Temporary Ovarian Suppression Helps Preserve Ovarian Function After Breast Cancer Chemotherapy

For premenopausal women undergoing early-stage breast cancer treatment, temporary gonadotropin-releasing hormone analogue therapy may help preserve ovarian function and fertility

medwireNews: Gonadotropin-releasing hormone analogue (GnRHa) therapy during premenopausal breast cancer neoadjuvant or adjuvant chemotherapy significantly reduces the risk of treatment-induced premature ovarian insufficiency (POI), confirms a pooled analysis of data from five trials.

As reported at the 2017 San Antonio Breast Cancer Symposium in Texas, USA, the research also demonstrated a higher rate of post-treatment pregnancy with GnRHa therapy, without impacting survival outcomes.

“This study provides level 1A of evidence for the efficacy and safety of temporary ovarian suppression with GnRHa during chemotherapy in premenopausal early breast cancer patients”, summarised presenting author Matteo Lambertini, from Institut Jules Bordet and Université Libre de Bruxelles in Belgium, and team.

The researchers collated information from the PROMISE-GIM6 and the Moffitt-led trials of triptorelin and the POEMS/SWOG S0230, GBG-37 ZORO and Anglo Celtic Group OPTION studies of goserelin, all of which used varying durations of amenorrhoea to define the primary endpoint of POI.

In all, 436 patients were randomly assigned to receive GnRHa during anthracycline and/or taxane-based chemotherapy, while 437 patients received chemotherapy alone.

The rate of POI was significantly lower for the patients given GnRHa than those who were not, at 14.1% versus 30.9%, giving an odds ratio (OR) of 0.38 after adjustment for age, oestrogen receptor status, and type and duration of chemotherapy.

At 1 year, amenorrhoea was present in a similar proportion of GnRHa-treated patients and controls (36.8 vs 40.4%) but by 2 years, significantly fewer patients using GnRHa were amenorrhoeic, at 18.2% versus 30.0% and an adjusted OR of 0.51.

Post-treatment, 10.3% of the patients given GnRHa achieved pregnancy versus 5.5% of controls, resulting in a significant incidence rate ratio of 1.83.

Finally, disease-free survival and overall survival were comparable between patients given GnRHa and controls, with nonsignificant adjusted hazard ratios of 1.01 and 0.67, respectively.

“Given the findings of this pooled analysis, temporary ovarian suppression with GnRHa during chemotherapy should be considered as a new standard option to reduce the likelihood of chemotherapy-induced [POI] and possibly improve future fertility in premenopausal early breast cancer patients”, the researchers concluded.

Reference

Lambertini M, Moore HCF, Leonard RCF, et al. Pooled analysis of five randomized trials investigating temporary ovarian suppression with gonadotropin-releasing hormone analogs during chemotherapy as a strategy to preserve ovarian function and fertility in premenopausal early breast cancer patients. San Antonio Breast Cancer Symposium; Texas, USA: 5–9 December 2017.

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