Utilization of gonadotropin-releasing hormone agonists for preservation of ovarian function in women with breast cancer receiving chemotherapy

Abstract

To determine the use and predictors of GnRH (gonadotropin-releasing hormone) agonists for ovarian conservation in young, reproductive age women with newly diagnosed breast cancer undergoing chemotherapy. Retrospective cohort study. The MarketScan database was used to identify women 15-45 years of age with newly diagnosed breast cancer from 2008-2017. All patients underwent cancer directed surgery (lumpectomy, mastectomy, biopsy or lymph node evaluation) and received cytotoxic chemotherapy within three months before or after surgery. Patients were considered to have received GnRH agonist therapy if they had one claim for a GnRH agonist in the same period. All women with history of oophorectomy before or during the study period were excluded from the study. Trends and predictors of GnRH agonist use were described and compared using Cochran-Armitage trend test and Chi-square tests. We identified a total of 13,634 women with breast cancer who underwent treatment with chemotherapy. The median age was 39 years with 755 women <30 (5.5%) years of age and 12,879 >30 (94.5%) years old. GnRH agonists were administered to 112 (0.8%, 95% CI 0.7-1.0%) women. The rate of GnRH agonist use was higher in women age 15-30 years compared to women age 30-45 (2.8% vs 0.7%) (P< 0.001). During the study period, the utilization of GnRH agonists increased from 0.3% in 2008 to 1.3% in 2017 (P<0.001). Use of GnRH agonists was higher in the Northeast (2.0%) compared to the north central (0.7%), southern (0.6%) and western (0.5%) U.S. (P<0.001). The utilization of GnRH agonists among reproductive age women with breast cancer undergoing chemotherapy is extremely low.