Novel approach to prevent ‘chemo’ induced menopause in breast cancer patients

By Dr. Ananya Mandal, MDJul 20 2011

It is known that women who undergo chemotherapy for breast cancer get an early menopause under age 40. Women can choose to have some eggs removed in advance of the treatment in order to preserve some chance of having a baby later, but that can be a difficult and complicated process. Now, however, there may be a medication to treat these women to avoid premature menopause. About 6% of women with breast cancer are diagnosed before age 40.

A new study with a drug called triptorelin (a hormone analogue) temporarily suppressed ovarian function and reduced the occurrence of premature menopause in women with breast cancer. The study appears in the Journal of the American Medical Association this tuesday.

Italian researchers conducted a Phase 3 study of 281 women diagnosed with breast cancer who had not begun menopause. The women were randomly assigned to receive triptorelin injections or a placebo before and during chemotherapy. The women were followed for one year after the last chemotherapy treatment.

Results showed that little over a quarter of the women in the placebo group experienced menopause due to chemotherapy compared with only 8.9% of the women who received triptorelin. The patients' ages and type of chemotherapy did not influence the risk of developing menopause.

The next step is to determine if preservation of menstruation also means that fertility is preserved. The long-term safety of using the medication and its effect on cancer survival is also not clear, especially for women with hormone-sensitive breast cancer. Other studies on similar types of medications found no effect on menopause onset.

More research is needed on the treatment, said the authors of a commentary accompanying the study, Dr. Hope S. Rugo and Dr. Mitchell P. Rosen of UC, San Francisco. They add that the data are “intriguing and represent an important and encouraging addition to the study of ovarian preservation for women in this difficult situation.” But the therapy can't yet be recommended as a standard approach, they added. Egg freezing is still the best option for fertility preservation and should be discussed with all young women facing chemotherapy for any type of cancer.

The treatment could have drawbacks, said Dr. Lauren Cassell, chief of breast surgery at Lenox Hill Hospital in New York City. “Just because you resume menses [menstruation] doesn't mean that you're going to have fertilization. You don't really know how this is going to affect long-term outcomes,” she said. Dr. Paula Ryan, a medical oncologist with Fox Chase Cancer Center in Philadelphia had the same two concerns: that adding triptorelin might affect long-term breast cancer outcomes and may not even preserve fertility. “I wouldn't take this study and ultimately suggest that it be the standard of care,” she said.

But on the positive side, said Ryan, “this study, along with a few other small, randomized studies, that have pointed to a benefit [that] at least could potentially be encouraging for young women. One of the burdens of getting breast cancer, on top of everything else, in young women is this huge issue [of preserving fertility]. Any study looking at this is giving us new and important information for this particular group of women.”