Good news for breast cancer patients who want to get pregnant
Good news for breast cancer patients who want to get pregnant4 Mar 2015
Among women with operable hormone-receptor-negative breast cancer, patients given goserelin (Zoladex) in addition to chemotherapy had lower rates of ovarian failure and higher rates of pregnancy 2 years after treatment compared with patients treated with chemotherapy alone, researchers said.
In addition, women who received the therapy were more likely to have a successful birth compared with women who didn't use goserelin, Halle C.F. Moore, MD, of the Cleveland Clinic Foundation and colleagues reported in the New England Journal of Medicine.
For the phase 3 trial, 218 premenopausal women ages 18 to 49 who had stage 1-3A, operable, hormone-receptor-negative breast cancer, were randomly assigned to receive either goserelin - a gonadotropin-releasing hormone (GnRH) agonist - with chemotherapy or chemotherapy alone.
None of the patients had taken any type of estrogen, anti-estrogen, hormonal contraceptives, or aromatase inhibitors during the month prior to enrollment.
The results of the study can be summarized as follows:
- Among women in the goserelin group, 21% had at least one pregnancy following treatment compared with 11% of women in the chemotherapy-alone group.
- The median age for women who became pregnant was younger than those who didn't get pregnant (32.9 years versus 39.6 years,).
- More women in the goserelin group attempted pregnancy compared with women in the chemotherapy group, 24% versus 16%, respectively.
- Miscarriage rates, pregnancy complications, and elective terminations were similar among the groups.
In total, 12 babies were born to women in the chemotherapy-alone group, and 18 were born to women in the goserelin group. Six patients of each group experienced grade 3 toxic effects. One woman in the goserelin group had a grade 4 toxic effect, a thromboembolism; none of the chemotherapy-alone patients experienced a grade 4 toxic effect.
"Very Important Information for women who want to consider having children after a breast cancer diagnosis"
"This is the second study that has proven that suppressing ovarian function in the short term during chemotherapy can preserve long-term fertility for breast cancer survivors. For women who want to consider having children after a breast cancer diagnosis, this is very important information," stated Harold Burstein, MD, PhD, of the Dana-Farber Cancer Institute.
Although previous studies have reported the potential protective effect for the ovary of administering goserelin during chemotherapy, this is the first that actually demonstrated improved pregnancy rates for those women attempting pregnancy after chemotherapy for breast cancer.
Limitations of the study
According to Michelle L. Matthews, MD, of the Carolinas HealthCare System, this study only included patients with hormone-receptor-negative breast cancers. It did not address the safety of the use of goserelin in patients with hormone-receptor-positive cancers which make up the majority of breast cancers, adding that the most significant limitation of the study is that data were missing for almost 40% of the original study participants.
Moreover, George Somlo, MD, of City of Hope in Duarte, Calif noted that “While the results were quite encouraging they suggest that the majority of patients would have preserved or recovered their ovarian function, regardless of goserelin,” and he added that the side effects associated with the drug and its sister drugs, with postmenopausal symptoms, interfere a lot with the quality of a patient’s life and should not go unnoticed.
Source: MedPage Today