Protection of Ovarian Function During Breast Cancer Treatment
Women diagnosed with breast cancer of childbearing age are concerned about how to maintain ovarian function even after undergoing chemotherapy. Therefore, a team of doctors from the United Kingdom focused on the gonadotropin-releasing hormone agonist and its ability to protect women from premature menopause after chemotherapy.
Premature Menopause Due to Chemotherapy
Chemotherapy in premenopausal patients with early diagnosed breast cancer can cause menstrual cycle disorders, which can lead to premature menopause and infertility. Therefore, these patients seek ways to protect their fertility.
One option is the temporary suppression of ovarian function using the gonadotropin-releasing hormone agonist (GnRHa) goserelin. Available studies show that GnRHa therapy is safe and reduces the likelihood of premature ovarian insufficiency (POI) induced by chemotherapy.
Goserelin is a GnRH agonist used to suppress the production of testosterone and estrogen during the treatment of breast or prostate cancer, and also endometriosis.
OPTION Study
The OPTION study focused specifically on the use of goserelin in women indicated for chemotherapy in cases of operable breast cancer without hormonal dependence or the need to suppress ovarian function as part of the treatment. The study included quality of life (QoL) questionnaires collected during and after treatment (up to 5 years from the start of therapy).
A total of 227 patients were included in the study (chemotherapy ± goserelin) and the primary analysis was conducted on 202 of them.
Results
Goserelin reduced the incidence of amenorrhea between the 12th and 24th month to 22% compared to 38% in the control group (p = 0.015) and the incidence of POI to 18.5% compared to 34.8% in the control group (p = 0.048). The concentration of follicle-stimulating hormone was also lower in all women treated with goserelin at 12 months (p = 0.027) and 24 months (p = 0.001).
Patients treated with goserelin had more vasomotor symptoms during therapy, which subsided within 24 months. Hot flashes were observed twice as often in the chemotherapy group (40.9%) compared to the chemotherapy + goserelin group (21.3%).
At least one QoL questionnaire was completed by 213 patients. There was no significant difference in QoL parameters between the two groups. Both experienced a decrease in QoL at the 3rd and 6th month of therapy, returning to baseline values after 12 months.
Conclusion
Women of reproductive age diagnosed with breast cancer experienced a short-term decline in quality of life when goserelin was added to chemotherapy. Goserelin reduced the incidence of premature menopause.
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Source: Leonard R., Yellowlees A., Mansi J. et al. The effect of goserelin on QoL of women undergoing chemotherapy for EBC: results from the OPTION trial. Breast 2020 Aug; 52: 122–131, doi: 10.1016/j.breast.2020.05.009.
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