness, and poorer prognosis compared to postmenopausal patients, with a significant 20%-30% 5-year postoperative recurrence rate. Endocrine therapy, particularly ovarian function suppression (OFS) using gonadotropin-releasing hormone agonists (GnRHa), is crucial for reducing recurrence risk. While GnRHa combined with endocrine therapy is standard for intermediate- and high-risk patients, long-term use (beyond 5 years) lacks standardized guidelines for patient selection, management, and drug switching, potentially impacting adherence and prognosis.

A panel of experts from the Committee of Breast Cancer Society of Chinese Anti-Cancer Association and other organizations developed this consensus using the Delphi method. They synthesized domestic and international evidence-based medical evidence alongside clinical practice in China. The primary objective was to standardize the long-term application and management of gonadotropin-releasing hormone agonists (GnRHa) for premenopausal HR+ breast cancer patients. This involved addressing appropriate patient populations for GnRHa use beyond 5 years, long-term management strategies, and drug switching approaches to provide a clear clinical reference.

This expert consensus reaffirms that gonadotropin-releasing hormone agonists (GnRHa) combined with endocrine therapy is the standard for intermediate- and high-risk premenopausal HR+ breast cancer patients, with a recommended treatment duration of 5 years. It acknowledges that extended treatment beyond 5 years may be considered for selected high-risk patients, given the 20%-30% 5-year postoperative recurrence rate in this population. The consensus identifies critical gaps in current practice, specifically the lack of standardization for GnRHa use beyond 5 years, long-term management strategies, and appropriate drug switching approaches.

The consensus aims to standardize these aspects, providing clinicians with a clear reference to help patients complete planned treatment courses and improve long-term prognosis and quality of life.