Gonadotropin-releasing hormone analogs for ovarian function protection during chemotherapy in young early breast cancer patients: the last piece of the puzzle?

In western countries, nearly 6% of women with newly diagnosed breast cancer are younger than 40 years old [1]. This percentage rises to 25% in developing countries [2]. At least half of young women with breast cancer desire children after treatment [3]. Nevertheless, breast cancer patients have the lowest chances among cancer survivors to subsequently become pregnant [4]. A potential important cause of such a low pregnancy rate in breast cancer survivors is represented by the possible gonadal damage induced by anticancer systemic therapies [5]. At the time of treatment decision-making, ∼50% of young breast cancer patients are concerned about the potential risk of developing chemotherapy-induced premature ovarian failure (POF) and subsequent fertility impairment [6]. Embryo or oocyte cryopreservation is considered standard fertility preserving techniques but they cannot protect gonadal function during chemotherapy [4, 7]. Temporary ovarian suppression with gonadotropin-releasing hormone analogs (GnRHa) during chemotherapy is another available option that has been mainly investigated as a strategy to preserve ovarian function during systemic cytotoxic therapy [5]. However, this strategy has been widely debated in the last years with supporters [8] and strong detractors [9] of its protective role.

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