Study: Chemo Plus Hormone Treatment for Breast Cancer Boosts Survival, Fertility

By Thomas Crocker
Wednesday, May 1, 2019

In the final results of a major international clinical trial, women with hormone receptor-negative breast cancer who received a combination of standard chemotherapy and hormone treatment were more likely to become pregnant and enjoyed a better five-year survival rate than patients who received chemotherapy alone.

For women of childbearing age who develop breast cancer, chemotherapy raises the specter of early menopause and loss of fertility.

“Chemotherapy reduces the likelihood a woman would continue to have her regular menstrual period,” says Lajos Pusztai, MD, DPhil, Professor of Medicine, Director of Breast Cancer Translational Research, Co-Director of the Yale Cancer Center Genetics and Genomics Program at Yale Cancer Center and Yale School of Medicine, and Chair of the SWOG Breast Committee. “The likelihood [of ovarian failure] depends on the type of chemotherapy regimen, and most importantly, the age of the patient.”

Further, a 2017 study in Current Oncology found that chemotherapy significantly reduced levels of anti-Müllerian hormone, an indicator of fertility, in premenopausal breast cancer survivors who experienced normal cycles compared with control patients.

Ovarian Protection

In 2014, initial results of the SWOG Cancer Research Network’s Prevention of Early Menopause Study (POEMS) showed women with hormone receptor-negative breast cancer who received standard chemotherapy and injections of the gonadotropin-releasing hormone agonist goserelin enjoyed fertility and survival advantages compared with those who received chemotherapy alone. The results prompted the National Comprehensive Cancer Network Guidelines for Oncology to incorporate the use of goserelin in younger patients concerned about fertility preservation.

The final POEMS results, which included five years of follow-up of 218 patients, confirmed the initial findings.

Approximately 23 percent of women who received chemotherapy and goserelin became pregnant, compared with about 12 percent who received only chemotherapy. Ninety-two percent of combination-therapy recipients were alive at the five-year mark, compared with 83 percent of chemotherapy recipients.

“[T]his is the only medical therapy that has been shown not just to improve fertility, but also to reduce the risk of early menopause and its potential consequences,” says Halle Moore, MD, staff physician in the Department of Solid Tumor Oncology at Cleveland Clinic Taussig Cancer Institute, Associate Professor of Medicine at Cleveland Clinic Lerner College of Medicine and lead researcher on the POEMS trial. “[T]his does not prohibit the use of more traditional assistive reproductive techniques.”

Potential for Broader Application

the Prevention of Early Menopause Study (POEMS) trial tracked women with hormone receptor-negative breast cancer but did not include patients with hormone receptor-positive disease, which is far more common. The study’s findings, however, may be applicable to both.

“Other studies, including a meta-analysis presented in the past year, demonstrated that the protection of ovarian function [for individuals receiving standard chemotherapy plus goserelin] appears to be similar, whether the cancer is hormone receptor-positive or hormone receptor-negative,” says Halle Moore, MD, staff physician in the Department of Solid Tumor Oncology at Cleveland Clinic Taussig Cancer Institute, Associate Professor of Medicine at Cleveland Clinic Lerner College of Medicine and lead researcher on the POEMS trial. “This approach also appeared to be safe, regardless of hormone receptor status. I think we can now comfortably offer this approach, regardless of receptor results, for women receiving adjuvant chemotherapy for breast cancer.”