Therapy appears to reduce rate of chemotherapy-induced early menopause for women with breast cancer
Temporarily suppressing ovarian function with use of the hormone analogue triptorelin reduced the occurrence of early menopause induced by chemotherapy among women with breast cancer, according to a study in the July 20 issue of JAMA.
Approximately 6 percent of women with breast cancer are diagnosed before age 40 years, with the majority of young patients receiving systemic treatment with chemotherapy, hormonal therapy, or both. Chemotherapy regimens are associated with an incidence of long-term amenorrhea (absence of menstruation) of at least 40 percent, according to background information in the article. No standard strategies for preventing chemotherapy-induced ovarian failure are yet available. Preclinical data have suggested that temporary ovarian suppression with a gonadotropin (hormones that are secreted by the pituitary gland)-releasing hormone (GnRH) analogue (chemical compound) during chemotherapy reduces ovarian toxicity.
Lucia Del Mastro, M.D., of the Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy, and colleagues conducted a phase 3 trial designed to assess the efficacy of temporary ovarian suppression induced by the GnRH analogue triptorelin in reducing the incidence of early menopause in young women with breast cancer undergoing supplemental or neoadjuvant (i.e., administered before surgery for breast cancer) chemotherapy. The randomized trial was conducted at 16 sites in Italy and enrolled 281 patients between October 2003 and January 2008. The patients were premenopausal women with stage I through III breast cancer who were candidates for adjuvant or neoadjuvant chemotherapy. Before beginning chemotherapy, patients were randomly allocated to receive chemotherapy alone or combined with triptorelin, which was administered intramuscularly at least 1 week before the start of chemotherapy and then every 4 weeks for the duration of chemotherapy.
After the patients received treatment as indicated in the trial, the researchers found that the rate of early menopause was 25.9 percent in the chemotherapy-alone group and 8.9 percent in the chemotherapy plus triptorelin group, an absolute difference of 17 percent. The number needed to treat (i.e., the number of patients that need to be treated with triptorelin to prevent early menopause in 1 patient) was 6. Further analysis showed that only treatment with triptorelin was associated with a significant reduction of the risk of developing early menopause. Patient age and the type of chemotherapy did not significantly affect the risk.
Resumption of menses was observed in 60 patients in the chemotherapy-alone group (49.6 percent) and in 88 in the chemotherapy plus triptorelin group (63.3 percent).
"In conclusion, our results suggest that temporarily suppressing ovarian function by administering triptorelin reduces the incidence of chemotherapy-induced early menopause. This treatment can therefore be offered to premenopausal patients with breast cancer who wish to decrease the risk of permanent ovarian failure associated with chemotherapy," the authors write.
Editorial: Reducing the Long-term Effects of Chemotherapy in Young Women With Early-Stage Breast Cancer
In an accompanying editorial, Hope S. Rugo, M.D., and Mitchell P. Rosen, M.D., of the University of California, San Francisco, write that the data reported in this study represent an important and encouraging addition to the study of ovarian preservation for women in this difficult situation.
"Given that patients with hormone receptor-positive disease in the current study who had evidence of ovarian recovery were immediately suppressed without data on long-term recovery and that breast cancer outcome data are not available, and given as well the potential adverse effects on disease outcome, the use of GnRH agonists concomitant [at the same time] with chemotherapy cannot be recommended as a standard treatment and should be approached with caution in women with hormone-sensitive disease."
"International guidelines recommend discussion of fertility options before starting chemotherapy, and when possible before surgery, to allow optimal timing for consultation and oocyte [egg cell] harvesting. When feasible, and for patients with hormone-insensitive disease, GnRH agonist therapy to suppress ovarian function during chemotherapy is an additional treatment that can potentially expand fertility possibilities. Although recovering menses is not the same as fertility preservation, it is one step in the right direction."
More information: Paper: JAMA. 2011;306[3]269-276. Editorial: JAMA. 2011;306[3]312-314.
Provided by
JAMA and Archives Journals
-
Study suggests chemotherapy diminishes fertility in breast cancer patients
May 30, 2008 |
not rated yet |
0
-
Study supports new standard of treatment for women with advanced ovarian cancer
Dec 03, 2008 |
not rated yet |
0
-
Hormone test predicts ovarian function after chemotherapy for breast cancer
Jun 06, 2011 |
not rated yet |
0
-
Breakthrough vaccine to treat chemo-resistant ovarian cancer
Mar 08, 2007 |
not rated yet |
0
-
Loss of protein could contribute to early breast and ovarian cancer deaths
Feb 01, 2011 |
not rated yet |
0
-
Motion perception revisited: High Phi effect challenges established motion perception assumptions
Apr 23, 2013 |
3 / 5 (2) |
2
-
Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update)
Apr 02, 2013 |
4.5 / 5 (11) |
5
-
The visual system as economist: Neural resource allocation in visual adaptation
Mar 30, 2013 |
5 / 5 (2) |
9
-
Separate lives: Neuronal and organismal lifespans decoupled
Mar 27, 2013 |
4.9 / 5 (8) |
0
-
Sizing things up: The evolutionary neurobiology of scale invariance
Feb 28, 2013 |
4.8 / 5 (10) |
14
-
Why is zone 1 in liver more prone to ischemic injury?
May 23, 2013
-
How can there be villous adenoma in colon, if there are no villi there
May 22, 2013
-
How can there be a term called "intestinal metaplasia" of stomach
May 21, 2013
-
Pressure-volume curve: Elastic Recoil Pressure don't make sense
May 18, 2013
-
If you became brain-dead, would you want them to pull the plug?
May 17, 2013
-
MRI bill question
May 15, 2013
- More from Physics Forums - Medical Sciences
More news stories
New fluorescent tools for cancer diagnosis
In recent years, microRNAs (miRNAs) and other non-coding RNAs are small molecules that help control the expression of specific proteins. In recent years they have emerged as disease biomarkers. miRNA profiles have been used ...
Cancer
5 hours ago |
not rated yet |
0
Modulating the immune system to combat metastatic cancer
Cancer cells spread and grow by avoiding detection and destruction by the immune system. Stimulation of the immune system can help to eliminate cancer cells; however, there are many factors that cause the immune system to ...
Cancer
5 hours ago |
not rated yet |
0
Scientists put bowel cancer under the microscope
Researchers from London's Kingston University have begun a two-year study which could help prolong the lives of people with colorectal tumours.
Cancer
8 hours ago |
5 / 5 (1) |
0
Researcher identifies breast cancer fighting hormone
Transformative research from Western University has identified new hormones in the body which may suppress breast cancer and stimulate the regression of breast tumors.
Cancer
9 hours ago |
5 / 5 (1) |
0
Ground breaking cancer research finds immune system link
(Medical Xpress)—Curtin University researchers have found evidence that targeting specific cells in the body can reverse the effects of cancer on the immune system.
Cancer
9 hours ago |
5 / 5 (3) |
0
Engineered cytomegalovirus protects monkeys from HIV equivalent
(Medical Xpress)—A new study by researchers in the US has shown that an ancient virus can be modified to help in the fight against the simian immunodeficiency virus SIV, which is the equivalent in monkeys ...
Hormone levels may provide key to understanding psychological disorders in women
Women at a particular stage in their monthly menstrual cycle may be more vulnerable to some of the psychological side-effects associated with stressful experiences, according to a study from UCL.
Going live: Immune cell activation in multiple sclerosis
Biological processes are generally based on events at the molecular and cellular level. To understand what happens in the course of infections, diseases or normal bodily functions, scientists would need to ...
Researchers identify first drug targets in childhood genetic tumor disorder
Two mutations central to the development of infantile myofibromatosis (IM)—a disorder characterized by multiple tumors involving the skin, bone, and soft tissue—may provide new therapeutic targets, according to researchers ...
Driving and hands-free talking lead to spike in errors, study shows
Talking on a hands-free device while behind the wheel can lead to a sharp increase in errors that could imperil other drivers on the road, according to new research from the University of Alberta.
Depression raises diabetics' risk of severe low blood sugar episodes
(Medical Xpress)—Patients with diabetes who are depressed are much more likely to develop episodes of dangerously low blood sugars, or hypoglycemia, than are those who are not depressed, a new study has ...