title: Adjuvant therapy with GnRH agonists/tamoxifen in breast cancer should be a good council for patients with hormone receptor-positive tumours and wish to preserve fertility.
abstract: Infertility represents one of the main long-term consequences of the chemotherapy used for the adjuvant treatment of breast cancer. Approximately 60-65% of breast cancers express the nuclear hormone receptor in premenopausal women. Adjuvant endocrine therapy is an integral component of care for patients with hormone receptor-positive (HR+) tumours. The GnRH agonist (GnRHa) alone or in combination with tamoxifen produces results at least similar to those obtained with the different chemotherapy protocols in patients with HR+ breast cancer with respect to recurrence-free survival and overall survival. It is time to indicate adjuvant therapy with GnRHa associated with tamoxifen for patients with breast cancer (HR+ tumours) if they want to preserve their reproductive function. The evaluation of ovarian reserve tests: follicle stimulating hormone (FSH), anti-Mullerian hormone (AMH), inhibin B, antral follicle count (AFC) and ovarian volume 6 months, and 1 year after the end of therapy with GnRHa/tamoxifen must be realised. The recurrence-free survival and overall survival should be analysed. The major implication of this hypothesis will be to avoid adjuvant chemotherapy for patients with breast cancer (HR+ tumours) that request fertility preservation. It is expected that ovarian function should not be altered in almost all cases and subsequent pregnancy a real possibility.
authors.affiliation: Center for Human Reproduction Prof. Franco Jr, Ribeirao Preto, Brazil. crh@crh.com.br
authors.forename: J G
authors.initials: JG
authors.lastname: Franco
authors.forename: J B A
authors.initials: JB
authors.lastname: Oliveira
authors.forename: C G
authors.initials: CG
authors.lastname: Petersen
authors.forename: A L
authors.initials: AL
authors.lastname: Mauri
authors.forename: R
authors.initials: R
authors.lastname: Baruffi
authors.forename: M
authors.initials: M
authors.lastname: Cavagna
mesh_terms: D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods*; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D007247:Infertility, Female / Q000517:prevention & control*; D017697:Premenopause; D018160:Receptors, Cytoplasmic and Nuclear / Q000378:metabolism*; D013629:Tamoxifen / Q000627:therapeutic use*
chemical_list: D018160:Receptors, Cytoplasmic and Nuclear; D013629:Tamoxifen; D007987:Gonadotropin-Releasing Hormone