July 22nd, 2011

Ovarian Suppression During Chemotherapy May Help Preserve Ovarian Function


Among young women receiving chemotherapy for early-stage breast cancer, use of a drug that suppresses ovarian function may reduce the risk of early menopause. These results were published in the Journal of the American Medical Association.

Roughly six percent of women with breast cancer are diagnosed before the age of 40. Many of these women are treated with chemotherapy and/or hormonal therapy and are at risk of early menopause as a result of treatment. Consequences of early menopause include infertility and symptoms such as hot flashes.

Young women with cancer who wish to preserve their fertility may be able to freeze embryos, eggs, or ovarian tissue before cancer treatment begins. Protection of the ovaries during treatment may also help to preserve ovarian function and fertility, but there have been no standard strategies for preventing chemotherapy-induced ovarian failure.

Drugs known as gonadotropin-releasing hormone (GnRH) analogues suppress ovarian function. In order to assess whether use of one of these drugs (triptorelin) during chemotherapy protects the ovaries from chemotherapy-induced damage, researchers conducted a Phase III clinical trial. The study enrolled 281 premenopausal women with Stage I through Stage III breast cancer. All study participants were candidates for chemotherapy.

Study participants were assigned to receive chemotherapy alone or in combination with triptorelin. For women in the triptorelin group, triptorelin was given at least one week prior to the start of chemotherapy and then every four weeks during chemotherapy.

The primary outcome of interest was early menopause. This was defined as postmenopausal hormone levels and no resumption of menstrual cycles one year after the last cycle of chemotherapy.

  • One year after the last cycle of chemotherapy, the rate of early menopause was 26% among women in the chemotherapy-alone group and 9% among women in the chemotherapy-plus-triptorelin group.

A potential concern with this approach is that preservation of ovarian function could increase risk of recurrence among women with hormone receptor-positive breast cancer. To address this concern, study participants with hormone receptor-positive breast cancer and resumption of ovarian function (as evidenced by a menstrual cycle or premenopausal hormone levels) were put back on triptorelin until the ovaries had been suppressed for at least two years. Study participants with hormone receptor-positive breast cancer also received tamoxifen for five years.

This study suggests that use of a GnRH analogue during chemotherapy may reduce the risk of early menopause among young women with breast cancer. The study did not, however, address the impact of GnRH use on breast cancer outcomes.

Young breast cancer patients who wish to preserve their fertility and/or ovarian function are advised to discuss the available options with their physician before treatment begins.

Reference: Del Mastro L, Boni L, Michelotti A et al. Effect of the gonadotropin-releasing hormone analogue triptorelin on the occurrence of chemotherapy-induced early menopause in premenopausal women with breast cancer. A randomized trial. Journal of the American Medical Association. 2011;306:269-276.

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Tags: Breast Cancer, News, Stage I Node Negative Breast Cancer, Stages II-III Breast Cancer, Uncategorized