GnRHa Therapy Aids Menses Recovery In Early-Stage Breast Cancer Patients

Evidence supports the use of gonadotropin-releasing hormone agonists for recovery of menses in young early-stage breast cancer patients

medwireNews:The gonadotropin-releasing hormone agonists (GnRHa) goserelin, triptorelin and leuprolide protect again premature menopause in young women undergoing chemotherapy for early-stage breast cancer, meta-analysis confirms.

Women aged 18–49 years who began GnRHa therapy in the week or 2 before chemotherapy were significantly more likely to have regular menses 6 months after the last chemotherapy cycle and after 12–24 months than those who did not, with odds ratios (ORs) of 2.41 and 1.85, respectively.

However, the authors caution in JAMA Oncology that the seven open-label clinical trials in the meta-analysis, including 856 patients with evaluable data, had inadequate information to allow comparisons of post-chemotherapy levels of estradiol and follicle-stimulating hormone with or without GnRHa therapy.

Moreover, although women using GnRHa had a significantly higher number of pregnancies than controls (OR=1.85), pregnancy rates and fertility were not the primary endpoint of any of the included trials and there was not complete information on the total number of attempted pregnancies.

Acknowledging that recovery of menses – used in the meta-analysis as a surrogate for ovarian function – does not necessarily equal fertility restoration, Rodrigo Munhoz, from Hospital Sírio Libanês in São Paulo, Brazil, and co-authors emphasise that “[t]herefore,the true effect of GnRHa in fertility remains unclear”, and further investigation is necessary to determine the impact on ovarian function and fertility.

Nevertheless, they observe that trials which included data on adverse effects during GnRHa described the treatment as “tolerable”, with little difference in the rates of side effects between women given and not given the agents.

“Currently available guidelines consider the use of GnRHa as experimental”, Rodrigo Munhoz et al. conclude.

“This study provides evidence suggesting that GnRHa given concurrently with chemotherapy to premenopausal patients undergoing treatment for [early-stage breast cancer] may be used to prevent early menopause.”

Reference

Munhoz RR, Pereira AAL, Sasse AD, et al. Gonadotropin-releasing hormone agonists for ovarian function preservation in premenopausal women undergoing chemotherapy for early-stage breast cancer.A Systematic Review and Meta-analysis. JAMA Oncol 2015; Advance online publication 1 October.doi:10.1001/jamaoncol.2015.3251 

Oktay K, Turan V. Failure of ovarian suppression with gonadotropin-releasing hormone analogs to preserve fertility. An assessment based on the quality of evidence. JAMA Oncol 2015; Advance online publication 1 October.doi:10.1001/jamaoncol.2015.3252

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