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Goserelin does not prevent ovarian failure from chemo for breast cancer

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Ovarian suppression, using a luteinizing hormone-releasing hormone agonist, during neoadjuvant chemotherapy for breast cancer in premenopausal women does not help preserve subsequent ovarian function, a German team reports.

Writing in the Journal of Clinical Oncology online May 2, Dr. Sibylle Loibl, with the German Breast Group in Neu-Isenburg, and colleagues note that many relatively young women with hormone-insensitive breast cancer treated with adjuvant systemic chemotherapy experience premature ovarian failure thereafter.

Based on prior observational studies, the group conducted a prospective trial to investigate the preventive effect of the LHRH agonist goserelin on ovarian failure in such patients. The trial involved 60 women younger than 46 randomized to receive anthracycline/cyclophosphamide-based neoadjuvant chemo either with or without simultaneous goserelin treatment.

The first goserelin injection was given at least 2 weeks before chemotherapy started and continued on a monthly basis until the end of the last chemo cycle. “Before the first administration of chemotherapy, ovarian suppression had to be proven (ie, estradiol level <50 pg/mg and LH level <10 mIE/mL),” the authors explain. “Otherwise, start of chemotherapy was postponed until proven ovarian suppression.”

Six month’s after the end of treatment, rates of regular menses were not significantly different in the two arms: 70.0% in the group given goserelin versus 56.7% in the group without goserelin (p=0.284), according to the report. After adjustment for age, the corresponding figures were 70.4% vs 65.9%.

Summing up, Dr. Loibl and colleagues conclude that the trial “did not provide evidence that use of goserelin for ovarian suppression was associated with a large clinically and statistically significant protective effect on ovarian function in patients with hormone-insensitive breast cancer.”

They add, “Other fertility preservation strategies such as oocyte or embryo freezing might be preferred.”

Reference:

Effect of Luteinizing Hormone–Releasing Hormone Agonist on Ovarian Function After Modern Adjuvant Breast Cancer Chemotherapy: The GBG 37 ZORO Study

J Clin Oncol 2011;29.