How to Protect Ovarian Function before and during Chemotherapy?

Arecco, Luca; Ruelle, Tommaso; Martelli, Valentino; Boutros, Andrea; Latocca, Maria Maddalena; Spinaci, Stefano; Marrocco, Camilla; Massarotti, Claudia; Lambertini, Matteo

doi:10.3390/jcm10184192

Cited by 21 publications

(15 citation statements)

References 105 publications

(166 reference statements)

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“…Patient-related factors such as age and baseline fertility, cumulative dose, and cycle schedule affect this risk. 39 These factors can be compared at various dosages across patient populations with the cyclophosphamide equivalent dose (CED) calculator, specifically in the case of alkylating agents. 40 A CED ≥4,000 mg/m 2 is associated with a significant risk of infertility.…”

Section: Design: Ovarian Dysfunction Resulting From Systemic Treatmentsmentioning

confidence: 99%

Cancer Treatment-Related Ovarian Dysfunction in Women of Childbearing Potential: Management and Fertility Preservation Options

Reynolds

McKenzie

2023

JCO

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PURPOSE To review the complex concerns of oncofertility created through increased cancer survivorship and the long-term effects of cancer treatment in young adults. DESIGN Review chemotherapy-induced ovarian dysfunction, outline how fertility may be addressed before treatment initiation, and discuss barriers to oncofertility treatment and guidelines for oncologists to provide this care to their patients. CONCLUSION In women of childbearing potential, ovarian dysfunction resulting from cancer therapy has profound short- and long-term implications. Ovarian dysfunction can manifest as menstrual abnormalities, hot flashes, night sweats, impaired fertility, and in the long term, increased cardiovascular risk, bone mineral density loss, and cognitive deficits. The risk of ovarian dysfunction varies between drug classes, number of received lines of therapy, chemotherapy dosage, patient age, and baseline fertility status. Currently, there is no standard clinical practice to evaluate patients for their risk of developing ovarian dysfunction with systemic therapy or means to address hormonal fluctuations during treatment. This review provides a clinical guide to obtain a baseline fertility assessment and facilitate fertility preservation discussions.

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Section: Design: Ovarian Dysfunction Resulting From Systemic Treatmentsmentioning

confidence: 99%

Cancer Treatment-Related Ovarian Dysfunction in Women of Childbearing Potential: Management and Fertility Preservation Options

Reynolds

McKenzie

2023

JCO

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“…In previous reports, the quality of life in premenopausal patients with breast cancer and CIA was reported to be impaired because of symptoms associated with premature ovarian dysfunction as well as the other side effects of chemotherapy ( 20 , 88 ). A significant number of women receive a cancer diagnosis before their age of natural menopause, the most frequent neoplasms included breast cancer, and most of these patients desire to preserve fertility ( 89 ); it is important to consider the assessment and management of CIA in the clinical treatment of premenopausal patients with breast cancer. In 2014, Zhao published a meta-analysis ( 5 ) that included 46 studies on the risk factors that affected CIA incidence and their prognostic effect.…”

Section: Discussionmentioning

confidence: 99%

Chemotherapy-Induced Amenorrhea and Its Prognostic Significance in Premenopausal Women With Breast Cancer: An Updated Meta-Analysis

Wang

Liang

et al. 2022

Front. Oncol.

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ObjectiveChemotherapy-induced amenorrhea (CIA) is one of the most common side effects in premenopausal patients with breast cancer, and several factors may contribute to the incidence of CIA. In this meta-analysis, we aimed to summarize clinical risk factors associated with CIA incidence and to evaluate their prognostic effects in patients with breast cancer.MethodsThree electronic databases (Cochrane Library, EMBASE, and MEDLINE) were systematically searched for articles published up to October 2021. The articles included clinical trials that evaluated risk factors associated with CIA and their prognostic value in treatment. For the meta-analysis, pooled odds ratio estimates (ORs) and 95% confidence intervals (CIs) were calculated using the inverse variance-weighted approach, in addition to publication bias and the chi-square test.ResultsA total of 68 studies involving 26,585 patients with breast cancer were included in this meta-analysis, and 16,927 patients developed CIA. From the 68 studies, 7 risk factors were included such as age group, hormone receptor (HR) status, estrogen receptor (ER) status, progesterone receptor (PR) status, tamoxifen administration, chemotherapeutic regimen, and tumor stage. Based on our results, patients with age of ≤40, HR-negative status, ER-negative status, PR-negative status, no use of tamoxifen, and use of anthracycline-based regimen (A) compared with anthracycline-taxane-based regimen (A+T) were associated with less incidence of CIA in patients with breast cancer. Moreover, CIA was associated with favorable disease-free survival (OR = 0.595, 95% CI = 0.537 to 0.658, p < 0.001) and overall survival (OR = 0.547, 95% CI = 0.454–0.660, p < 0.001) in premenopausal patients with breast cancer.ConclusionAge, HR status, ER status, PR status, tamoxifen administration, and chemotherapeutic regimen can be considered independent factors to predict the occurrence of CIA. CIA is a favorable prognostic factor in premenopausal patients with breast cancer. CIA should be a trade-off in the clinical management of premenopausal patients with breast cancer, and further large cohort studies are necessary to confirm these results.

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“…Women who cannot delay the start of oncological treatment by two weeks and refuse or are unable to undergo surgery for ovarian tissue retrieval, should be offered the option to receive the administration of GnRHa during chemotherapy [10]. In fact, even if it is still controversial the effectiveness of GnRHa as fertility preservation technique [50], it seems that women who receive GnRHa during gonadotoxic chemotherapy, preserve the ovarian functionality with fewer women experiencing permanent amenorrhea [51].…”

Section: Assisted Reproductive Technologiesmentioning

confidence: 99%

Fertility Preservation in Girls and Women: State of Art and Future Possibilities

Marin¹,

Ambrosini²,

Esposito³

et al. 2022

Clin. Exp. Obstet. Gynecol.

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Background: Many women worldwide are diagnosed with cancer in prepubertal, postpubertal and childbearing age. Oncological treatments can compromise future fertility through different mechanisms mainly depending on the type of treatment and the age of the patient. International societies recommend that cancer patients should receive information regarding the effects of oncological treatments on their reproductive health and cancer survivors should not be discouraged from becoming pregnant. About a quarter of these patients still do not receive an adequate counselling and young cancer survivors may face several barriers to conceiving a pregnancy due to the concerns from gynaecologists and oncologists. Methods: This review aims to investigate the infertility risk for female cancer patients who undergo oncological treatments and to provide an overview of actual and future fertility preservation possibilities for female cancer patients. Results: Different fertility preservation techniques have been developed in order to ensure the possibility for cancer survivors to complete their family planning after cancer. Oocyte/embryo freezing and ovarian tissue cryopreservation are the established choices, but the research is still going on to increase the success rate of these techniques and to develop other techniques to overcome actual limitations. Patients with a systemic oncological disease such as leukaemia could particularly benefit from the new experimental techniques which involve the creation of an artificial ovary or the in vitro growth of follicles or even the obtaining of mature oocytes from stem cells. All these techniques would allow the achievement of pregnancy without the risk of reintroducing malignant cells within autologous cryopreserved ovarian tissue transplantation. Regarding the concerns over pregnancy in cancer survivors, research is rapidly advancing and reassuring data are increasing. Conclusions: The rate of utilisation of gametes, embryos or ovarian tissue previously stored for fertility preservation is still low and the motivations can be various. Further data are needed in order to reassure both women and oncologists about the safety of pregnancy in cancer survivors and in order to increase the rate of women experiencing pregnancy after cancer.

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How to Protect Ovarian Function before and during Chemotherapy?

Cited by 21 publications

References 105 publications

Cancer Treatment-Related Ovarian Dysfunction in Women of Childbearing Potential: Management and Fertility Preservation Options

Cancer Treatment-Related Ovarian Dysfunction in Women of Childbearing Potential: Management and Fertility Preservation Options

Chemotherapy-Induced Amenorrhea and Its Prognostic Significance in Premenopausal Women With Breast Cancer: An Updated Meta-Analysis

Fertility Preservation in Girls and Women: State of Art and Future Possibilities

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