Infertility rates following POMB/ACE chemotherapy for male and female germ cell tumours – a retrospective long-term follow-up study

Abstract

The risk of chemotherapy-induced infertility in male and female germ cell tumour (GCT) survivors is unclear, but may correlate with cisplatin dose. Here, we examine a large series of GCT patients for the effect of chemotherapy on those attempting to have children. Our GCT database was screened for nonseminomatous GCT patients who had (1) received POMB/ACE chemotherapy (cisplatin, vincristine, methotrexate, bleomycin alternating with actinomycin D, cyclophosphamide and etoposide) and (2) stage I male GCT patients who were untreated between 1977 and 1996. Fertility was assessed by questionnaire and medical records. A total of 64 of 153 treated and 35 of 115 untreated men attempted to have children. In all, 28% (18 out of 64) receiving POMB/ACE were unsuccessful. Radiotherapy (six), atrophic remaining testis (one) or prior infertility (three) were implicated in 10 cases, so chemotherapy-induced infertility may have occurred in only 11% (eight out of 64). Strikingly, 26% (nine out of 35) of untreated stage I patients also failed to have children (three had radiotherapy, three prior infertility). Moreover, in treated men, no association was seen between cisplatin dose and infertility. In contrast, radiotherapy significantly increased male infertility (P ¼ 0.001). Of 28 treated women who attempted to have children, 25% (seven out of 28) were unsuccessful. One previously had infertility and one subsequently had successful IVF so chemotherapy-induced infertility potentially occurred in only 18% (five out of 28) and was not related to cisplatin dose. In conclusion, the risk of chemotherapy-induced infertility is low in both male and female GCT patients and does not clearly correlate with the cumulative cisplatin dose.

Volasertib preclinical activity in high-risk hepatoblastoma

“…Surgical strategies include conventional surgical resection or liver transplant. Salvage chemotherapeutic strategies do not work for every patient, and can result in long-term side effects, including severe hearing loss [44], infertility [45] and thinning of the heart wall [46].…”

A review of the close surveillance policy for stage I female germ cell tumors of the ovary and other sites

“…Perrin et al (29) demonstrated a pregnancy success rate of 7 of 29 (24%) in patients who had received chemotherapy and Bower et al (9) demonstrated a pregnancy rate of 14 of 33 (42%) following POMB/ACE chemotherapy, which are both comparable with our rate of 45%. A paper by Gaffan et al (30) looked at women who had fertility‐conserving surgery and then received chemotherapy and subsequently wanted to have a child, ie, excluded those who never tried. Of the 28 treated (POMB/ACE) women who attempted to have children, 25% (7/28) were unsuccessful.…”

Influence of high‐dose methotrexate therapy on the primordial follicles of the mouse ovary

“…failed to find any evidence of reduced fertility in patients administered etoposide, methotrexate, actinomycin‐D, cyclophosphamide, and vincristine (EMA/CO regimen) for gestational trophoblastic tumors. A recent retrospective study by Gaffen and colleagues showed that the risk of infertility is low in both male and female germ cell tumor survivors taking 6‐mercaptopurine, vincristine, methotrexate, and prednisone / doxorubicin, cyclophosphamide, an etoposide (POMP/ACE regimen) 21 . Although the applied doses of MTX were not clearly mentioned, in a review it was reported that there is a 97% conception rate after the cessation of MTX treatment in women with gestational trophoblastic tumors 10 …”