Deciding whether to have a child—or more children—is a decision that takes on immediacy when a premenopausal woman is diagnosed with early stage breast cancer.
Yet, of the approximately 80 000 women who are diagnosed with cancer in their reproductive years, only about half discuss options for fertility preservation with their oncologists, a decision that can lead to life-long regret.
American Society of Clinical Oncology (ASCO) guidelines recommend embryo or oocyte cryopreservation as standard procedure for fertility preservation in women with cancer.1
However, “no proven methods for preservation of ovarian function are yet available,” according to Lambertini and colleagues, authors of a JAMA study on the use of temporary ovarian suppression with the luteinizing hormone-releasing hormone analogue (LHRHa) triptorelin during chemotherapy for breast cancer.2
Considered an “experimental strategy to preserve ovarian function and fertility, mainly because of the lack of data on long-term ovarian function and pregnancies,” the study results supported the use of LHRHa as “an option to preserve ovarian function in premenopausal women with early stage breast cancer receiving adjuvant chemotherapy.”
In the group that received triptorelin, the 5-year cumulative incidence estimate of menstrual resumption was 73% and there were 8 pregnancies, compared with 64% and 3 pregnancies in the control group.
The 5-year disease-free survival was 80.5% in the LHRHa group and 84% in the control group, with the increased but statistically nonsignificant risk appears specific to patients with tumors that were hormone receptor-negative.
Previously, Moore and colleagues found that goserelin, when administered with chemotherapy, “appeared to protect against ovarian failure, reducing the risk of early menopause and improving prospects for fertility.”3
Ann H. Partridge, MD, MPH, of Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School in Boston, MA, wrote in an editorial in JAMA that the Lambertini and colleagues study represented the largest randomized controlled trial to date “testing the use of LHRHa for preservation of menses, ovarian function, and fertility in young women with breast cancer.”
In her editorial, she wrote that “in contrast to a number of the prior studies, the trial included predominantly women with estrogen receptor–positive breast cancer (80%) and is thus generalizable to the majority of young women with breast cancer.”
These results added to the growing literature, “ultimately providing hope regarding an issue that is highly valued by many young patients diagnosed with cancer.”4
Dr Partridge told Cancer Therapy Advisor that “continued menstruation can provide some hope that a woman may still be fertile.” Nonetheless, “even women who have continued menses and have signs that point to fertility intact may be unable to achieve a pregnancy both after breast cancer treatment as well as in the general population.”
However, “not every premenopausal woman with early stage hormone receptor–positive breast cancer should be treated with an LHRH agonist,” she added.
Contraindications “may include severe osteoporosis, severe sexual dysfunction at baseline, which may be worsened with any hormonal agent but particularly with menopause or even chemical menopause, which is temporary, and, of course, there can be things like allergic reactions and more idiosyncratic reactions to drugs.”