Friday, January 22, 2016

Is it possible to protect the gonads during chemotherapy?



 It is estimated that in  USA about 843,820 new cases of cancer all site would be diagnosed in women in the year 2016 out of which 89,140 will be younger than 45 years of age.

As a result of improved knowledge and increased health awareness combined with increased availability of screening tests and healthcare resources many cancers are now diagnosed at a younger age than before.

According to WHO the 5 most common sites of cancer in women are breast, colorectal, lung, cervix, and stomach cancer.

The treatment for cancers diagnosed at early stage is more specific, less destructive and results in more Disease-free survival (DFS) and progression-free survival (PFS) resulting in improved quality of life.

When the rapidly dividing cancer cells are targeted with chemotherapy/ radiotherapy, the germ cells in gonads are also affected and are destroyed.

As a result older women with decreased ovarian reserve may end up in ovarian failure, losing the capacity to reproduce while younger women become hypoestrogenic.

According to the International guidelines on fertility preservation it is recommended that the physicians address the issue of fertility preservation with all patients of reproductive age as early as possible before initiating the treatment and keeping them informed about all the options.

As recommended by the American Society of Clinical Oncology and the European Society for Medical Oncology, sperm cryopreservation and embryo/oocyte cryopreservation are standard strategies for fertility preservations in male and female patients, respectively.

Other strategies (e.g. pharmacological protection of the gonads and gonadal tissue cryopreservation) are still at experimental stage due to lack of large data and guidelines..

This Systematic Review and Meta-analysis by Elgindy E et al published in the December issue of Journal of Obstetrics and Gynecology aims to estimate whether gonadotropin-releasing hormone (GnRH) analog administration during chemotherapy can protect against development of ovarian toxicity.

Many studies have earlier evaluated the use of GnRH to preserve the endocrinological and biological function of the gonads in cancer chemotherapy/Radiotherapy with conflicting results.

Meta-analysis by Shen YW et al published in Journal of Oncotargets and Therapy (2015 Nov 13;8:3349-59) did show that  GnRH agonists cotreatment with chemotherapy in premenopausal women with breast cancer plays a beneficial role in resumption of ovarian function, with a higher rate of resumption of menses. However, treatment with GnRH agonists does not appear to exhibit its protective effects in fertility.

Another Meta-analysis Wang C et al in PloS One(2013 Jun 21;8(6):e66360. Print 2013) also concluded a potential benefit of GnRH cotreatment with chemotherapy in premenopausal women, producing higher rates of spontaneous resumption of menses.

Both the trials reported an increased pregnancy rate, however both these meta-analysis included trials with patients having breast cancer only.

A total of 10 RCTs with 907 women were included in the analysis comparing resumption of ovarian function between use of GnRH analogs plus chemotherapy with chemotherapy without GnRH the analogs.

The primary outcomes were resumed ovarian function at the longest follow-up after the end of chemotherapy. Secondary outcomes were evaluating ovarian reserve parameters and pregnancy.

Resumption of menstrual cycles was observed in 320 of 468 in in GnRH analog arm and 263 of 439 in the chemotherapy alone arm, which did not reach statistical significance.

No significant difference was observed when the data was analyzed according to different type of cancer, age below 40 vs above 40 years.

Other parameters of   ovarian capacity (baseline follicle-stimulating hormone level, anti-Müllerian hormone level, or antral follicle count) and pregnancy rates upon completion of chemotherapy also did not show a significantly difference between the two arms.

On the basis of this meta-analysis, it was seen that GnRHa co-treatment had no significant impact on rates of resumption of ovarian function among reproductive-age women undergoing chemotherapy.

National Comprehensive Cancer Network (NCCN) guidelines have been updated to acknowledge the use of LHRHa in preventing chemotherapy-induced ovarian failure of hormone receptor negative breast cancer patients.

However, ovarian suppression with GnRH during chemotherapy is still considered an experimental strategy to preserve fertility by some international guidelines due to both the uncertainty regarding the efficacy of this strategy and the absence of data on pregnancies and long-term ovarian function.



References:








http://www.ncbi.nlm.nih.gov/pubmed/26241272


1 comment:

  1. Chemicals used in industries gives me Leukemia Cancer and it's all started when I wanted to get off my job to get another job that when I got diagnose, at that very point I was so scared to die because it has infected my blood cells also I was prescribed drugs like Cyclophosphamide,Busulfan,Bosutinib,Cytarabine, Cytosar-U (Cytarabine),Dasatinib in all that was just to keep me waiting for my dying day. I got inspired by what I read from a lady called Tara Omar on blog spot on how Dr Itua cure her HIV/Aids then they were lettered below that says he can cure Cancer so I pick his contact on the testimony she wrote then I emailed Dr Itua hopefully he replied swiftly to my mail then I purchased his Herbal medicine also it was shipped to me here in Texas, I went to pick it at post office so he instructs me on how the treatment will take me three weeks to cure my Leukemia Disease, Joyfully I was cured by this Dr Itua Herbal Medicine.
    I will advise you too to give a try to Dr Itua Herbal Medicine with the following diseases that he can help you cure forever___Diabetes, Herpes,HIV/Aids, Bladder Cancer, Breast Cancer, Vaginal Cancer, Kidney Cancer, Lung Cancer, Skin Cancer, Uterine Cancer, Prostate Cancer, Colo_Rectal Cancer, Leukemia Cancer, Hepatitis, Brain Tumors, Tach Disease,Love Spell, Infertility, Hpv. GoodLuck,XoXo****
    Dr Itua Contact Information:::
    Email (info@drituaherbalcenter.com)(drituaherbalcenter@gmai.com)
    WhatsApp-(+2348149277967)

    ReplyDelete