Gonadotropin-releasing hormone agonists for the preservation of ovarian function among women with breast cancer who did not use tamoxifen after chemotherapy: a systematic review and meta-analysis

Objective: To determine whether concurrent use of GnRH agonists with chemotherapy preserves ovarian function in women with breast cancer who did not use tamoxifen. Design: Systematic review and meta-analysis. Setting: University-based hospitals. Patient(s): Premenopausal women with breast cancer treated with chemotherapy who did not receive tamoxifen. Intervention(s): Randomization to concurrent GnRH agonists with chemotherapy or chemotherapy alone. Main Outcome Measure(s): Odds ratio (OR) of resumption of menses 1 year or more after chemotherapy. Result(s): Searches were conducted in PubMed, Scopus, Cochrane Trials Register, and the National Research Register through March 2014, and all randomized trials that reported resumption of menses 1 year or more after GnRH agonist with chemotherapy or chemotherapy alone among women with breast cancer who did not receive tamoxifen were included. Four studies were analyzed in the meta-analysis and included 252 patients (GnRH agonist with chemotherapy, n = 131; chemotherapy alone, n = 121). There was no significant difference in the rate of return of menses between the two groups (OR, 1.47; 95% confidence interval [0.60-3.62]). Heterogeneity among the trials was not significant (I-2 = 16.6%). Conclusion(s): Concurrent GnRH agonists with chemotherapy may not preserve ovarian function in women with breast cancer. Furthermore, randomized data are limited regarding fertility after concurrent use of GnRH agonists with chemotherapy. (C)2014 by American Society for Reproductive Medicine.