Gonadotropin-Releasing Hormone Agonists During Chemotherapy for Preservation of Ovarian Function and Fertility in Premenopausal Patients With Early Breast Cancer: A Systematic Review and Meta-Analysis of Individual Patient–Level Data
- Study type
- Meta-analysis
- Study name
- POMP-IPD
- Design
- Systematic review and individual patient-level data meta-analysis of randomised trials (random-effects model)
- Sample size
- 873 patients from 5 trials
- Source
- JCO · 2018
In plain words
Chemotherapy can damage the ovaries and cause early menopause and reduced fertility. This study pooled the results of 5 trials and 873 women with breast cancer. Giving injections of drugs that temporarily switch off the ovaries (GnRHa) during chemotherapy lowered the chance of early ovarian failure (14.1% vs 30.9%). There were also more pregnancies in this group, and no harmful effect on survival was seen. The decision to use this approach should be made with your treating doctor.
Key results
Treatment arms and regimens
(Neoadjuvant/adjuvant) chemotherapy with a concurrent gonadotropin-releasing hormone agonist (GnRHa).
Individual patient-data meta-analysis; the type and dose of GnRHa and chemotherapy varied between trials.
(Neoadjuvant/adjuvant) chemotherapy alone.
Source of the regimen details: Abstract of the paper
Doses are given for the information of specialists, as in this study’s protocol, and are not a prescription. Every drug must be prescribed by the treating physician for the individual patient.
Study population
Premenopausal women with early breast cancer who, in the eligible trials, were randomised to (neoadjuvant/adjuvant) chemotherapy alone or with a concurrent gonadotropin-releasing hormone agonist (GnRHa).
Endpoints
Primary endpoints: rate of premature ovarian insufficiency (POI) and post-treatment pregnancy rate. Secondary endpoints: disease-free survival and overall survival.
Safety and side effects
The abstract reports no data on grade ≥3 adverse events. In terms of oncological safety, no significant difference in disease-free or overall survival was seen between the two groups.
Clinical significance and place in guidelines
Based on the abstract, concurrent GnRHa during chemotherapy is an available option to reduce the risk of premature ovarian insufficiency and potentially improve future fertility in premenopausal women with early breast cancer. Its place in clinical guidelines should be checked against the latest guideline versions.
Limitations
The abstract does not state the study's limitations explicitly. Patients came from 5 trials, and the statistical significance for pregnancies was borderline (P=0.030). Other limitations are detailed in the full text of the paper.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.