Gonadotropin releasing hormone agonists for the preservation of ovarian function among women with breast cancer who did not use tamoxifen after chemotherapy A systematic review and meta analysis

Capsule:
Resumption of menses 1 year or more after treatment is similar among women with breast cancer who receive a gonadotropin-releasing hormone agonist with chemotherapy or chemotherapy alone.

Authors:
Wendy S. Vitek, M.D., Michelle Shayne, M.D., Kathleen Hoeger, M.D., M.P.H., Yu Han, M.S., Susan Messing, M.S., Chunkit Fung, M.D., M.S.

Volume 102, Issue 3, Pages 808-815

Abstract:

Objective:
To determine whether concurrent use of GnRH agonists with chemotherapy preserves ovarian function in women with breast cancer who did not use tamoxifen.

Design:
Systematic review and meta-analysis.

Setting:
University-based hospitals.

Patient(s):
Premenopausal women with breast cancer treated with chemotherapy who did not receive tamoxifen.

Intervention(s):
Randomization to concurrent GnRH agonists with chemotherapy or chemotherapy alone.

Main Outcome Measure(s):
Odds ratio (OR) of resumption of menses 1 year or more after chemotherapy.

Result(s):
Searches were conducted in PubMed, Scopus, Cochrane Trials Register, and the National Research Register through March 2014, and all randomized trials that reported resumption of menses 1 year or more after GnRH agonist with chemotherapy or chemotherapy alone among women with breast cancer who did not receive tamoxifen were included. Four studies were analyzed in the meta-analysis and included 252 patients (GnRH agonist with chemotherapy, n = 131; chemotherapy alone, n = 121). There was no significant difference in the rate of return of menses between the two groups (OR, 1.47; 95% confidence interval [0.60–3.62]). Heterogeneity among the trials was not significant (I2 = 16.6%).

Conclusion(s):
Concurrent GnRH agonists with chemotherapy may not preserve ovarian function in women with breast cancer. Furthermore, randomized data are limited regarding fertility after concurrent use of GnRH agonists with chemotherapy.

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