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GnRHa Hormone Analog Treatment May Preserve Fertility in Women Undergoing Chemo

Premenopausal women who are being treated for early-stage breast cancer may benefit from gonadotropin-releasing hormone analog (GnRHa).

In a meta-analysis presented at the 2017 San Antonio Breast Cancer Symposium, revealed that treatment with the hormone analog could help preserve fertility by protecting the ovarian function of premenopausal women undergoing chemotherapy.

Matteo Lambertini, a medical oncologist at the Institut Jules Bordet in Brussels and member of the European Society for Medical Oncology (ESMO), reviewed the data of 837 patients across 5 clinical trials with his team of researchers. They discovered that women who received GnRHA treatment alongside chemotherapy had a 62 percent less chance of developing premature ovarian insufficiency (POI), compared to those who received chemotherapy alone. Only 14.1 percent of the GnRHa group had POI versus 30.9 percent in the control group.

During the symposium, Lambertini discussed these findings and explained that treating with GnRHa while undergoing chemotherapy resulted in temporary ovarian suppression. It also showed potential in preserving ovarian function and fertility in premenopausal women with breast cancer.

He emphasizes that their study provides relevant evidence on the efficacy and safety of this approach in women who are either estrogen receptor (ER) positive or ER-negative. Although promising, the practice remains controversial and is considered experimental by both the American Society of Clinical Oncology (ASCO) and ESMO.

Using GnRHa for temporary ovarian suppression was primarily developed to reduce a woman’s risk for treatment-induced POI during chemotherapy. Because it was not employed as a fertility-saving measure, most trials on GnRHa treatment had a short follow-up and did not report post-treatment pregnancies, leaving a lot of unknown variables. Randomized clinical trials which investigated the efficacy of GnRHa treatment likewise produced conflicting results due to their small patient populations.

Lambertini insists their findings should put any controversy to rest. He refers to their meta-analysis of 5 major, randomized, controlled trials as “the highest level of evidence” they could provide the scientific community, since it offers more conclusive clinical evidence. He adds that researchers in the future should instead focus on understanding how the strategy works.

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