Preventing Early Menopause in Breast Cancer Patients

Risk of sudden onset menopause reduced by adding goserelin to chemotherapy regimen.

A novel approach to early breast cancer treatment in young women can significantly reduce the risk of sudden onset menopause, a new study indicated.

Published in The New England Journal of Medicine, a major international clinical trial showed the addition of the drug goserelin (Zoladex) to a chemotherapy regimen in women who wanted to have children improved their chances of getting pregnant and delivering a healthy baby.

"Some of the most distressing side effects of chemotherapy in young women with breast cancer are early and sudden onset of menopause and infertility," senior author Kathy Albain, MD, said in a press release. "These findings provide hope for young women with breast cancer who would like to prevent early menopause or still have children."

During chemotherapy, the addition of goserelin to the regimen temporarily puts the ovaries at rest during treatment, the study noted.

"We found that, in addition to reducing the risk of sudden, early menopause, and all of the symptoms that go along with menopause, goserelin was very safe and may even improve survival," Dr. Albain said. "These findings are changing how we manage young women with breast cancer."

In a phase 3 multicenter trial with premenopausal women younger than 50 years of age with estrogen and progesterone-receptor negative early stage breast cancer, 257 patients were randomly assigned to receive standard chemotherapy or chemotherapy plus goserelin.

The researchers found that after 2 years, 22% of patients in the standard chemotherapy group had stopped menstruating or had elevated levels of the FSH hormone, which is an indication of reduced estrogen production and egg supply, according to the study. Just 8% of women in the group who received chemotherapy plus goserelin stopped menstruating or had elevated FSH.

Additionally, the pregnancy rate in the goserelin group was 21%, versus 11 % in the group who received chemotherapy alone.

After 4 years of treatment, 78% in the standard chemotherapy group had no signs or symptoms of cancer, compared with 89% of patients in the goserelin treatment group. The overall survival rate after 4 years in the standard chemotherapy group was 82%, while the survival rate in the goserelin group was 92%.

"Premenopausal women beginning chemotherapy for early breast cancer should consider this new option to prevent premature ovarian failure," Dr. Albain noted.