Goserelin Reduces Ovarian Failure Risk from Breast Cancer Chemotherapy

POEMS confirms fertility benefits of goserelin treatment in premenopausal breast cancer patients

medwireNews: Results from the Prevention of Early Menopause Study (POEMS) support the use of the gonadotropin-releasing hormone (GnRH) agonist goserelin for women undergoing cyclophosphamide-based chemotherapy for operable hormone Receptor-negative breast cancer.

“POEMS is the first study to provide strong evidence that fertility prospects are improved following ovarian suppression during chemotherapy”, commented lead author Halle Moore, from the Cleveland Clinic Foundation in Ohio, USA, in a press release.

“Preserving ovarian function is a vital survivorship issue for young breast cancer patients. In addition to improving prospects for fertility, this intervention should help avoid a variety of unwanted effects of early menopause.”

The primary endpoint of ovarian failure at 2 years, defined as absence of menses in the past 6 months and postmenopausal levels of Follicle-stimulating hormone, occurred in 8% of the 66 goserelin-treated patients compared with 22% of the 69 patients given chemotherapy alone, giving a significant odds ratio of 0.30.

Interpretation of this finding was “complicated” by missing data, the authors explain, with primary endpoint results available for only 135 of the 257 patients originally enrolled in the study.

However, the team was able to show there was no imbalance in the missing data between the two treatment groups and used sensitivity analysis to confirm that there was a “consistent benefit of goserelin in preserving ovarian function”.

Receipt of goserelin was also associated with a significantly higher pregnancy rate than chemotherapy alone, with at least one pregnancy reported for a respective 21% and 11% of the 218 patients who were evaluated.

The 4-year estimates of disease-free and overall survival rates among these patients were significantly higher in the goserelin-treated patients than controls, at 89% versus 78%, and 92% versus 82%, respectively. And overall survival continued to be significantly higher with goserelin treatment when considering all 257 patients.

Halle Moore et al note that these survival benefits were “unexpected” for hormone receptor-negative patients. While unable to draw any conclusions on this potential therapeutic effect, the authors suggest that the “favorable disease-related outcomes confirm the safety of concurrent administration of a GnRH agonist with chemotherapy in patients with [Oestrogen receptor] (ER)-negative breast cancer.”

They add: “Ovarian protection would also be anticipated with the use of GnRH analogues in young women with non breast cancer who are receiving treatment with similar cyclophosphamide-based chemotherapy.”

Reference

Moore HCF, Unger JM, Philips K-A, et al. Goserelin for ovarian protection during breast-cancer adjuvant chemotherapy. N Engl J Med 2015; 372: 923–932. DOI: 10.1056/NEJMoa1413204

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