In a nutshell
This study evaluated the long-term outcomes of using gonadotropin-releasing hormone (GnRH) agonist during chemotherapy to preserve ovarian function in premenopausal patients with early-stage breast cancer (BC). The data showed that GnRH agonist use during chemotherapy was safe and effective to preserve ovarian function in these patients.
BC is classified into different subtypes depending on the presence or absence of certain receptors (proteins found on the surface of the cancer cells). Hormone receptor (HR)-positive is a subtype of BC that tests positive for estrogen and/or progesterone (female sex hormones). Endocrine treatment (hormone therapy) is the preferred treatment option for women with HR+ early-stage BC. Hormonal therapy drugs block the production of estrogen and progesterone from the ovary. However, many premenopausal BC patients are also treated with chemotherapy.
Breast cancer treatment in young women has been known to result in issues with fertility and menstruation. Gonadotropin-releasing hormone (GnRH) is a chemical produced by the brain to stimulate the ovaries to release other hormones such as follicle-stimulating hormone (FSH). Recent studies have suggested that using drugs that activate GnRH (GnRH agonists) like triptorelin (Trelstar) during chemotherapy can preserve ovarian function in premenopausal patients with BC. However, the long-term outcomes of using GnRH agonist during chemotherapy to preserve ovarian function in premenopausal patients with early-stage BC are not known.
Methods & findings
This study involved 281 premenopausal women with early-stage BC. Patients were randomly assigned into 2 groups. Group 1 included 148 women who received GnRH agonist (triptorelin) plus chemotherapy. Group 2 included 133 women who received chemotherapy alone. The average follow-up time was 12.4 years.
After 12 years, the survival rate of patients without any signs or symptoms of cancer was 65.7% for group 1 compared to 69.2% for group 2. This difference was not considered significant. After 12 years, the overall survival rate was also similar between group 1 (81.2%) and group 2 (81.3%).
9 patients in group 1 and 4 in group 2 had a pregnancy after treatment. Patients treated with GnRH agonist (triptorelin) plus chemotherapy were 2.14 times more likely to have a pregnancy after treatment than patients treated with chemotherapy alone.
The bottom line
This study concluded that GnRH agonist use during chemotherapy was safe and effective to preserve ovarian function in premenopausal patients with early-stage BC.
The fine print
The GnRH agonist (triptorelin) used in the study was provided by Ipsen. This study only included Italian patients.
Published By :
Journal of the National Cancer Institute (JNCI)
Nov 28, 2021
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