Preventing ovarian failure associated with chemotherapy

Area of Science:

• Oncology
• Reproductive Endocrinology
• Pharmacology

Background:

• Alkylating chemotherapy poses a risk of ovarian failure and infertility in pre-menopausal women.
• Chemotherapy-associated ovarian failure can lead to long-term adverse health effects.
• Randomized trials demonstrate the efficacy of gonadotropin-releasing hormone agonists (GnRHa) in mitigating this risk, particularly in breast cancer patients.

Purpose of the Study:

• To evaluate the role of GnRHa, specifically goserelin, in preventing chemotherapy-associated ovarian failure.
• To inform clinical practice regarding the use of goserelin for ovarian function preservation in women undergoing alkylating chemotherapy.
• To highlight updated guidelines recommending concurrent GnRHa use.

Main Methods:

• Review of randomized trials and clinical guidelines (e.g., St Gallen, NCCN).
• Focus on the efficacy of goserelin, a GnRHa, administered as a monthly subcutaneous injection.
• Consideration of goserelin's recent listing on the Australian Pharmaceutical Benefits Scheme.

Main Results:

• GnRHa have shown efficacy in preventing chemotherapy-induced ovarian failure.
• Goserelin is recommended by major guidelines for breast cancer patients.
• Goserelin is now available for pre-menopausal women receiving alkylating therapies for malignancy or autoimmune disease.

Conclusions:

• Concurrent goserelin use should be considered for all pre-menopausal women starting alkylating chemotherapy, except those with incurable cancer.
• Goserelin administration should ideally begin at least one week before chemotherapy and continue every four weeks.
• While preserving ovarian function, other fertility preservation methods like embryo or oocyte cryopreservation should be discussed for women who have not completed childbearing.