Gonadotropin-releasing hormone (GnRH) agonists are demonstrating efficacy in preserving fertility and improving outcomes for premenopausal women with breast cancer undergoing chemotherapy. These findings, supported by recent studies, offer a comprehensive approach to balancing family-building goals with favorable breast cancer outcomes.
Impact of GnRH Agonists on Ovarian Function
Final results from the phase 3 POEMS trial (NCT00068601), published in 2018 in the Journal of the National Cancer Institute, showed that administering the GnRH agonist goserelin during chemotherapy significantly reduced the risk of ovarian failure in patients with premenopausal, hormone receptor (HR)-negative breast cancer. Stephanie L. Graff, MD, FACP, FASCO, director of breast oncology at Lifespan Cancer Institute, noted that this intervention was associated with a high rate of ovarian function restoration post-treatment, improving the likelihood of future pregnancies. The use of GnRH agonists also improved disease-free survival (DFS) and overall survival outcomes in the HR-negative patient population.
Benefits of Ovarian Function Suppression (OFS)
Ovarian function suppression (OFS) has also proven beneficial in HR-positive breast cancer. An Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) meta-analysis, presented at the 2023 ASCO Annual Meeting, highlighted that OFS combined with endocrine therapy significantly improves outcomes, particularly for patients with high-risk disease. This approach allows for more effective treatment strategies in women with HR-positive breast cancer.
POSITIVE Study and Interruption of Endocrine Therapy
The POSITIVE study (NCT02308085) provided reassurance for women with HR-positive breast cancer desiring pregnancy. The trial demonstrated that a temporary interruption of endocrine therapy to attempt conception did not compromise DFS. Patients were able to pause therapy for up to 2 years, pursue pregnancy, and resume treatment thereafter. According to Dr. Graff, this allows patients to balance optimal family-building goals with favorable breast cancer outcomes.
Comprehensive Approach to Fertility Preservation
Together, these data support a comprehensive approach to fertility preservation and OFS, allowing women with breast cancer to maintain reproductive potential and achieve optimal cancer outcomes. By combining OFS and fertility preservation, patients can later benefit from taking a break from these therapies, successfully moving toward pregnancy, and then go back on those therapies after a 2-year break to have their optimal family and breast cancer outcomes.
