New Hope for Fertility Preservation In Breast Cancer Patients
Good news for young women with a diagnosis of breast cancer. Adding a hormone-suppressing drug to chemotherapy helps avert premature menopause in hormone-insensitive breast cancer patients, according to a recent clinical trial that some oncologists called practice-changing.
In the phase III intergroup trial known as SWOG S0230, or POEMS (Prevention of Early Menopause Study), women with early breast cancer who received the luteinizing hormone-releasing hormone (LHRH) goserelin in addition to chemotherapy were 64% less likely to develop premature ovarian failure than women who received chemotherapy alone, and they were more likely to get pregnant. Unexpectedly, women who received goserelin were also 50% more likely to be alive and well 4 years later.
In the study, 257 premenopausal women with stage I–IIIA estrogen receptor (ER)–negative and progesterone receptor (PR)–negative breast cancer were randomized to treatment with cyclophosphamide-containing chemotherapy alone or chemotherapy plus goserelin. Goserelin (Zoladex) was given as monthly injections starting 1 week before the first chemotherapy treatment.
“Premenopausal women beginning chemotherapy for early breast cancer sho uld consider this new option to prevent premature ovarian failure,” said Kathy Albain, M.D., of Loyola University Medical Center in suburban Chicago, the study’s senior author. “I think it will be practice-changing, not just to preserve fertility but to prevent premature menopause, which can be debilitating.”
Patricia Ganz, M.D., director of cancer prevention and control research at the Jonsson Comprehensive Cancer Center at the University of California, Los Angeles, said, “Preserving fertility is an important component of quality survivorship care. This study provides strong evidence for a safe and effective strategy for younger women with breast cancer to preserve ovarian function and the possibility of pregnancy.”
This latest study fills me with hope, but I do need to stress again that the treatment is only suitable for women who are ER negative. About 75% of all breast cancers are Endocrine Receptor Positive “ER positive” meaning they grow in response to the hormone estrogen. ER negative describes cells that do not have a protein to which the hormone estrogen will bind. Cancer cells that are estrogen receptor negative do not need estrogen to grow. It is clear too that this treatment protocol needs to be individualized, and a multidisciplinary team including both oncologists and reproductive endocrinologists can best do that.