The treatment of young women's breast cancer continues to undergo refinement, including dual goals of improving scientific knowledge and developing tools to positively affect long-term survivorship. The expanded use of gonadotropin-releasing hormone agonists (GnRHa) as an ovarian protectant and in combination with endocrine therapy represents a substantial achievement for both.
Cytotoxic chemotherapy has clinically significant risk for gonadotoxic effects, influenced by the regimen and age of the women. Rates of premature ovarian insufficiency and negative effects on fertility and sexual functioning are serious concerns to many patients.[1–5] In young women's breast cancer, concomitant GnRHa with chemotherapy can preserve ovarian function and increase subsequent pregnancies.[6–11] These data resulted in multiple breast cancer guidelines adopting recommendations for incorporating GnRHa as ovarian protection during cytotoxic chemotherapy.[7,12–15] Nonetheless, concerns remained over the efficacy of the approach and long-term safety, particularly in hormone receptor–positive disease.[11,16]
In the article accompanying this editorial, Lambertini et al.[17]present the mature data from the PROMISE-GIM6, a multicenter, randomized, open-label, phase III, superiority study of GnRHa as ovarian protection for premenopausal women undergoing chemotherapy, now with a median follow-up of more than 12 years. The primary endpoint, prevention of chemotherapy-induced premature ovarian insufficiency at 1 year, was met with a statistically significant reduction from 25.9% to 8.9% (odds ratio = 0.28, 95% confidence interval [CI] = 0.14 to 0.59) for the women cotreated with GnRHa. In this post hoc extension analysis, the authors report on 10 women identified as having a
