Temporary ovarian suppression during chemotherapy to preserve ovarian function and fertility in breast cancer patients: A GRADE approach for evidence evaluation and recommendations by the Italian Association of Medical Oncology. (January 2017)

• Record Type: Journal Article
• Authors: Lambertini, Matteo; Cinquini, Michela; Moschetti, Ivan; Peccatori, Fedro A.; Anserini, Paola; Valenzano Menada, Mario; Tomirotti, Maurizio; Del Mastro, Lucia
• Is Part Of: European journal of cancer. Volume 71(2017)
• Page Start: 25
• Page End: 33
• Publication Date: 2017-01
• Subjects: Premature ovarian failure -- Breast cancer -- Luteinising hormone-releasing hormone analogues (LHRHa) -- Fertility preservation -- Italian Association of Medical Oncology (AIOM) -- Grades of Recommendation, Assessment, Development, and Evaluation (GRADE); Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2016.10.034
• Languages: English
• ISSNs: 0959-8049

Abstract

Abstract: The development of premature ovarian failure and subsequent infertility are possible consequences of chemotherapy use in pre-menopausal women with early-stage breast cancer. Among the available strategies for fertility preservation, pharmacological protection of the ovaries using luteinising hormone-releasing hormone analogues (LHRHa) during chemotherapy has the potential to restore ovarian function and fertility after anticancer treatments; however, the possible efficacy and clinical application of this strategy has been highly debated in the last years. Following the availability of new data on this controversial topic, the Panel of the Italian Association of Medical Oncology (AIOM) Clinical Practice Guideline on fertility preservation in cancer patients decided to apply the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methodology around the relevant and current question on the clinical utility of temporary ovarian suppression with LHRHa during chemotherapy as a strategy to preserve ovarian function and fertility in breast cancer patients. To answer this question, preservation of ovarian function and fertility were judged as critical outcomes for the decision-making. Three possible outcomes of harm were identified: LHRHa-associated toxicities, potential antagonism between concurrent LHRHa and chemotherapy, and lack of the prognostic impact of chemotherapy-induced premature ovarian failure. According to the GRADE evaluation conducted, the result was a strong positive recommendation in favour of using this option to preserve ovarian function and fertility in breast cancer patients. The present manuscript aims to update and summarise the evidence for the use of this strategy in light of the new data published up to January 2016, according to the GRADE process. Highlights: Treatment-induced ovarian function loss is of great concern for young breast cancer patients. The protective role of luteinising hormone-releasing hormone analogues (LHRHa) during chemotherapy has been highly debated in the last years. Grades of Recommendation, Assessment, Development and Evaluation approach by the Italian Association of Medical Oncology (AIOM) to investigate this issue. The Panel of the AIOM Clinical Practice Guideline recommends the use of LHRHa during chemotherapy.