Abstract
Fertility preservation represents one important goal of cancer patients’ management due to the high impact on health and quality of life of survivors. The available preventive measures cannot be performed in all patients and are not feasible in all health-care facilities. Therefore, the pharmacological treatment with GnRHa has become a valuable non-invasive and well-tolerated alternative, especially in those who cannot access to cryopreservation options due to clinical and/or logistic issues. Supporting data demonstrate a significant advantage for the survivors who received GnRHa in the long-term maintenance of ovarian function and preservation of fertility. The prevention of the risk of ovarian failure with GnRHa is a typical off-label use, defined as the administration of a medicinal product not in accordance with the authorized product information. Italy has officially recognized the off-label use of GnRHa in adult women at risk of premature and permanent menopause following chemotherapy. However, fertility preservation still represents an unmet medical need in adolescents who cannot access to other treatment options.
Highlights
In Europe, nearly 80% of children and adolescents with cancer treated on current protocols survive at least 5 years on average [1]
Ovarian failure following chemotherapy represents an adverse event with an important impact on health and quality of life of survivors
Pharmacological treatment with GnRH analogs (GnRHa) is a non-invasive and well-tolerated alternative, which can be offered to all subjects if cryopreservation is not feasible due to clinical or logistic issues
Summary
In Europe, nearly 80% of children and adolescents with cancer treated on current protocols survive at least 5 years on average [1]. That could represent a more accessible FP option burdened by less discomfort for postpubertal patients, could be the concomitant use of gonadotropin-releasing hormone (GnRH) analogs (triptorelin, goserelin, leuprolide) during the course of chemotherapy [18, 29, 30] This noninvasive and less expensive approach could allow preventing POF in cancer survivors and has been recently integrated in clinical guidelines [17, 18, 31,32,33,34]. The resultant low systemic concentrations of these endogen molecules induce a feedback on the hypothalamus and pituitary gland, increasing the gonadotropins secretion, mainly follicle-stimulating hormone (FSH) [54], which enhance the follicle recruitment and maturation These growing follicles are more exposed to the gonadotoxic effects, ending in an accelerated rate of follicular apoptosis and degeneration. Pereyra Pacheco et al [88] (Prospective nonrandomized study with historical controls)
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