Department of Medical Oncology and Breast Cancer Translational Research Laboratory, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium.
Fertility Clinic, CUB-Hôpital Erasme and Research Laboratory on Human Reproduction, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium.
Cancer Treat Rev. 2019 Jan;72:65-77. doi: 10.1016/j.ctrv.2018.11.006. Epub 2018 Dec 1.
Survivorship issues are an area of crucial importance to be addressed as early as possible by all health care providers dealing with cancer patients. In women diagnosed during their reproductive years, the possible occurrence of chemotherapy-induced premature ovarian insufficiency (POI) is of particular concern being associated with important menopause-related symptoms, psychosocial issues as well as infertility. Temporary ovarian suppression by administering a gonadotropin-releasing hormone agonist (GnRHa) during chemotherapy has been studied to reduce the gonadotoxic impact of chemotherapy thus diminishing the chance of developing POI. Despite more than 30 years of research in both preclinical and clinical settings, the performance of this strategy has remained highly debated until recently. In particular, the potential mechanisms of action for the protective effects of GnRHa during chemotherapy are still not clearly identified. Nevertheless, important novel research efforts in the field have better elucidated the role of this option that is now endorsed for clinical use by several guidelines. This manuscript aims at providing an extensive overview of the literature on the use of temporary ovarian suppression with GnRHa during chemotherapy in cancer patients by addressing its biological rationale, the available preclinical and clinical evidence as well as the still existing grey zones in this field that future research efforts should address.
生存问题是所有治疗癌症患者的医疗保健提供者都应尽早解决的一个关键领域。对于在生育年龄被诊断出患有癌症的女性，化疗引起的卵巢早衰（POI）的发生尤其令人担忧，因为这可能会导致与绝经相关的重要症状、心理社会问题以及不孕。通过在化疗期间使用促性腺激素释放激素激动剂（GnRHa）进行暂时的卵巢抑制，已经研究了这种方法来降低化疗的性腺毒性作用，从而减少发生 POI 的机会。尽管在临床前和临床环境中进行了 30 多年的研究，但直到最近，这种策略的效果仍然存在很大争议。特别是，GnRHa 在化疗期间发挥保护作用的潜在作用机制仍未明确确定。然而，该领域的重要新研究努力更好地阐明了这种选择的作用，现在有几个指南支持将其用于临床。本文旨在通过探讨其生物学原理、现有的临床前和临床证据以及该领域仍然存在的灰色地带，为癌症患者在化疗期间使用 GnRHa 进行暂时卵巢抑制提供广泛的文献综述，未来的研究工作应该解决这些问题。
