Gonadotropin-releasing hormone agonists cotreatment to preserve ovarian function during chemotherapy in women with breast cancer.

Introduction: Breast cancer in young women is typically characterized by aggressive disease, and treatment with adjuvant chemotherapy has significantly improved prognosis of patients, which is associated with ovarian toxicity. gonadotropin-releasing hormone (GnRH) agonists may have a protective effect against chemotherapy-induced ovarian toxicity. Studies of GnRHa efficacy have reported conflicting results. We performed a review of studies examining whether a GnRHa administered before and during chemotherapy is protective of ovarian function,fertility and provides better reproductive outcomes. Material and methods: Randomized controlled trials, which examined the effect of GnRHa for chemotherapy-induced ovarian failure in premenopausal women, were eligible for inclusion in the review . This review summarizes the current evidence for use of GnRHa in preserving ovarian function in young breast cancer patients. Findings: A potential fertility preservation strategy is administration of gonadotropin-releasing hormone agonists (GnRHas ) during adjuvant chemotherapy. The mechanism of action is based on suppression of the gonadotropin levels to simulate pre-pubertal hormonal milieu and decrease utero-ovarian perfusion. Based on the available studies, intramuscular or subcutaneous GnRH agonists, seem to be effective in protecting ovaries during chemotherapy, improve ovarian function, reduced the occurrence of chemotherapy-induced early menopause and improve the ability to achieve pregnancy following chemotherapy, with higher rates of spontaneous resumption of menses and ovulation. On the other hand in some studies showed , up to 97% of patients suffer from hypoestrogenic symptoms when using a GnRH agonist along with chemotherapy. Furthermore, when the agonist is used for > 4 months, patients may experience bone loss, which may not be reversible with longer periods of use.Conclusions:. Our review of randomized studies shows that the temporary ovarian suppression induced by GnRHa significantly reduces the risk of chemotherapy-induced POF in young breast cancer patients. More well-designed prospective studies are needed to carry out for further understanding of this topic .

کلیدواژه ها:

GNRH analogue ، breast cancer ، chemotherapy ، fertility