Temporary ovarian suppression during chemotherapy to preserve ovarian function and fertility in breast cancer patients: A GRADE approach for evidence evaluation and recommendations by the Italian Association of Medical Oncology

2017 ◽  
Vol 71 ◽  
pp. 25-33 ◽  
Author(s):  
Matteo Lambertini ◽  
Michela Cinquini ◽  
Ivan Moschetti ◽  
Fedro A. Peccatori ◽  
Paola Anserini ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Ovarian Function ◽  
Medical Oncology ◽  
Breast Cancer Patients ◽  
Ovarian Suppression ◽  
Italian Association ◽  
Evidence Evaluation ◽  
Grade Approach

scholarly journals Ovarian Function and Fertility Preservation in Breast Cancer: Should Gonadotropin-Releasing Hormone Agonist be administered to All Premenopausal Patients Receiving Chemotherapy?

2019 ◽  
Vol 13 ◽  
pp. 117955811982839 ◽  
Author(s):  
Matteo Lambertini ◽  
François Richard ◽  
Bastien Nguyen ◽  
Giulia Viglietti ◽  
Cynthia Villarreal-Garza
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Fertility Preservation ◽  
Clinical Evidence ◽  
Ovarian Function ◽  
Gonadotropin Releasing Hormone ◽  
Breast Cancer Patients ◽  
Premenopausal Breast Cancer ◽  
Ovarian Suppression ◽  
Gonadotropin Releasing Hormone Agonist

Chemotherapy-induced premature ovarian insufficiency (POI) is one of the potential drawbacks of chemotherapy use of particular concern for newly diagnosed premenopausal breast cancer patients. Temporary ovarian suppression obtained pharmacologically with the administration of a gonadotropin-releasing hormone agonist (GnRHa) during chemotherapy has been specifically developed as a method to counteract chemotherapy-induced gonadotoxicity with the main goal of diminishing the risk of POI. In recent years, important clinical evidence has become available on the efficacy and safety of this strategy that should now be considered a standard option for ovarian function preservation in premenopausal breast cancer patients, including women who are not interested in conceiving after treatment or that would not be candidates for fertility preservation strategies because of their age. Nevertheless, in women interested in fertility preservation, this is not an alternative to gamete cryopreservation, which remains as the first option to be offered. In this setting, temporary ovarian suppression with GnRHa during chemotherapy should be also proposed following gamete cryopreservation or to women who have no access, refuse, or have contraindications to surgical fertility preservation techniques. In this article, we present an overview about the role of temporary ovarian suppression with GnRHa during chemotherapy in breast cancer patients by addressing the available clinical evidence with the aim of identifying both the best candidates for the use of this strategy and the still existing gray zones requiring further investigation.

scholarly journals Depression, Sexual dysfunction and Quality of Life Among Breast Cancer Patients with Ovarian Function Suppression: A Cross Sectional Study between Ovarian Ablation Verse GnRH Agonists

2020 ◽  
Author(s):  
junhan Jiang ◽  
Junnan Xu ◽  
Li Cai ◽  
Juan Hu ◽  
Li Man ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Sexual Dysfunction ◽  
Cancer Patients ◽  
Ovarian Function ◽  
Breast Cancer Patients ◽  
Ovarian Suppression ◽  
Ovarian Function Suppression ◽  
Ovarian Ablation

Abstract Background: Ovarian function suppression is being widely utilized as endocrine therapy to reduce estrogen release in premenopausal breast cancer patients and was achieved either by medical treatment with bilateral oophorectomy, irradiation, or the Gonadotropin releasing hormone (GnRH) agonist. This study aimed to examine whether GnRHa differed from ovarian ablation on depression, sexual dysfunction and quality of life.Methods: The premenopausal breast cancer patients who received ovarian function suppression were enrolled from seven hospital between June 2019 and June 2020. Our independent variable was the type of ovarian suppression, categorized as Ovarian Ablation (OA cohort, n=174) and medical GnRH agonist (GnRHa cohort, n=389). The self-administered questionnaire (OFS-Q5) was developed and used in this study aimed to assess the depression (PHQ-9), sexual dysfunction (FSFI) and quality of life (EORTC QLQ-BR23).Results: In this cross-sectional study, 563 patients with ovarian function suppression completed surveys were collected. The mean sum score of the PHQ-9 tend to be slight decrease in GnRHa cohort than that in ovarian ablation (OA) cohort (11.4 ±5.7 vs. 12.8 ±5.8, OR=1.910, P=0.079). Patients with major depression (PHQ-9≧15) was indicated significantly fewer in GnRHa cohort (31.1% vs 40.2%, P=0.025). The more surprising correlation is less patients with sexual dysfunction (61.5%, FSFI< 23) in OA cohort, a remarkable increase in GnRHa cohort (72.2%, P = 0.011). The ratio of sexual dysfunction remained lower for ovarian ablation women in long-term ovarian suppression (duration of ovarian suppression > 2 years: OA vs GnRHa, OR=1.555, P=0.037). No significantly difference for most subscales of QLQ-BR23 between two cohorts was evident.Conclusions: Our current investigation demonstrate here for the first time that medical GnRHa resulted in favour depression, worse sexual function than those with ovarian ablation, with similar quality of life. This new understanding should help to improve and alleviate adverse effect in patients with diverse ovarian function suppression.

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