No Decrease in Chemotherapy-Induced Premature Ovarian Failure with Triptorelin

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(ChemotherapyAdvisor) – Use of the gonadotropin-releasing hormone (GnRH) agonist triptorelin did not significantly decrease risk of chemotherapy-induced premature ovarian failure after 1 year of follow-up in young patients treated for Hodgkin or non-Hodgkin lymphoma, according to a study in the Journal of Clinical Oncology online November 5.

Triptorelin may, however, provide protection of the ovarian reserve, noted Isabelle Demeestere, MD, PhD, of the Universite´ Libre de Bruxelles, Brussels, Belgium.

The investigators randomly assigned patients 18 to 45 years of age to triptorelin plus norethisterone or norethisterone alone, both with alkylating agents. Primary end point was rate of premature ovarian failure, defined as follicle-stimulating hormone (FSH) ≥40 IU/L after 1 year of follow-up.

Of the 129 patients, 84 completed the study. Although mean FSH values were higher in the norethisterone alone arm than in the triptorelin arm during chemotherapy, this difference was not observed after 6 months of follow-up.

After 1 year, 20% of patients in the triptorelin arm and 19% in the control arm exhibited premature ovarian failure (P=1.00), they found.

“More than half of patients in each group completely restored their ovarian function (FSH <10 IU/L),” Dr. Demeestere noted. Anti-Müllerian hormone values were higher in the triptorelin arm (1.4 ± 0.35 ng/mL) than in the control arm (0.5 ± 0.15 ng/mL; P=0.040).

Metrorrhagia was more frequently observed in the control arm (38.4%) than in the triptorelin arm (15.6%; P=0.024).

The authors concluded that although this study did not provide evidence that triptorelin prevents premature ovarian failure, a long-term benefit of the GnRH agonist “on fertility of patients who spontaneously experience restoration of ovarian function” is suggested.

“However, until long-term results confirm the benefit of GnRH agonists to improve future fertility, the treatment should not be administered to prevent premature ovarian failure apart from in experimental protocols.”


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