Effect of GnRHa Treatment During Chemotherapy on Preservation of Ovarian Function and Fertility in Premenopausal Patients With Early Breast Cancer


Key Points

  • Premature ovarian insufficiency was significantly reduced with GnRHa treatment.
  • Pregnancy occurred more frequently in the GnRHa group. 

A meta-analysis of patient-level data reported by Lambertini et al in the Journal of Clinical Oncology indicated that temporary ovarian suppression with gonadotropin-releasing hormone agonists (GnRHa) during chemotherapy was effective in preserving ovarian function and fertility in premenopausal women with early breast cancer.

Study Details

The meta-analysis included a total of 873 patients from 5 trials in which premenopausal women with early breast cancer were randomly assigned to receive (neo)adjuvant chemotherapy alone (n = 437) or with concurrent GnRHa (n = 436). Primary outcomes were rate of premature ovarian insufficiency (POI; as defined in the individual trials) and posttreatment pregnancy rate.

Ovarian Function and Pregnancy

Overall, the POI rate was 14.1% in the GnRHa group vs 30.9% in the control group (adjusted odds ratio [OR] = 0.38, P < .001). On multivariate analysis, only treatment with GnRHa (adjusted OR = 0.38, P < .001) and younger age at diagnosis (adjusted OR = 0.35, P < .001) were significantly associated with reduced risk of chemotherapy-induced POI. At least 1 posttreatment pregnancy was observed in 10.3% of patients in the GnRHa group vs 5.5% in the control group (incidence rate ratio = 1.83, P = .030).

Five-year disease-free survival was 79.5% in the GnRHa group vs 80.0% in the control group (adjusted hazard ratio [HR] = 1.01, P = .999). Five-year overall survival was 90.2% vs 86.3% (adjusted HR = 0.67, P = .083).

The investigators concluded, “Our findings provide evidence for the efficacy and safety of temporary ovarian suppression with GnRHa during chemotherapy as an available option to reduce the likelihood of chemotherapy-induced POI and potentially improve future fertility in premenopausal patients with early breast cancer.”

The study was supported in part by the Italian Association for Cancer Research.

Matteo Lambertini, MD, of Institut Jules Bordet and Université Libre de Bruxelles, is the corresponding author for the Journal of Clinical Oncology article. 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.