Ovarian protection with goserelin during adjuvant chemotherapy for pre-menopausal women with early breast cancer (EBC).
OBJECTIVE
Ovarian failure and infertility following adjuvant chemotherapy for early breast cancer are major concerns for some young women. Techniques for oocyte harvesting are associated with delay in starting treatment, potentially undesirable estrogen stimulation and a relatively low success rate. We report an audit of our experience with the luteinising hormone-releasing hormone agonist, goserelin, to achieve transient ovarian suppression during chemotherapy as a means of preserving ovarian function.


METHODS
Pre-menopausal women were offered goserelin 3.6 mg by subcutaneous injection every 28 days during chemotherapy, starting 0-14 days prior to treatment. The primary end-point was recovery of menstruation. Serum luteinising hormone, follicle stimulating hormone and oestradiol were measured at recovery of menstruation or at first year follow-up if amenorrhoea persisted. Subsequent pregnancies were recorded.


RESULTS
Fifty-one evaluable women were audited. Amenorrhoea occurred in all but one. All received combination anthracycline-containing chemotherapy regimens with a mean cumulative cyclophosphamide dose of 3.9 g/m(2). Forty-five (90%) recovered menstruation during the first year of follow-up; mean time to recovery 5 months. Eight pregnancies in 10 women attempting this so far.


CONCLUSIONS
Using goserelin concurrently with chemotherapy is associated with a high rate of ovarian function preservation.
Urruticoechea
Ander
A
Institut Catala d'Oncologia, Hospital Duran i Reynalds, Gran Via km 2.7. L'Hospitalet de Llobregat, Barcelona, Spain.
Arnedos
Monica
M
Walsh
Geraldine
G
Dowsett
Mitch
M
Smith
Ian E
IE
D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005298:Fertility / Q000187:drug effects; D017273:Goserelin / Q000627:therapeutic use*; D006801:Humans; D010053:Ovary / Q000187:drug effects*; D017697:Premenopause; D016649:Primary Ovarian Insufficiency / Q000139:chemically induced / Q000517:prevention & control
D018931:Antineoplastic Agents, Hormonal; D017273:Goserelin