New hope for preserving fertility during breast cancer treatment

Like many young women diagnosed with breast cancer, Charlotte Melton only learned that chemotherapy that could save her life could also destroy her fertility and send her into early menopause when doctors were planning her treatment.

Melton, then a 33-year-old mom from Danville, Va., was told the only way to guarantee she’d be able to have children after her treatments was to delay chemo until fertility specialists could collect her eggs for later use. Though Melton wished to have another child, she couldn’t imagine postponing those potentially life-saving treatments.

“I wanted them to cut this thing out of me right away,” Melton, now 37, said. “I had a 1 year old with Down syndrome and my main concern was being there for the child I already had.”

Up until now women with breast cancer have been faced with the same heartbreaking choice as Melton: delay chemo to give doctors time to collect their eggs or roll the dice with their fertility.

But a new study suggests that there now may be another option. Researchers have found that a woman’s likelihood of coming through chemo with her fertility intact is greatly improved if she is given a medication named goserelin that essentially shuts down the ovaries and puts them at rest. (They start up again once the medication is withdrawn)

In fact, women who were given goserelin during chemotherapy were nearly two-thirds more likely to maintain fertility compared to those who received only chemo, according to the study presented at the annual meeting of the American Society of Clinical Oncology.

“Anywhere from one third to two thirds of premenopausal women receiving standard chemotherapy agents experience premature menopause,” said Dr. Joseph Unger, a senior statistical analysis in the Public Health Sciences Division at Fred Hutchinson Cancer Research Center who was one of study’s authors. And up until now, the only proven way to preserve fertility was harvest a woman’s eggs prior to the beginning of chemotherapy treatments, Unger said.

Thirty four of the 218 patients in the study became pregnant after their treatments were over: 22, or 21 percent, of those treated with goserelin versus 12, or 11 percent, of those who received only chemo.

The unfortunate side-effect goes further than simply preventing women from having babies.  It also thrusts them into premature menopause.

Women often don’t recognize how severely that will impact their lives. 

Adrienne Reed, 41, didn’t know what to expect when she had her ovaries removed as part of the recommended treatment for her breast cancer because she was BRCA2 positive.  

“It’s better now and I’m running regularly again but when my ovaries were suddenly removed I was catapulted into menopause at 40,” the Seattle resident said. “I didn’t realize that the impact would be like hitting a wall. I got a frozen shoulder condition that affects mostly menopausal women and developed issues with sleeplessness.”

Reed says she might have delayed the oophorectomy by a few years if she had any idea of what the fallout would be. 

But as it turns out, treatment with goserelin might have a benefit beyond preserving ovarian function – it might actually make chemo work better, Unger said.

“Although the study was not powered to examine cancer outcomes differences, we explored cancer outcomes to ensure there were no detrimental effects from the goserelin treatment,” Unger said. “To our surprise we found that women receiving goserelin with their chemotherapy had both better disease free and overall survival than women receiving chemotherapy alone.”

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Solid tumors, such as those of the breast, are the focus of Solid Tumor Translational Research, a network comprised of Fred Hutchinson Cancer Research Center, UW Medicine and Seattle Cancer Care Alliance. STTR is bridging laboratory sciences and patient care to provide the most precise treatment options for patients with solid tumor cancers.