Failure of ovarian ablation with Leuprolide acetate in a pre-menopausal breast cancer patient with metastasis resulting in pregnancy: a case report

Abstract

Ovarian ablation was the main target of systemic therapy for breast cancer. In premenopausal women, the ovaries are the predominant source of estrogen synthesis and by this reason treatment options are oophorectomy, ovarian irradiation and luteinizing hormone releasing hormone (LHRH) analogues such as goserelin acetate (GA) and leuprolide acetate (LA) which act on the hypothalamic-pituitary-ovarian axis to suppress the hormones. Rarely these agents cannot succeed and patient may become pregnant who was under treatment of LHRH analogues. We report a premenopausal patient with breast cancer in whom ovarian ablation failed while on leuprolide acetate treatment. A 34-year-old woman was presented with bone metastatic left breast cancer. Tamoxifen 10 mg twice a day, LA 3.75mg SC every 28 days and zoledronic acid 4mg IV every 28 days were started. In May 2013, receiving LA since 7 months, the patient reported a 3-4 kg weight gain and felt movement in the abdomen due to pregnancy. To date there are 4 published case reports, patients receiving GA due to breast cancer in whom a failure in ovarian ablation. All of four cases failed after at least 15 months of treatment but our case was the earliest failure of LHRH analogues in the literature and it was failure with LA, not GA as like as the other cases. It is essential for clinicians to be aware and suggest to the patients of the potential risk of pregnancy despite using the LHRH analogs. Keywords Abstract ÖzetOlgu Sunumu / Case Report

Possibilities of Ovarial Suppression in Hormone-Dependent Mammary Gland Cancer

“…Ряд авторов указывают на необходимость мониторирования уровня эстрадиола на фоне лекарствен-ной ОС аналогами ГРГ, поскольку имеются наблюдения, когда у больных после снижения уровня эстрадиола до менопаузального уровня на фоне терапии аналогами ГРГ и ингибиторами ароматазы через несколько месяцев уро-вень эстрадиола возвращался к нормальному [22]. Опубликованы несколько наблюдений наступления бере-менности на фоне терапии аналогом ГРГ и ингибитором ароматазы [23,24]. Авторы рекомендуют больным РМЖ, получающим аналоги ГРГ, дополнительно пользоваться барьерными методами контрацепции.…”