Addressing Chemotherapy Induced Ovarian Failure in Patients With Breast Cancer

Don S. Dizon, MD, FACP

One of the biggest quality of life issues affecting young women treated with chemotherapy for breast cancer is chemotherapy induced ovarian failure.

One of the biggest quality of life issues affecting young women treated with chemotherapy for breast cancer is chemotherapy induced ovarian failure. This causes an early menopause and can cause estrogen deficiency with significant consequences from hot flashes to irritability to depression. In fact, the sequelae of estrogen deprivation can be a huge detriment to the quality of life of women surviving breast cancer. While one of the most effective therapies for hot flashes is estrogen, it is not typically recommended, particularly in women with hormone receptor positive disease, on the risk that any estrogen stimulation may cause breast cancer to recur.

Testosterone supplementation has been an option to reverse much of these symptoms, but one concern is the conversion of testosterone to estrogen in the human body. In order to evaluate whether testosterone can be safely given, R. Glaser from Wright State University examined whether a subcutaneous preparation of anastrazole and testosterone can improve symptoms related to hormone deprivation without raising estradiol levels in women surviving breast cancer. Her results were presented earlier this month at the 2010 Breast Cancer Symposium.

Fifty five patients received two implants containing 120 mg of testosterone and 8 mg of anastrazole, implanted in their gluteal region and underwent blood tests to measure serum levels of estradiol and testosterone 2 weeks after insertion.

Glaser reported improvement of symptoms attributable to hormone deficiencies and demonstrated consistently low estradiol levels (<30 pg/ml) and therapeutic testosterone levels. In 110 insertions there were no reported adverse events. Of more importance, none of the women treated in this cohort have relapsed in the time of treatment, which ranged up to 3 years.

These results are especially hopeful in pointing out a potential way to control the symptoms of hormone deficiency without elevating a perceived risk of relapse. While the study results are very promising, we must wait for a randomized trial to prove these benefits are real, prior to the adoption of this technique in women with breast cancer.

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Reference: Glaser, RL. Subcutaneous testosterone-anastrazole implant therapy in breast cancer survivors. 2010 Breast Cancer Symposium. Available at: http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=100&abstractID=60007. Accessed 10/20/2010.