Ovarian suppression during chemotherapy may prevent infertility in women with breast cancer

Issue: December 10, 2015

Temporary ovarian suppression during chemotherapy may reduce the risk for infertility in young women with breast cancer, according to results of a meta-analysis presented at the European Cancer Congress.

Matteo Lambertini, MD, medical oncologist at the IRCCS AOU San Martino-IST in Genoa, Italy, and colleagues found that luteinizing hormone-releasing hormone analogue (LHRHa) used during chemotherapy to preserve ovarian function may help women with breast cancer remain fertile and result in a higher rate of pregnancy.

Matteo Lambertini

“Chemotherapy can damage the ovaries and push young women into menopause,” Lambertini said in a press release. “They may experience infertility, sleep disturbance, sexual dysfunction and osteoporosis. It is psychologically distressing, harmful to health and affects the treatment decisions of many young women.

“We found that the temporary suppression of ovarian function with LHRHa significantly reduces the risk of premature ovarian failure caused by chemotherapy. It also seems to be associated with a higher pregnancy rate in young breast cancer patients.”

Pooling data from 12 randomized trials, Lambertini and colleagues evaluated data from 1,231 patients with breast cancer who were receiving chemotherapy.

The initial calculation determined that the rate of premature ovarian failure decreased 64% (OR = 0.36; 95% CI, 0.23-0.57) in patients who received LHRHa. However, there was significant heterogeneity in the data that was due mostly to varying definitions of premature ovarian failure.

In a secondary analysis — limited to trials that included specific data about the return of a woman’s menstrual cycle 1 year after chemotherapy — LHRHa appeared to reduce the rate of premature ovarian failure 45% (OR = 0.55; 95% CI, 0.41-0.73). Researchers noted there was no heterogeneity in these results.

Only five of the studies reported on pregnancies following treatment for breast cancer. Overall, there were 33 pregnancies among patients who received LHRHa and 19 among those who did not, equating to an 83% increase (OR = 1.83; 95% CI, 1.02-3.28) in the likelihood of becoming pregnant.

However, the use of LHRHa has been controversial, especially due to the potential for adverse effects among women with hormone receptor-positive breast cancer.

The 2015 St. Gallen International Expert Consensus panel and the National Comprehensive Cancer Network guidelines have been updated to recognize the role LHRHa plays in the prevention of premature ovarian failure induced by chemotherapy; however, these guidelines only acknowledge its benefits for hormone receptor-negative breast cancer.

ASCO and European Society for Medical Oncology guidelines have not been recently updated because LHRHa during chemotherapy is considered experimental due to a lack of long-term data on ovarian function and pregnancies, according to Lambertini.

However, data from two large studies — POEMS-SWOG S0230 and PROMISE-GIM6 — have become available since the last guideline update. Results from PROMISE-GIM6 showed LHRHa did not negatively impact DFS among women with hormone receptor-positive breast cancer.

“These data suggest that this strategy could be useful and safe not only in women with hormone receptor-negative breast cancer, but also in those with hormone receptor positive tumors who account for two-thirds of new cases of breast cancer in young women,” Lambertini said in the release. “In breast cancer patients, we believe there is now sufficient evidence to suggest that the administration of LHRHa could be considered a potential standard strategy to preserve ovarian function and might also play a role in increasing the likelihood of pregnancy after chemotherapy.”– by Anthony SanFilippo

Reference: Lambertini M, et al. Abstract 1957. Presented at: European Cancer Congress; Sept. 25-29, 2015; Vienna.

Disclosure: The researchers report no relevant financial disclosures.