Preserving Ovarian Function in Young Women with Breast Cancer

Balancing strategies to reduce the risk for disease recurrence while optimizing fertility preservation is a critical tension when caring for young women with early-stage breast cancer. To determine whether the use of the gonadotropin-releasing hormone agonist goserelin reduces the risk for chemotherapy-induced premature ovarian insufficiency (POI) in women with early breast cancer, investigators conducted a prospective, randomized study (OPTION) of 202 premenopausal patients (median age, 38 years) with stage I–III disease (about 44% estrogen receptor positive) receiving neoadjuvant or adjuvant chemotherapy.

Patients received six to eight cycles of cyclophosphamide, an anthracycline, or both, with or without a taxane. In addition, they were randomized to receive goserelin (starting 1–2 weeks prior to chemotherapy and continued every 3–4 weeks until chemotherapy was complete) or nothing (control group). Hormone levels were checked after cycle 3, after the final cycle, at 9 months, at 12 months, and annually thereafter. The primary endpoint was the rate of amenorrhea, defined as no menses between 12 and 24 months following randomization along with an elevated level of follicle stimulating hormone (FSH).

The rate of amenorrhea between 12 and 24 months was lower in the goserelin group than in the control group (22% vs. 38%; P=0.015), as were FSH levels at 12 months (P=0.027) and 24 months (P=0.001). The prevalence of POI was also lower with goserelin (18.5% vs. 34.8%; P=0.048), especially in women 40 or younger.