Gonadotropin-releasing hormone analogs (GnRHa) may reduce the risk of ovarian insufficiency in premenopausal women undergoing chemotherapy for breast cancer, according to a clinical trial. The trial, which included 330 women, found that the premature ovarian insufficiency rate was 10.3% in the GnRHa group versus 44.5% in the control group. The study also indicated that GnRHa was associated with improved tumor-free survival in patients younger than 35 years.
Breast cancer is one of the most common cancers in women. It is estimated that 1 in 8 women will develop breast cancer in their lifetime. Chemotherapy is an essential part of the treatment for breast cancer, but it can have side effects, including premature ovarian insufficiency. This can result in infertility and menopause-like symptoms, such as hot flashes and vaginal dryness.
GnRHa is a medication that can suppress ovarian function, which may reduce the risk of ovarian insufficiency during chemotherapy. Previous studies have shown mixed results regarding the use of GnRHa for this purpose. This randomized clinical trial aimed to determine whether administering GnRHa during chemotherapy in premenopausal women with breast cancer can reduce ovarian impairment.
The trial involved premenopausal women aged 18 to 49 years with operable stage I to III breast cancer who were planning to receive adjuvant or neoadjuvant cyclophosphamide-containing chemotherapy. Eligible patients were randomly assigned to receive chemotherapy with or without GnRHa. In patients randomized to receive GnRHa, the medication was injected subcutaneously once every 28 days from 1 to 2 weeks before the first cycle of chemotherapy to 4 weeks after the last cycle of chemotherapy.
The primary endpoint of the trial was the rate of premature ovarian insufficiency (POI) at 12 months after chemotherapy. POI was defined as anti-Müllerian hormone levels of less than 0.5 ng/mL. The secondary endpoint was overall survival and tumor-free survival.
At 12 months after the completion of chemotherapy, the POI rate was 10.3% in the GnRHa group and 44.5% in the control group. Anti-Müllerian hormone resumption in the GnRHa group was significantly better than that in the control group. After a median follow-up of 49 months, the differences in 4-year OS and TFS between the two groups were not significant. However, a post hoc analysis showed that in patients younger than 35 years, the TFS was higher in the GnRHa group than in the control group.
The results of this trial suggest that administering GnRHa during chemotherapy can reduce the risk of ovarian insufficiency in premenopausal women with breast cancer. This can help preserve fertility and improve the quality of life of these patients. However, further studies are needed to confirm these findings and to determine the optimal dosing and duration of GnRHa treatment.
Premenopausal women with breast cancer who are undergoing chemotherapy should consider the use of GnRHa to protect their ovarian function. This medication has the potential to reduce the risk of ovarian insufficiency and improve tumor-free survival, especially in younger patients. It is important to discuss the potential benefits and risks of GnRHa treatment with your healthcare provider.