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Triptorelin Shows No Advantage for Resuming Menstruation After Chemotherapy

June 4, 2012

Written By Robin Warshaw
Reviewed By Lidia Schapira, MD

Research on a medicine used to protect premenopausal women’s ovaries during chemotherapy was stopped early when no difference in results was seen. 

The study was conducted by a team from the University of California, San Francisco, and published in the Journal of Clinical Oncology.

Background and Reason for the Study

Chemotherapy can affect the ovaries. Women who are premenopausal before chemotherapy may lose their periods (amenorrhea) or experience premature menopause, with hot flashes and related symptoms.

Recovery of periods after chemotherapy may not be a good predictor of future fertility. Some women who stop having periods remain fertile while others may continue to menstruate but have chemotherapy-related infertility.

Doctors and researchers have theorized that by protecting the ovaries from the harsh effects of chemotherapy, women might gain a quicker and fuller recovery of ovarian function. One method being explored to reduce such effects is using gonadotropin-releasing hormone (GnRH) analog medicines, also called LHRH agonists, to shut down, or suppress, the actions of ovaries.

The researchers wanted to see if a GnRH analog, triptorelin, was effective in preserving ovarian function in women treated with chemotherapy.

Study Structure

Women included in the study were:

  • premenopausal;
  • age 44 or younger;
  • being treated for early-stage breast cancer;
  • randomly assigned either to receive triptorelin or not during chemotherapy;
  • subdivided for analysis by:
    • age: under 35, 35 to 39, older than 39;
    • estrogen receptor status;
    • chemotherapy medicines being received.

The study planned to include 124 women, but only 47 were treated, ranging in age from 21 to 43. Return of ovarian function after chemotherapy was measured by:

  • if, and when, menstruation resumed;
  • levels of follicle-stimulating hormone (FSH);
  • levels of the hormones inhibin A and B.

Findings

There were 21 women in the control (no triptorelin) group and 26 in the study group that received the medicine.

Among the women not taking triptorelin, 90 percent resumed their periods at a median (mid-point of all results) of five months after completing chemotherapy. For those in the medicine group, 88 percent had their periods again by a median 5.8 months.

Findings were analyzed by age, estrogen receptor status and treatment medicines used.

The results for the two groups were so similar that the study was ended early.

What This Means for You

It may be hard to see the value in a study that isn’t a “success.” Yet this research, although not the final word, adds to the continuing study of whether ovarian suppression during chemotherapy preserves fertility and prevents premature menopause.

Other studies have found no benefit, but at least two others had favorable findings. Right now, there is no clear answer. If you are considering using ovarian suppression during chemotherapy, talk with your doctor and healthcare team about your situation.

Ongoing randomized trials continue to explore this important issue. Living Beyond Breast Cancer will monitor new studies and report findings in the Breast Cancer News section of lbbc.org.

PN Munster, AP Moore, R Ismail-Khan, et al. Randomized trial using gonadotropin-releasing hormone agonist triptorelin for the preservation of ovarian function during (neo)adjuvant chemotherapy for breast cancer. Journal of Clinical Oncology 2012; 30(5): 533.

This article was supported by Cooperative Agreement Number DP11-1111 from The Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.

 

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