Medical approaches to preservation of fertility in female cancer patients

Abstract

the administration of GnRHa before and during chemotherapy is associated with an absolute reduction in the incidence of early menopause of nearly 20%. Such a strategy may be offered to young cancer patients who are candidates for chemotherapy. The capability of such an approach in inducing long-term preservation of ovarian function including fertility is still unknown.

Chemotherapy-induced ovarian toxicity in patients affected by endocrine-responsive early breast cancer

“…Other than age, the incidence of CRM/CRA mainly depends on the type of CT and the schedule of administration used (Table 1) [39,44]. However, further factors related to CT delivery may influence the onset of POF, including the combination of more than one drug (poly-CT), the cumulative dose of alkylating agents, and the phase of the menstrual cycle when CT is delivered.…”

“…A number of effective methods are available for younger BC patients wishing to preserve their fertility potential from damage of CT, including cryopreservation techniques and/or the administration of GnRH-agonists [15,44]. However, each of these methods presents various pros and contras.…”

“…Approximately 30% of patients are premenopausal and 10% are aged [35][36][37][38][39][40][41][42][43][44] at diagnosis [3]. Despite the fact that BC in women under the age of 40 is infrequent (5.5% in the United States) [4], a dramatic increase in the number of BC diagnosed in premenopausal women has been reported in several countries [5].…”

Recognizing menopause in women with amenorrhea induced by cytotoxic chemotherapy for endocrine-responsive early breast cancer

“…Rates of CIA in premenopausal women receiving a poly-CT regimen for EBC may range from 49 to 100% in women O40 years and from 21 to 71% in younger women (Goldhirsch et al 1990, Bines et al 1996, Goodwin et al 1999, Basser et al 2006, Del Mastro et al 2011. Transient and prolonged amenorrhea was more frequent with CMF-and CEF/CAF-type regimens compared with AC (Bines et al 1996), presumably due to a higher cumulative dose of cyclophosphamide received.…”

Survivorship in Hodgkin Lymphoma

“…Interestingly, concomitant use of alkylating agents or pelvic radiation can have protective effects against development of breast cancer, thought to be related to decreased estrogen production induced by treatmentrelated ovarian suppression or premature ovarian failure. [54] If efforts at fertility preservation with administration of gonadotropin releasing hormone agonists prove successful, as may be the case in breast cancer therapy [55], it is possible this benefit may be either abrogated or nullified. [56] The optimal surveillance strategy for patients placed at increased risk for breast cancer by their HL therapy remains a subject of investigation, but standards of care are beginning to emerge.…”