Ovarian Suppression Before Chemotherapy Can Preserve Fertility in Young Patients With Breast Cancer

By Alex Morrisson

SAN ANTONIO, Tex -- December 12, 2017 -- Premenopausal women who are diagnosed with breast cancer and require adjuvant chemotherapy can increase their chances of regaining fertility after their treatment when they undergo ovarian function suppression before they take cytotoxic regimens, according to a study presented here at the 2017 Annual San Antonio Breast Cancer Symposium (SABCS).

“Premature ovarian insufficiency is a common side effect of chemotherapy in premenopausal women [and has] a substantial negative impact on their quality of life,” said Matteo Lambertini, MD, European Society for Medical Oncology, Institut Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium, on December 7. “Oocyte/embryo cryopreservation is standard strategy for fertility preservation, but [it does] not prevent the risk of premature ovarian insufficiency. Temporary ovarian suppression during chemotherapy has been studied in several randomised controlled trials as a strategy to preserve ovarian function and potential fertility. However, the data are mixed, and its role remains controversial.”

The researchers performed a meta-analysis of 5 studies, which included 436 patients who received ovarian suppression with gonadotropin-releasing hormone analogues (median age, 38 years) and 437 patients as controls (median age, 39 years). The primary endpoints were the rates of premature ovarian insufficiency and pregnancy at the end of the trials.

Among patients who were given temporary ovarian suppression, the rate of premature ovarian insufficiency at the end of the trials was 14.1%, but the rate in the control subjects was 30.9% (P < .001).

The posttreatment pregnancy rate in the women receiving ovarian suppression was 10.3%, versus 5.5% among controls (P = .030).

After 2 years, 18.2% of the ovarian-suppression group versus 30.0% of the control group experienced amenorrhoea, said Dr. Lambertini, noting that amenorrhoea is another marker of difficulty in regaining fertility.

Disease-free survival was no different between patients who had ovarian suppression and those who did not, which showed that ovarian suppression did not compromise oncology-related survival. Overall survival was numerically higher in the ovarian-suppression group, but that difference did not achieve statistical significance (P = .083).

As a meta-analysis, the study had multiple limitations, Dr. Lambertini acknowledged, including the number of women who sought to regain fertility or have children.

The researchers concluded that temporary ovarian suppression with gonadotropin-releasing hormone analogues during chemotherapy should be considered a new standard option to reduce the risk of premature ovarian insufficiency and possibly improve future fertility in premenopausal patients with early breast cancer.

[Presentation title: 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. Abstract GS4-01]
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