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For women who receive chemotherapy, the timing of the initiation of ovarian suppression is worthy of consideration. TEXT and SOFT differed with respect to the approach to the initiation of ovarian suppression in women who received chemotherapy. Patients in TEXT began receiving adjuvant ovarian suppression with triptorelin concurrently with chemotherapy, an average of 1.2 months after surgery; patients assigned to exemestane plus ovarian suppression had a rate of freedom from breast-cancer recurrence at 5 years of 91.5% (Fig. S3 in the ), despite the fact that 66% of the women in TEXT who received chemotherapy had node-positive disease. The early initiation of ovarian suppression to target the estrogen-receptor pathway concurrently with chemotherapy deserves further investigation.

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