Adjuvant therapy with GnRH agonists/tamoxifen in breast cancer could be a good council for patients with hormone receptor-positive tumors and wish to preserve fertility (original) (raw)
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Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia, 2017
Aim To assess ovarian reserve (OVR) by means of follicle-stimulating hormone (FSH), anti-Müllerian hormone (AMH), and antral follicle count (AFC) measurement in eumenorrheic women with breast cancer, exposed to gonadotoxic chemotherapy. Method Fifty-two women (35.3 ± 3.8 years old) with breast cancer and undergoing cyclophosphamide-containing chemotherapy were enrolled. The assessment was performed before chemotherapy (T1) and after 2 (T2) and 6 months (T3). Results Six months after chemotherapy, the prevalence of regular cycles was 60%. Anti-Müllerian hormone decreased down to undetectable levels at T2 and T3 (T1: 2.53 [1.00-5.31]; T2 < 0.08; T3: < 0.08 [< 0.08-1.07] ng/mL), (p < 0.0001). Antral follicle count was 11 [8.0-13.5] follicles at T1 and lower at T2 (5.50 [3.75-8.0] and T3 (5.0 [2.5-7.0]) (p < 0.0001). In patients who remained with regular cycles during chemotherapy or resumed normal menses, FSH and estradiol levels remained unchanged. Conclusion Anti-Mülle...
Breast Cancer: Targets and Therapy, 2021
Over the last several decades, improvements in breast cancer treatment have contributed to increased cure rates for women diagnosed with this malignancy. Consequently, great importance should be paid to the long-term side effects of systemic therapies. For young women (defined as per guideline ≤40 years at diagnosis) who undergo chemotherapy, one of the most impactful side effects on their quality of life is premature ovarian insufficiency (POI) leading to fertility-related problems and the side effects of early menopause. Regimens, type, and doses of chemotherapy, as well as the age of patients and their ovarian reserve at the time of treatment are major risk factors for treatment-induced POI. For these reasons, childbearing desire and preservation of ovarian function and/or fertility should be discussed with all premenopausal patients before planning the treatments. This manuscript summarizes the available fertility preservation techniques in breast cancer patients, the risk of treatment-induced POI with different anticancer treatments, and the possible procedures to prevent it. A special focus is paid to the role of oncofertility counseling, as a central part of the visit in this setting, during which the patient should receive all the information about the potential consequences of the disease and of the proposed treatment on her future life.
Asia-Pacific journal of clinical oncology, 2017
The goal of this study is to evaluate possible factors affecting the survival of patients treated with gonadotropin-releasing hormone (GnRH) analogues. Demographic characteristics, treatment modalities, overall survival (OS) and the possible factors affecting the survival a total of 554 premenopausal breast cancer patients in Turkey evaluated retrospectively. The median duration of GnRH analogues use was 22 ± 13.6 (range, 1-87) months. Patients were divided into three groups according to the duration of GNRH analogues use; 4-12 months (Group A), 13-24 months (Group B) and ≥25 months (Group C). Overall, 530 patients were analyzed; 23.2%, 45.8%, 30.9% of the patients were in Group A, B and C, respectively. The median follow-up duration was 34 ± 30.3 (range, 4-188) months. The OS in patients ≤35 years of age was found to be significantly longer than that of patients >35 years of age in Group B (log rank, P = 0.023). The disease-free survival of the patients in Group A was significan...
Clinical Medicine Insights: Reproductive Health
Chemotherapy-induced premature ovarian insufficiency (POI) is one of the potential drawbacks of chemotherapy use of particular concern for newly diagnosed premenopausal breast cancer patients. Temporary ovarian suppression obtained pharmacologically with the administration of a gonadotropin-releasing hormone agonist (GnRHa) during chemotherapy has been specifically developed as a method to counteract chemotherapy-induced gonadotoxicity with the main goal of diminishing the risk of POI. In recent years, important clinical evidence has become available on the efficacy and safety of this strategy that should now be considered a standard option for ovarian function preservation in premenopausal breast cancer patients, including women who are not interested in conceiving after treatment or that would not be candidates for fertility preservation strategies because of their age. Nevertheless, in women interested in fertility preservation, this is not an alternative to gamete cryopreservati...
Fertility and Sterility, 2010
Fertility preservation is an important issue for young women diagnosed with breast cancer. The most well-established options for fertility preservation in cancer patients, embryo and oocyte cryopreservation, have not been traditionally offered to breast cancer patients as estradiol rise during standard stimulation protocols may not be safe for those patients. Potentially safer stimulation protocols using tamoxifen and aromatase inhibitors induce lower levels of estradiol while similar results in terms of number of oocyte and embryo obtained to standard protocols. Cryopreservation of immature oocytes and ovarian cortical tissue, both still experimental methods, are also fertility preservation options for breast cancer patients.
Frontiers in women's health, 2017
Background: Patients with cancer must be aware of preventive measures that can be undertaken to preserve their fertility before embarking on gonadotoxic therapy. Different theories have been published on the efficacy and the mechanism of action of gonadotropin releasing hormone agonists (GnRHa) in preventing ovarian failure. We hereof report our experience with the GnRHa, leuprolide (Lupron®), used before chemotherapy to preserve ovarian function concerning resumption of menses and fertility. Objective: To determine whether GnRHa could prevent the early onset of ovarian insufficiency and resume menses in patients with cancer who received chemotherapy. Methods: This is a retrospective case series that included all pre-menopausal women, who attended a tertiary referral center, between December 2010 and December 2015. Patients who are diagnosed with cancer had been referred from the oncology department before receiving chemotherapy. Women were given leuprolide (luteinizing hormone releasing hormone agonist) monthly, which was started before or at first chemotherapy cycle and continued every month until the last cycle of chemotherapy. The GnRHa was started 3-20 days before treatment. The main clinical endpoint was the recovery of menstruation after chemotherapy. The other end point was the rate of successful conception post chemotherapy. Results: Twelve patients were included in the study. Median age was 25.5 years (range 16-48); eleven patients (92%) were less than the age of 40. Most of the patients were single, nine (75%), and only three (25%) were married; two patients had infertility problems (16.7%). Patients received different regimens of chemotherapy, according to their type of cancer. Resumption of menstrual activity after chemotherapy was observed in 10 out of 12 patients (83.3%), and all were less than 40 years. The median time to recovery of menses was 2 to 3 months after cessation of chemotherapy. The paired t-test has shown that there is a statistical significant difference between of FSH serum level before and after administering Leuprolide (P = 0.025). On the other hand, there is moderate significant correlation (r = 0.285) between FSH serum level before and after administering Leuprolide. Conclusion: Current case series, suggests that use of GnRHa given with chemotherapy for cancer patients is successful in preventing chemotherapy-induced amenorrhea. Larger studies are needed to affirm this finding.
Endocrine treatment and prevention of breast and gynaecological cancers
European Journal of Cancer, 2002
From epidemiological studies, we know that total oestrogen exposure increases a woman's risk for developing breast and endometrial cancer. However, sex steroids do not damage epithelial cell DNA directly, but stimulate or inhibit epithelial cell proliferation resulting in a modulating role on tumour growth, developmental progression, invasion and metastasis. The last three decades have brought a variety of modalities that can intervene between oestrogen-and the oestrogen receptor (ER). In late stage cancer, such agents are able to stop tumoral growth in some oestrogen-sensitive tumours, while in early stage disease, after surgical removal of the tumour, adjuvant endocrine therapy may protect the remaining tissue and distant organs from becoming cancerous. Endocrine agents also have a promising role in the prevention of cancer in healthy 'atrisk' women.