Medical Research: What is the background for this study? What are the main findings?
Dr. Munhoz: Chemotherapy-induced early menopause and its impact on quality of life is clinically relevant issue that often arises during the treatment with curative intent of premenopausal patients with early breast cancer. The use of neo-/adjuvant chemotherapy is associated with risks of ovarian dysfunction, permanent or transient amenorrhea, infertility and symptoms of menopause with a premature onset. In addition to osteoporosis, loss of libido, increased cardiovascular risk and atrophic vaginitis, early ovarian dysfunction may adversely impact quality of life and result in significant psychosocial burden.
Currently available guidelines addressing fertility preservation in young women undergoing treatment for early breast cancer recommend that patients at reproductive ages should be advised about the potential risks of fertility impairment and additional effects of adjuvant chemotherapy and that preservation techniques should be carefully considered. However, “evidence regarding the effectiveness of ovarian suppression” is quoted as “insufficient” and the use GnRH agonists as “experimental” .
The current meta-analysis includes a large number of patients and also the results of recently presented clinical trials, and suggest that the use of GnRH agonists is associated a higher rate of recovery of regular menses in patients with breast cancer undergoing chemotherapy.These results summarize the findings of different clinical trials and has immediate clinical implications – this was not clear in the literature, since negative results had been reported across different clinical trials.
Medical Research: What should clinicians and patients take away from your report?
Dr. Munhoz: The main message from this work is that the use of GnRH can be benefitial for this subgroup of patients and should be carefully considered as an alternative to prevent early menopause. Nevertheless it is important to highlight that menstruation is not a perfect surrogate of fertility and ovarian function; hence, proven methods such as embryo and oocyte cryopreservation should also be considered.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Munhoz: It is important to highlight that additional outcomes associated with ovarian function preservation need to be further investigated. Definitions of ovarian failure vary widely and the use of GnRH agonists as a means of ovarian suppression for fertility preservation has mostly been studied in small trials, with no long-term data and using imperfect outcomes.
Munhoz RR, Pereira AL, Sasse AD, et al. Gonadotropin-Releasing Hormone Agonists for Ovarian Function Preservation in Premenopausal Women Undergoing Chemotherapy for Early-Stage Breast Cancer: A Systematic Review and Meta-analysis. JAMA Oncol. Published online October 01, 2015. doi:10.1001/jamaoncol.2015.3251.
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Rodrigo R. Munhoz, MD (2015). Can Menopause Be Prevented In Young Women on Chemotherapy For Early Breast Cancer?