GnRH agonist may protect breast cancer patient fertility

By medwireNews Reporters

Treatment with a gonadotropin-releasing hormone (GnRH) agonist may reduce the risk for chemotherapy-induced amenorrhea, research shows.

In addition, treatment was associated with a high chance of pregnancy, with 71% of patients trying to conceive reporting success.

"Our analysis, involving the largest number of women with breast cancer so far, shows that the administration of the GNRH analogue goserelin during chemotherapy is safe and is associated with a high rate of return of menstruation," report investigators.

Writing in the Annals of Oncology, Ian Smith (Royal Marsden Hospital, London, UK) and colleagues note that the data are not randomized, but the rate of menses return was considerably higher than other reports in the literature.

Of the 125 women treated with subcutaneous goserelin 3.6 mg every 28 days, beginning 2 weeks before chemotherapy, 84% recovered menstruation. The median time to recovery was 6 months, with a range of 1 to 43 months.

The cumulative percentage of patients who recovered menstrual activity at 3 months was 21%, 54% at 6 months, 82% at 12 months, and 94% at 18 months. At 36 months, 99% of women had recovered menstrual activity.

For 71 women older than 35 years of age, 76% recovered menstruation. Overall, 42 women tried to conceive, with 30 women having 42 pregnancies a median of 40 months after breast cancer diagnosis. Thirty healthy deliveries had occurred at time of publication with three further pregnancy outcomes awaited.

"The resumption of menstruation does not necessarily equate with fertility, but we have also shown in our series, with a long follow-up, that 71% of our patients who attempted pregnancies managed to achieve these with successful outcomes after the use of goserelin during chemotherapy," report Smith and colleagues.

The next steps, say the researchers, will be larger randomized, controlled trials to further address the use of GnRH agonists in premenopausal women with early breast cancer.

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