Gonadotropin-Releasing Hormone (GnRH) Agonists for Fertility Preservation: Is POEMS the Final Verse?
Menée auprès de 218 patientes atteintes d'un cancer du sein ER-/PR- de stade I à IIIA avant la ménopause, cette étude évalue l'efficacité de la goséréline, un analogue de l'hormone entraînant la libération des gonadotrophines, pour prévenir une ménopause précoce induite par une chimiothérapie
The detrimental effect of chemotherapy on ovarian function and fertility is widely recognized. All current oncology practice guidelines recommend that oncologists address this issue in female cancer patients of reproductive age and refer interested patients to reproductive specialists as soon as possible after cancer diagnosis. Standard fertility preservation methods including embryo or oocyte cryopreservation are available in most fertility centers with assisted reproductive technologies laboratories. Ideally, cryopreservation of embryos or oocytes should be performed before the start of gonadotoxic cancer treatment. However, with limited insurance coverage in most states for fertility treatments, fertility preservation using assisted reproductive technologies is not a financially viable option for many patients, especially in the face of a new cancer diagnosis. Also, for some cancers such as acute leukemia, a two- to three-week delay in starting life-saving cancer treatment in exchange for fertility preservation and the higher risks associated with oocyte retrieval in the setting of pancytopenia are not acceptable. In addition, preserving embryos or gametes does not protect ovaries from damage by gonadotoxic cancer treatment, and premature ovarian insufficiency/failure or early menopause has adverse effects on subsequent cardiovascular, bone, and mental health. Therefore, much effort has been devoted to finding measures that may preserve both fertility and ovarian function and are financially and medically feasible for all patients. GnRH agonists (GnRHa) have shown promise in this regard.
Journal of the National Cancer Institute , commentaire, 2017