EMBARGOED UNTIL 5 P.M. ET, Wednesday, March 4, 2015, Cleveland: Breast cancer patients who are given the hormone-blocking drug goserelin during chemotherapy are less likely to experience ovarian failure and more likely to have successful pregnancies, according to results from the Prevention of Early Menopause Study (POEMS) to be published in the New England Journal of Medicine.
Women who received goserelin - a synthetic version of a naturally occurring gonadotropin-releasing hormone (GnRH) - during chemotherapy for breast cancer experienced an 8 percent ovarian failure rate compared to 22 percent for the control group two years after treatment. In addition, 21 percent of women who received goserelin became pregnant within the first 5 years post-treatment compared to only 11 percent of women who became pregnant in the control group during the same timeframe.
"POEMS is the first study to provide strong evidence that fertility prospects are improved following ovarian suppression during chemotherapy," said Halle C.F. Moore, M.D., a breast cancer oncologist at Cleveland Clinic and the study's lead investigator. "Preserving ovarian function is a vital survivorship issue for young breast cancer patients. In addition to improving prospects for fertility, this intervention should help avoid a variety of unwanted effects of early menopause."
Ovarian failure, or the development of early menopause, is a common long-term side effect of chemotherapy. Cancer patients with premature ovarian failure are at increased risk for unpleasant symptoms of menopause and for developing long-term health problems, such as osteoporosis, infertility and possibly cardiovascular disease.
"A cancer diagnosis is a life-changing event for anyone, but young women diagnosed with breast cancer often face a different array of challenges than the typical breast cancer patient who is in their 60s or 70s. Issues such as the long-term effects of treatment, impact on fertility, caring for young children, effect on career and relationships as well as concerns about genetic risk factors add to the heavy weight of a cancer diagnosis," Dr. Moore said. "We recently opened a Young Women's Breast Clinic because we recognize the particular needs of this patient group and want to provide these women with timely and appropriate treatment, consultations and support from the time of their initial diagnosis."
POEMS included 218 premenopausal women worldwide diagnosed with early stage hormone-receptor-negative breast cancer from 2004 to 2011; 135 participants were included in the ovarian failure analysis.Patients were randomized to receive standard chemotherapy with or without goserelin every four weeks for the duration of treatment, beginning at least one week prior to its start. Goserelin works by putting the ovaries in a "resting" state and preventing their normal cycle, making them less vulnerable to the toxic effects of chemotherapy.
In addition to preserving ovarian function, patients who were given goserelin experienced better disease-free survival and overall survival rates than the control group.
POEMS is the largest published randomized study addressing the role of a GnRH agonist during chemotherapy for ovarian protection in women with hormone receptor-negative breast cancer.
POEMS was coordinated by Southwest Oncology Group (SWOG), a cancer research cooperative group that designs and conducts multidisciplinary clinical trials. This research was funded by the National Cancer Institute with additional support from AstraZeneca, Australia and New Zealand Breast Cancer Trials Group, and the Breast Cancer Institute of Australia.
For more information on Cleveland Clinic cancer services, call the Cancer Answer Line at 1.866.223.8100 or visit clevelandclinic.org/cancer.
About Cleveland Clinic
Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. U.S.News & World Report consistently names Cleveland Clinic as one of the nation's best hospitals in its annual "America's Best Hospitals" survey. More than 3,000 full-time salaried physicians and researchers and 11,000 nurses represent 120 medical specialties and subspecialties. The Cleveland Clinic health system includes a main campus near downtown Cleveland, more than 75 Northern Ohio outpatient locations, including 16 full-service Family Health Centers, Cleveland Clinic Florida, the Lou Ruvo Center for Brain Health in Las Vegas, Cleveland Clinic Canada, and, currently under construction, Cleveland Clinic Abu Dhabi.
New England Journal of Medicine