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

Matteo Lambertini, Michela Cinquini, Ivan Moschetti, Fedro A Peccatori, Paola Anserini, Mario Valenzano Menada, Maurizio Tomirotti, Lucia Del Mastro

Research output: Contribution to journalReview article

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.

Original languageEnglish
Pages (from-to)25-33
Number of pages9
JournalEuropean Journal of Cancer
Volume71
DOIs
Publication statusPublished - Jan 2017

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Medical Oncology
Fertility
Gonadotropin-Releasing Hormone
Breast Neoplasms
Drug Therapy
Fertility Preservation
Primary Ovarian Insufficiency
Manuscripts
Practice Guidelines
Infertility
Ovary
Decision Making
Pharmacology
Neoplasms

Keywords

  • Antineoplastic Agents, Hormonal/therapeutic use
  • Breast Neoplasms/drug therapy
  • Chemotherapy, Adjuvant
  • Female
  • Fertility/drug effects
  • Fertility Preservation/methods
  • Gonadotropin-Releasing Hormone/analogs & derivatives
  • Humans
  • Primary Ovarian Insufficiency/prevention & control

Cite this

@article{1e0d0f0d7da2483c9cdb10fb4a3adc3c,
title = "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",
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.",
keywords = "Antineoplastic Agents, Hormonal/therapeutic use, Breast Neoplasms/drug therapy, Chemotherapy, Adjuvant, Female, Fertility/drug effects, Fertility Preservation/methods, Gonadotropin-Releasing Hormone/analogs & derivatives, Humans, Primary Ovarian Insufficiency/prevention & control",
author = "Matteo Lambertini and Michela Cinquini and Ivan Moschetti and Peccatori, {Fedro A} and Paola Anserini and {Valenzano Menada}, Mario and Maurizio Tomirotti and {Del Mastro}, Lucia",
note = "Copyright {\circledC} 2016 Elsevier Ltd. All rights reserved.",
year = "2017",
month = "1",
doi = "10.1016/j.ejca.2016.10.034",
language = "English",
volume = "71",
pages = "25--33",
journal = "European Journal of Cancer",
issn = "0959-8049",
publisher = "Elsevier Ltd",

}

TY - JOUR

T1 - Temporary ovarian suppression during chemotherapy to preserve ovarian function and fertility in breast cancer patients

T2 - A GRADE approach for evidence evaluation and recommendations by the Italian Association of Medical Oncology

AU - Lambertini, Matteo

AU - Cinquini, Michela

AU - Moschetti, Ivan

AU - Peccatori, Fedro A

AU - Anserini, Paola

AU - Valenzano Menada, Mario

AU - Tomirotti, Maurizio

AU - Del Mastro, Lucia

N1 - Copyright © 2016 Elsevier Ltd. All rights reserved.

PY - 2017/1

Y1 - 2017/1

N2 - 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.

AB - 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.

KW - Antineoplastic Agents, Hormonal/therapeutic use

KW - Breast Neoplasms/drug therapy

KW - Chemotherapy, Adjuvant

KW - Female

KW - Fertility/drug effects

KW - Fertility Preservation/methods

KW - Gonadotropin-Releasing Hormone/analogs & derivatives

KW - Humans

KW - Primary Ovarian Insufficiency/prevention & control

U2 - 10.1016/j.ejca.2016.10.034

DO - 10.1016/j.ejca.2016.10.034

M3 - Review article

C2 - 27940355

VL - 71

SP - 25

EP - 33

JO - European Journal of Cancer

JF - European Journal of Cancer

SN - 0959-8049

ER -