Treatment may protect young women with breast cancer from early menopause

An early menopause is often in store for women under age 40 who have chemotherapy for breast cancer. Women can choose to have some eggs removed in advance of the treatment in order to preserve some chance of having a baby later, but that can be a difficult and complicated process. Now, however, there may be a medication to treat these women to avoid premature menopause.

A study published Tuesday found a drug called triptorelin (a hormone analogue, which mimics the actions of a hormone) temporarily suppressed ovarian function and reduced the occurrence of premature menopause in women with breast cancer. About 6% of women with breast cancer are diagnosed before age 40.

Researchers in Italy conducted a Phase 3 study of 281 women diagnosed with breast cancer who had not begun menopause. The women were randomly assigned to receive triptorelin injections or a placebo before and during chemotherapy. The women were followed for one year after the last chemotherapy treatment.

Just over one-quarter of the women in the placebo group experienced menopause due to chemotherapy compared with only 8.9% of the women who received triptorelin. The patients’ ages and type of chemotherapy did not influence the risk of developing menopause.

Questions remain about the treatment, however. It’s not clear whether preservation of menstruation also means that fertility is preserved. The long-term safety of using the medication and its effect on cancer survival is also not clear, especially for women with hormone-sensitive breast cancer. Other studies on similar types of medications found no effect on menopause onset.

More research is needed on the treatment, said the authors of a commentary accompanying the study, Dr. Hope S. Rugo and Dr. Mitchell P. Rosen of UC, San Francisco.

The data are “intriguing and represent an important and encouraging addition to the study of ovarian preservation for women in this difficult situation,” they wrote. But the therapy can’t yet be recommended as a standard approach, they added. Egg freezing is still the best option for fertility preservation and should be discussed with all young women facing chemotherapy for any type of cancer.

The study appears in the Journal of the American Medical Assn.

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