Center for Human Reproduction Prof. Franco Jr, Ribeirao Preto, Brazil.
Med Hypotheses. 2012 Apr;78(4):442-5. doi: 10.1016/j.mehy.2011.12.015. Epub 2012 Jan 28.
Infertility represents one of the main long-term consequences of the chemotherapy used for the adjuvant treatment of breast cancer. Approximately 60-65% of breast cancers express the nuclear hormone receptor in premenopausal women. Adjuvant endocrine therapy is an integral component of care for patients with hormone receptor-positive (HR+) tumours. The GnRH agonist (GnRHa) alone or in combination with tamoxifen produces results at least similar to those obtained with the different chemotherapy protocols in patients with HR+ breast cancer with respect to recurrence-free survival and overall survival. It is time to indicate adjuvant therapy with GnRHa associated with tamoxifen for patients with breast cancer (HR+ tumours) if they want to preserve their reproductive function. The evaluation of ovarian reserve tests: follicle stimulating hormone (FSH), anti-Mullerian hormone (AMH), inhibin B, antral follicle count (AFC) and ovarian volume 6 months, and 1 year after the end of therapy with GnRHa/tamoxifen must be realised. The recurrence-free survival and overall survival should be analysed. The major implication of this hypothesis will be to avoid adjuvant chemotherapy for patients with breast cancer (HR+ tumours) that request fertility preservation. It is expected that ovarian function should not be altered in almost all cases and subsequent pregnancy a real possibility.
不孕是乳腺癌辅助化疗的主要长期后果之一。大约 60-65%的乳腺癌在绝经前妇女中表达核激素受体。辅助内分泌治疗是激素受体阳性 (HR+) 肿瘤患者治疗的重要组成部分。GnRH 激动剂 (GnRHa) 单独或与他莫昔芬联合使用,在 HR+ 乳腺癌患者的无复发生存率和总生存率方面,至少与不同的化疗方案的结果相似。对于希望保留生育功能的 HR+ 乳腺癌 (HR+ 肿瘤) 患者,现在是时候考虑使用 GnRHa 联合他莫昔芬进行辅助治疗了。应在 GnRHa/他莫昔芬治疗结束后 6 个月和 1 年时进行卵巢储备试验(卵泡刺激素 (FSH)、抗苗勒管激素 (AMH)、抑制素 B、窦卵泡计数 (AFC) 和卵巢体积)的评估。应分析无复发生存率和总生存率。这一假设的主要意义在于避免对要求保留生育能力的 HR+ 乳腺癌患者进行辅助化疗。预计在几乎所有情况下都不会改变卵巢功能,并且随后妊娠成为可能。