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Drug Protects Fertility for Women With Cancer

June 4, 2014

Fertility drugs for cancer

[su_quote url=”http://www.nytimes.com/2014/05/31/business/drug-could-protect-fertility-in-breast-cancer-patients.html?_r=0″]A commonly used drug can help young women with breast cancer retain the ability to have babies, apparently protecting their ovaries from the damage caused by chemotherapy, researchers reported here on Friday.

The treatment could provide a new option for dealing with one of the painful dilemmas faced by young cancer patients — that doing the utmost to save their lives might impair or even ruin their fertility.

Researchers said the drug, goserelin, which temporarily shuts down the ovaries, appears to protect women from the more permanent premature menopause that can be induced by chemotherapy. In a clinical trial, women who were given goserelin injections along with chemotherapy had less ovarian failure and gave birth to more babies than women receiving only the chemotherapy.

“Premenopausal women beginning chemotherapy for early breast cancer should consider this new option to prevent premature ovarian death,” the study’s lead author, Dr. Halle Moore of the Cleveland Clinic, said at a news conference here at the annual meeting of the American Society of Clinical Oncology.

Dr. Ann H. Partridge, a breast cancer specialist at the Dana-Farber Cancer Institute in Boston and another author of the study, said about 16,000 American women under age 45 get breast cancer each year. Impaired fertility from chemotherapy is also a problem for women and men with other types of cancer and for children who survive the disease, though it is not clear if the results of this study would apply to them, she said.

Goserelin is sold by AstraZeneca under the brand name Zoladex. Global sales of the drug were about $1 billion in 2013.

Goserelin and similar drugs, known as gonadotropin-releasing hormone agonists, are commonly used as hormonal therapies to treat breast and prostate cancer. They are also used at fertility clinics to control the timing of ovulation.

The main option now for young breast cancer patients wanting to increase their chances of having babies is to have multiple eggs removed from their ovaries, as is done for in vitro fertilization. The eggs can be frozen or used to create embryos, which are then frozen.[/su_quote]

Despite these seemingly exciting results, there are some cautions that need to be cited for this study. The results suggest a benefit but the article makes it sound like women who have the medicine during chemo treatment have no effect on their fertility. Based on what’s covered in the news article, there is no mention of comparing the fertility potential (ovarian reserve), only menopause incidence and pregnancies.

The overall numbers in the study, while relatively large, still are not a large enough sample to separate the nuances of individuals when it comes to ovarian reserve. Many of the pregnancies could have occurred in the younger patients that would be much more likely to have some remaining ovarian function after chemotherapy. What we currently know about fertility potential and chemotherapy is ovarian function is dramatically affected. While the menopause rate and pregnancy rates may be better with this treatment, only time will tell if patients go into menopause earlier and if the pregnancy potential will be the same for these women long term.

It is our opinion based on earlier trials, that even with the protective effect noted in this study, we can’t say that the drug prevented any damage to the ovaries and that fertility was fully preserved. The study only followed patients for two years. For a 28 year old that is a fraction of her fertility future.

Once the data is available for review, we can make further assessments. This is a good example of how news coverage of medicine is often misleading (“Drug Saves Fertility for Women with Cancer”). The impression of the article is that using Goserelin will fully protect the ovaries from the damaging effects of cancer. Egg harvesting before chemotherapy would still be an important treatment to offer these women. The use of this medicine, may extend or improve the outcome and should be considered in these patients.

   
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