scholarly journals Potential Mechanisms of Ovarian Protection with Gonadotropin-Releasing Hormone Agonist in Breast Cancer Patients: A Review

2019 ◽  
Vol 13 ◽  
pp. 117955811986458 ◽  
Author(s):  
Francesca Poggio ◽  
Matteo Lambertini ◽  
Claudia Bighin ◽  
Benedetta Conte ◽  
Eva Blondeaux ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Ovarian Function ◽  
Gonadotropin Releasing Hormone ◽  
Premature Menopause ◽  
Breast Cancer Patients ◽  
Premenopausal Breast Cancer ◽  
Releasing Hormone ◽  
Gonadotropin Releasing Hormone Agonist ◽  
Ovarian Protection

The use of chemotherapy in premenopausal cancer patients may lead to chemotherapy-induced premature ovarian failure. Pharmacological temporary ovarian suppression obtained with the gonadotropin-releasing hormone agonist (GnRHa) administered concomitantly with chemotherapy has been investigated as a technique capable to reduce the gonadotoxicity, reducing the risk of developing premature menopause. In recent years, important evidence has become available on the efficacy and safety of this strategy that should now be considered a standard option for ovarian function preservation in premenopausal breast cancer patients. However, in women interested in fertility preservation, this is not an alternative to cryopreservation strategies, which remains the first option to be proposed. The purpose of this review is to summarize the mechanisms of GnRHa in the preservation of fertility in premenopausal cancer patient candidates to receive chemotherapy, highlighting the areas of doubt that require further investigation.

scholarly journals Ovarian Function and Fertility Preservation in Breast Cancer: Should Gonadotropin-Releasing Hormone Agonist be administered to All Premenopausal Patients Receiving Chemotherapy?

2019 ◽  
Vol 13 ◽  
pp. 117955811982839 ◽  
Author(s):  
Matteo Lambertini ◽  
François Richard ◽  
Bastien Nguyen ◽  
Giulia Viglietti ◽  
Cynthia Villarreal-Garza
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Fertility Preservation ◽  
Clinical Evidence ◽  
Ovarian Function ◽  
Gonadotropin Releasing Hormone ◽  
Breast Cancer Patients ◽  
Premenopausal Breast Cancer ◽  
Ovarian Suppression ◽  
Gonadotropin Releasing Hormone Agonist

Chemotherapy-induced premature ovarian insufficiency (POI) is one of the potential drawbacks of chemotherapy use of particular concern for newly diagnosed premenopausal breast cancer patients. Temporary ovarian suppression obtained pharmacologically with the administration of a gonadotropin-releasing hormone agonist (GnRHa) during chemotherapy has been specifically developed as a method to counteract chemotherapy-induced gonadotoxicity with the main goal of diminishing the risk of POI. In recent years, important clinical evidence has become available on the efficacy and safety of this strategy that should now be considered a standard option for ovarian function preservation in premenopausal breast cancer patients, including women who are not interested in conceiving after treatment or that would not be candidates for fertility preservation strategies because of their age. Nevertheless, in women interested in fertility preservation, this is not an alternative to gamete cryopreservation, which remains as the first option to be offered. In this setting, temporary ovarian suppression with GnRHa during chemotherapy should be also proposed following gamete cryopreservation or to women who have no access, refuse, or have contraindications to surgical fertility preservation techniques. In this article, we present an overview about the role of temporary ovarian suppression with GnRHa during chemotherapy in breast cancer patients by addressing the available clinical evidence with the aim of identifying both the best candidates for the use of this strategy and the still existing gray zones requiring further investigation.

scholarly journals Major Depression in Breast Cancer Patients with Ovarian Function Suppression: A Cross-Sectional Study Comparing Ovarian Ablation and Gonadotropin-Releasing Hormone Agonists

2021 ◽  
Author(s):  
Junhan Jiang ◽  
Junnan Xu ◽  
Li Cai ◽  
Li Man ◽  
Limin Niu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Major Depression ◽  
Sexual Dysfunction ◽  
Sexual Function ◽  
Cancer Patients ◽  
Gonadotropin Releasing Hormone ◽  
Breast Cancer Patients ◽  
Premenopausal Breast Cancer ◽  
Releasing Hormone ◽  
Ovarian Ablation

Abstract Purpose: We examined whether there were differences in major depression outcomes and independent risk factors associated with gonadotropin-releasing hormone agonists (GnRHa) and ovarian ablation (OA) in premenopausal breast cancer patients. Methods: Premenopausal breast cancer patients from seven hospitals who received OFS participated in the study between June 2019 and June 2020. The independent variable was the type of ovarian suppression, categorized as either OA (n = 174) or GnRHa (n = 389). Major depression was evaluated using the Patient Health Questionnaire (PHQ-9), and the Female Sexual Function Index questionnaire was used to assess sexual function.Results: A total of 563 patients completed the surveys. The mean PHQ-9 sum score was slightly lower in the GnRHa cohort than in the OA cohort (11.4 ± 5.7 vs. 12.8 ± 5.8, P = 0.079). There were significantly fewer patients with major depression (PHQ-9 ≥ 15) in the GnRHa cohort (31.1% vs. 40.2%, P = 0.025). Further, the duration of OFS was closely correlated with major depression, indicating a time-dependent trend [duration of OFS > 2 years vs. duration of OFS ≤ 2 years: Exp (B) = 1.651, P = 0.031]. Sexual dysfunction was negatively correlated with major depression [sexual dysfunction vs. normal: Exp (B) = 0.769, P = 0.046].Conclusions: This is the first study to demonstrate that GnRHa results in more favorable depression outcomes than OA. Moreover, most patients preferred alternatives to their OFS treatment. These findings can contribute to improving and alleviating the adverse effects of OFS.

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