Gonadotropin-releasing hormone agonists for prevention of chemotherapy-induced premature ovarian failure in premenopausal women with breast cancer

Objective: To test the efficacy of GnRHa administered before and during combination chemotherapy in ovarian function preservation for breast cancer women. Patient(s): In this prospective, randomized, study, sixty three patients younger than or equal to 45y old with non metastatic unilateral adenocarcinoma of the breast who had undergone modified radical mastectomy or breast-conserving surgery were included in the study. Patients were assigned randomly to receive combined GnRHa and chemotherapy (anthracycline/ cyclophosphamide/ fluorouracil) or chemotherapy alone. The first GnRHa injection was administered at least 2 weeks before the first chemotherapy cycle, continuing at 3.6 mg subcutaneously every 4 weeks until the end of the last cycle. The primary objective was the reappearance of normal ovarian function, defined as two consecutive menstrual periods within 21 to 35 days at 6 months after end of chemotherapy. Result(s): In this study group, 81.2% resumed menses and 71.8% resumed spontaneous ovulation within 3–8 months of termination of the GnRHa/chemotherapy co-treatment; 18.8% experienced hyper-gonadotrophic amenorrhoea and ovarian failure 12 months after treatment. In the control group (chemotherapy without GnRHa), 54.8% resumed menses and 45.1% resumed normal ovarian activity. The mean FSH concentrations, 6 months after completion of the GnRHa/chemotherapy co-treatment group, were significantly less than the control group. During the GnRHa/chemotherapy co-treatment, the concentrations of FSH, LH, and P (progesterone) decreased to almost pre-pubertal levels. However, within 1–3 months after the last GnRHa injection, an increase in LH and FSH concentrations was detected, followed several weeks later in by an increase in progesterone concentrations to within normal levels. The median Time to restoration of menstruation was 178 days with goserelin compared to 220 day without goserelin with statistical significant difference (p<0.00). Conclusion(s): GnRHa administration before and during combination chemotherapy for breast cancer may preserve post-treatment ovarian function in women <45 years. However, Long-term studies are required. [Amr Ghannam, Rasha abdel-Ghany, Abdel-hady zayed. Gonadotropin-releasing hormone agonists for prevention of chemotherapy-induced premature ovarian failure in premenopausal women with breast cancer. Cancer Biology 2014;4(1):18-25]. (ISSN: 2150-1041): (ISSN: 2150-105X (online). http://www.cancerbio.net. 3