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Erschienen in: Der Gynäkologe 4/2015

01.04.2015 | Gynäkologie aktuell

Fertilitätsprotektion vor Chemotherapie bei Brustkrebs: neue Optionen

verfasst von: M. Rodewald, T. Gundelach, V. Geyer, J. Huober, W. Janni, Prof. Dr. K. Hancke

Erschienen in: Die Gynäkologie | Ausgabe 4/2015

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Zusammenfassung

Nach adjuvanter Chemotherapie liegt das Risiko für eine Ovarialinsuffizienz bei Frauen unter 40 Jahren je nach Art und Anzahl der Chemotherapiezyklen zwischen 10 und 80 %. Daher sollte jede prämenopausale Patientin mit Kinderwunsch über dieses Risiko und die Möglichkeiten des Fertilitätserhaltes aufgeklärt werden. Sowohl die Entnahme und Kryokonservierung von Ovarialgewebe als auch die hormonelle Stimulation mit nachfolgender Kryokonservierung von befruchteten und unbefruchteten Eizellen haben in den letzten Jahren vielversprechende Ergebnisse gezeigt und sollten mit den Patientinnen besprochen werden. Ob GnRH-Agonisten kombiniert oder allein verwendet werden sollten, ist weiterhin kontrovers; für die einzelne Patientin kann dies in Abhängigkeit vom individuellen Risiko entschieden werden.
Literatur
1.
Zurück zum Zitat Lambertini M, Anserini P, Levaggi A et al (2013) Fertility counseling of young breast cancer patients. J Thorac Dis 5(Suppl 1):S68–S80PubMedCentralPubMed Lambertini M, Anserini P, Levaggi A et al (2013) Fertility counseling of young breast cancer patients. J Thorac Dis 5(Suppl 1):S68–S80PubMedCentralPubMed
2.
Zurück zum Zitat Linkeviciute A, Boniolo G, Chiavari L, Peccatori FA (2014) Fertility preservation in cancer patients: the global framework. Cancer Treat Rev 40(8):1019–1027CrossRefPubMed Linkeviciute A, Boniolo G, Chiavari L, Peccatori FA (2014) Fertility preservation in cancer patients: the global framework. Cancer Treat Rev 40(8):1019–1027CrossRefPubMed
3.
Zurück zum Zitat Von Wolff M, Montag M, Dittrich R et al (2011) Fertility preservation in women – a practical guide to preservation techniques and therapeutic strategies in breast cancer, Hodgkin’s lymphoma and borderline ovarian tumours by the fertility preservation network FertiPROTEKT. Arch Gynecol Obstet 284(2):427–435CrossRef Von Wolff M, Montag M, Dittrich R et al (2011) Fertility preservation in women – a practical guide to preservation techniques and therapeutic strategies in breast cancer, Hodgkin’s lymphoma and borderline ovarian tumours by the fertility preservation network FertiPROTEKT. Arch Gynecol Obstet 284(2):427–435CrossRef
4.
Zurück zum Zitat Donnez J, Dolmans MM, Demylle D et al (2004) Livebirth after orthotopic transplantation of cryopreserved ovarian tissue. Lancet 364(9443):1405–1410CrossRefPubMed Donnez J, Dolmans MM, Demylle D et al (2004) Livebirth after orthotopic transplantation of cryopreserved ovarian tissue. Lancet 364(9443):1405–1410CrossRefPubMed
5.
Zurück zum Zitat Meirow D, Levron J, Eldar-Geva T et al (2005) Pregnancy after transplantation of cryopreserved ovarian tissue in a patient with ovarian failure after chemotherapy. N Engl J Med 353(3):318–321CrossRefPubMed Meirow D, Levron J, Eldar-Geva T et al (2005) Pregnancy after transplantation of cryopreserved ovarian tissue in a patient with ovarian failure after chemotherapy. N Engl J Med 353(3):318–321CrossRefPubMed
6.
Zurück zum Zitat Oktay K (2006) Spontaneous conceptions and live birth after heterotopic ovarian transplantation: is there a germline stem cell connection? Hum Reprod 21(6):1345–1348CrossRefPubMed Oktay K (2006) Spontaneous conceptions and live birth after heterotopic ovarian transplantation: is there a germline stem cell connection? Hum Reprod 21(6):1345–1348CrossRefPubMed
7.
Zurück zum Zitat Demeestere I, Simon P, Buxant F et al (2006) Ovarian function and spontaneous pregnancy after combined heterotopic and orthotopic cryopreserved ovarian tissue transplantation in a patient previously treated with bone marrow transplantation: case report. Hum Reprod 21(8):2010–2014CrossRefPubMed Demeestere I, Simon P, Buxant F et al (2006) Ovarian function and spontaneous pregnancy after combined heterotopic and orthotopic cryopreserved ovarian tissue transplantation in a patient previously treated with bone marrow transplantation: case report. Hum Reprod 21(8):2010–2014CrossRefPubMed
8.
Zurück zum Zitat Wølner-Hanssen P, Hägglund L, Ploman F et al (2005) Autotransplantation of cryopreserved ovarian tissue to the right forearm 4(1/2) years after autologous stem cell transplantation. Acta Obstet Gynecol Scand 84(7):695–698PubMed Wølner-Hanssen P, Hägglund L, Ploman F et al (2005) Autotransplantation of cryopreserved ovarian tissue to the right forearm 4(1/2) years after autologous stem cell transplantation. Acta Obstet Gynecol Scand 84(7):695–698PubMed
9.
Zurück zum Zitat Rosendahl M, Loft A, Byskov AG et al (2006) Biochemical pregnancy after fertilization of an oocyte aspirated from a heterotopic autotransplant of cryopreserved ovarian tissue: case report. Hum Reprod 21(8):2006–2009CrossRefPubMed Rosendahl M, Loft A, Byskov AG et al (2006) Biochemical pregnancy after fertilization of an oocyte aspirated from a heterotopic autotransplant of cryopreserved ovarian tissue: case report. Hum Reprod 21(8):2006–2009CrossRefPubMed
10.
Zurück zum Zitat Oktay K, Buyuk E, Veeck L et al (2004) Embryo development after heterotopic transplantation of cryopreserved ovarian tissue. Lancet 363(9412):837–840CrossRefPubMed Oktay K, Buyuk E, Veeck L et al (2004) Embryo development after heterotopic transplantation of cryopreserved ovarian tissue. Lancet 363(9412):837–840CrossRefPubMed
11.
Zurück zum Zitat Oktay K (2001) Ovarian tissue cryopreservation and transplantation: preliminary findings and implications for cancer patients. Hum Reprod Update 7(6):526–534CrossRefPubMed Oktay K (2001) Ovarian tissue cryopreservation and transplantation: preliminary findings and implications for cancer patients. Hum Reprod Update 7(6):526–534CrossRefPubMed
12.
Zurück zum Zitat Sánchez-Serrano M, Novella-Maestre E, Roselló-Sastre E et al (2009) Malignant cells are not found in ovarian cortex from breast cancer patients undergoing ovarian cortex cryopreservation. Hum Reprod 24(9):2238–2243CrossRefPubMed Sánchez-Serrano M, Novella-Maestre E, Roselló-Sastre E et al (2009) Malignant cells are not found in ovarian cortex from breast cancer patients undergoing ovarian cortex cryopreservation. Hum Reprod 24(9):2238–2243CrossRefPubMed
13.
Zurück zum Zitat Rosendahl M, Timmermans Wielenga V, Nedergaard L et al (2011) Cryopreservation of ovarian tissue for fertility preservation: no evidence of malignant cell contamination in ovarian tissue from patients with breast cancer. Fertil Steril 95(6):2158–2161CrossRefPubMed Rosendahl M, Timmermans Wielenga V, Nedergaard L et al (2011) Cryopreservation of ovarian tissue for fertility preservation: no evidence of malignant cell contamination in ovarian tissue from patients with breast cancer. Fertil Steril 95(6):2158–2161CrossRefPubMed
14.
Zurück zum Zitat Rodriguez-Wallberg KA, Oktay K (2012) Fertility preservation and pregnancy in women with and without BRCA mutation-positive breast cancer. Oncologist 17(11):1409–1417CrossRefPubMedCentralPubMed Rodriguez-Wallberg KA, Oktay K (2012) Fertility preservation and pregnancy in women with and without BRCA mutation-positive breast cancer. Oncologist 17(11):1409–1417CrossRefPubMedCentralPubMed
15.
Zurück zum Zitat Kotsopoulos J, Librach CL, Lubinski J et al (2008) Infertility, treatment of infertility, and the risk of breast cancer among women with BRCA1 and BRCA2 mutations: a case-control study. Cancer Causes Control 19(10):1111–1119CrossRefPubMed Kotsopoulos J, Librach CL, Lubinski J et al (2008) Infertility, treatment of infertility, and the risk of breast cancer among women with BRCA1 and BRCA2 mutations: a case-control study. Cancer Causes Control 19(10):1111–1119CrossRefPubMed
16.
Zurück zum Zitat Donnez J, Dolmans MM, Pellicer A et al (2013) Restoration of ovarian activity and pregnancy after transplantation of cryopreserved ovarian tissue: a review of 60 cases of reimplantation. Fertil Steril 99(6):1503–1513CrossRefPubMed Donnez J, Dolmans MM, Pellicer A et al (2013) Restoration of ovarian activity and pregnancy after transplantation of cryopreserved ovarian tissue: a review of 60 cases of reimplantation. Fertil Steril 99(6):1503–1513CrossRefPubMed
17.
Zurück zum Zitat Von Wolff M, Thaler CJ, Frambach T et al (2009) Ovarian stimulation to cryopreserve fertilized oocytes in cancer patients can be started in the luteal phase. Fertil Steril 92(4):1360–1365CrossRef Von Wolff M, Thaler CJ, Frambach T et al (2009) Ovarian stimulation to cryopreserve fertilized oocytes in cancer patients can be started in the luteal phase. Fertil Steril 92(4):1360–1365CrossRef
18.
Zurück zum Zitat Oktay K, Buyuk E, Libertella N et al (2005) Fertility preservation in breast cancer patients: a prospective controlled comparison of ovarian stimulation with tamoxifen and letrozole for embryo cryopreservation. J Clin Oncol 23(19):4347–4353CrossRefPubMed Oktay K, Buyuk E, Libertella N et al (2005) Fertility preservation in breast cancer patients: a prospective controlled comparison of ovarian stimulation with tamoxifen and letrozole for embryo cryopreservation. J Clin Oncol 23(19):4347–4353CrossRefPubMed
19.
Zurück zum Zitat Oktay K, Hourvitz A, Sahin G et al (2006) Letrozole reduces estrogen and gonadotropin exposure in women with breast cancer undergoing ovarian stimulation before chemotherapy. J Clin Endocrinol Metab 91(10):3885–3890CrossRefPubMed Oktay K, Hourvitz A, Sahin G et al (2006) Letrozole reduces estrogen and gonadotropin exposure in women with breast cancer undergoing ovarian stimulation before chemotherapy. J Clin Endocrinol Metab 91(10):3885–3890CrossRefPubMed
20.
Zurück zum Zitat Dahhan T, Balkenende E, Wely M van et al (2013) Tamoxifen or letrozole versus standard methods for women with estrogen-receptor positive breast cancer undergoing oocyte or embryo cryopreservation in assisted reproduction. Cochrane Database Syst Rev 11:CD010240PubMed Dahhan T, Balkenende E, Wely M van et al (2013) Tamoxifen or letrozole versus standard methods for women with estrogen-receptor positive breast cancer undergoing oocyte or embryo cryopreservation in assisted reproduction. Cochrane Database Syst Rev 11:CD010240PubMed
21.
Zurück zum Zitat Azim AA, Costantini-Ferrando M, Oktay K (2008) Safety of fertility preservation by ovarian stimulation with letrozole and gonadotropins in patients with breast cancer: a prospective controlled study. J Clin Oncol 26(16):2630–2635CrossRefPubMed Azim AA, Costantini-Ferrando M, Oktay K (2008) Safety of fertility preservation by ovarian stimulation with letrozole and gonadotropins in patients with breast cancer: a prospective controlled study. J Clin Oncol 26(16):2630–2635CrossRefPubMed
22.
Zurück zum Zitat Azim HA, Kroman N, Paesmans M et al (2013) Prognostic impact of pregnancy after breast cancer according to estrogen receptor status: a multicenter retrospective study. J Clin Oncol 31(1):73–79CrossRefPubMedCentralPubMed Azim HA, Kroman N, Paesmans M et al (2013) Prognostic impact of pregnancy after breast cancer according to estrogen receptor status: a multicenter retrospective study. J Clin Oncol 31(1):73–79CrossRefPubMedCentralPubMed
23.
Zurück zum Zitat Levi Setti PE, Porcu E, Patrizio P et al (2014) Human oocyte cryopreservation with slow freezing versus vitrification. Results from the National Italian Registry data, 2007–2011. Fertil Steril 102(1):90–5.e2CrossRef Levi Setti PE, Porcu E, Patrizio P et al (2014) Human oocyte cryopreservation with slow freezing versus vitrification. Results from the National Italian Registry data, 2007–2011. Fertil Steril 102(1):90–5.e2CrossRef
24.
Zurück zum Zitat Blumenfeld Z, Dann E, Avivi I et al (2002) Fertility after treatment for Hodgkin’s disease. Ann Oncol 13(Suppl 1):138–147CrossRefPubMed Blumenfeld Z, Dann E, Avivi I et al (2002) Fertility after treatment for Hodgkin’s disease. Ann Oncol 13(Suppl 1):138–147CrossRefPubMed
25.
Zurück zum Zitat Somers EC, Marder W, Christman GM et al (2005) Use of a gonadotropin-releasing hormone analog for protection against premature ovarian failure during cyclophosphamide therapy in women with severe lupus. Arthritis Rheum 52(9):2761–2767CrossRefPubMed Somers EC, Marder W, Christman GM et al (2005) Use of a gonadotropin-releasing hormone analog for protection against premature ovarian failure during cyclophosphamide therapy in women with severe lupus. Arthritis Rheum 52(9):2761–2767CrossRefPubMed
26.
Zurück zum Zitat Recchia F, Saggio G, Amiconi G et al (2006) Gonadotropin-releasing hormone analogues added to adjuvant chemotherapy protect ovarian function and improve clinical outcomes in young women with early breast carcinoma. Cancer 106(3):514–523CrossRefPubMed Recchia F, Saggio G, Amiconi G et al (2006) Gonadotropin-releasing hormone analogues added to adjuvant chemotherapy protect ovarian function and improve clinical outcomes in young women with early breast carcinoma. Cancer 106(3):514–523CrossRefPubMed
27.
Zurück zum Zitat Del Mastro L, Catzeddu T, Boni L et al (2006) Prevention of chemotherapy-induced menopause by temporary ovarian suppression with goserelin in young, early breast cancer patients. Ann Oncol 17(1):74–78 Del Mastro L, Catzeddu T, Boni L et al (2006) Prevention of chemotherapy-induced menopause by temporary ovarian suppression with goserelin in young, early breast cancer patients. Ann Oncol 17(1):74–78
28.
Zurück zum Zitat Badawy A, Elnashar A, El-Ashry M, Shahat M (2009) Gonadotropin-releasing hormone agonists for prevention of chemotherapy-induced ovarian damage: prospective randomized study. Fertil Steril 91(3):694–697CrossRefPubMed Badawy A, Elnashar A, El-Ashry M, Shahat M (2009) Gonadotropin-releasing hormone agonists for prevention of chemotherapy-induced ovarian damage: prospective randomized study. Fertil Steril 91(3):694–697CrossRefPubMed
29.
Zurück zum Zitat Gerber B, Stehle H, Ricardo F (2009) ZORO: a prospective randomized multicenter study to prevent chemotherapy-induced ovarian failure with the GnRH-agonist goserelin in young hormone-insensitive breast cancer patients receiving anthracycline containing (neo-)adjuvant chemotherapy (GBG 37). ASCO Meeting Abstracts. 27:15s(526) Gerber B, Stehle H, Ricardo F (2009) ZORO: a prospective randomized multicenter study to prevent chemotherapy-induced ovarian failure with the GnRH-agonist goserelin in young hormone-insensitive breast cancer patients receiving anthracycline containing (neo-)adjuvant chemotherapy (GBG 37). ASCO Meeting Abstracts. 27:15s(526)
30.
Zurück zum Zitat Gerber B, Minckwitz G von, Stehle H et al (2011) Effect of luteinizing hormone-releasing hormone agonist on ovarian function after modern adjuvant breast cancer chemotherapy: the GBG 37 ZORO Study. J Clin Oncol Off J Am Soc Clin Oncol. http://www.ncbi.nlm.nih.gov/pubmed/21537042 Gerber B, Minckwitz G von, Stehle H et al (2011) Effect of luteinizing hormone-releasing hormone agonist on ovarian function after modern adjuvant breast cancer chemotherapy: the GBG 37 ZORO Study. J Clin Oncol Off J Am Soc Clin Oncol. http://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​21537042
31.
Zurück zum Zitat Munster PN, Moore AP, Ismail-Khan R et al (2012) Randomized trial using gonadotropin-releasing hormone agonist triptorelin for the preservation of ovarian function during (neo)adjuvant chemotherapy for breast cancer. J Clin Oncol 30(5):533–538CrossRefPubMedCentralPubMed Munster PN, Moore AP, Ismail-Khan R et al (2012) Randomized trial using gonadotropin-releasing hormone agonist triptorelin for the preservation of ovarian function during (neo)adjuvant chemotherapy for breast cancer. J Clin Oncol 30(5):533–538CrossRefPubMedCentralPubMed
32.
Zurück zum Zitat Elgindy EA, El-Haieg DO, Khorshid OM et al (2013) Gonadatrophin suppression to prevent chemotherapy-induced ovarian damage: a randomized controlled trial. Obstet Gynecol 121(1):78–86PubMed Elgindy EA, El-Haieg DO, Khorshid OM et al (2013) Gonadatrophin suppression to prevent chemotherapy-induced ovarian damage: a randomized controlled trial. Obstet Gynecol 121(1):78–86PubMed
33.
Zurück zum Zitat Behringer K, Wildt L, Mueller H et al (2010) No protection of the ovarian follicle pool with the use of GnRH-analogues or oral contraceptives in young women treated with escalated BEACOPP for advanced-stage Hodgkin lymphoma. Final results of a phase II trial from the German Hodgkin Study Group. Ann Oncol 21(10):2052–2060CrossRefPubMed Behringer K, Wildt L, Mueller H et al (2010) No protection of the ovarian follicle pool with the use of GnRH-analogues or oral contraceptives in young women treated with escalated BEACOPP for advanced-stage Hodgkin lymphoma. Final results of a phase II trial from the German Hodgkin Study Group. Ann Oncol 21(10):2052–2060CrossRefPubMed
34.
Zurück zum Zitat Blumenfeld Z, Katz G, Evron A (2014) „An ounce of prevention is worth a pound of cure“: the case for and against GnRH-agonist for fertility preservation. Ann Oncol 25(9):1719–1728CrossRefPubMed Blumenfeld Z, Katz G, Evron A (2014) „An ounce of prevention is worth a pound of cure“: the case for and against GnRH-agonist for fertility preservation. Ann Oncol 25(9):1719–1728CrossRefPubMed
35.
Zurück zum Zitat Demeestere I, Brice P, Peccatori FA et al (2013) Gonadotropin-releasing hormone agonist for the prevention of chemotherapy-induced ovarian failure in patients with lymphoma: 1-year follow-up of a prospective randomized trial. J Clin Oncol 31(7):903–909CrossRefPubMed Demeestere I, Brice P, Peccatori FA et al (2013) Gonadotropin-releasing hormone agonist for the prevention of chemotherapy-induced ovarian failure in patients with lymphoma: 1-year follow-up of a prospective randomized trial. J Clin Oncol 31(7):903–909CrossRefPubMed
36.
Zurück zum Zitat Nitzschke M, Raddatz J, Bohlmann MK et al (2010) GnRH analogs do not protect ovaries from chemotherapy-induced ultrastructural injury in Hodgkin’s lymphoma patients. Arch Gynecol Obstet 282(1):83–88CrossRefPubMed Nitzschke M, Raddatz J, Bohlmann MK et al (2010) GnRH analogs do not protect ovaries from chemotherapy-induced ultrastructural injury in Hodgkin’s lymphoma patients. Arch Gynecol Obstet 282(1):83–88CrossRefPubMed
37.
Zurück zum Zitat LHRH-agonists in Early Breast Cancer Overview group, Cuzick J, Ambroisine L et al (2007) Use of luteinising-hormone-releasing hormone agonists as adjuvant treatment in premenopausal patients with hormone-receptor-positive breast cancer: a meta-analysis of individual patient data from randomised adjuvant trials. Lancet 369(9574):1711–1723CrossRef LHRH-agonists in Early Breast Cancer Overview group, Cuzick J, Ambroisine L et al (2007) Use of luteinising-hormone-releasing hormone agonists as adjuvant treatment in premenopausal patients with hormone-receptor-positive breast cancer: a meta-analysis of individual patient data from randomised adjuvant trials. Lancet 369(9574):1711–1723CrossRef
38.
Zurück zum Zitat Gerber B, Ortmann O (2014) Prevention of Early Menopause Study (POEMS): is it possible to preserve ovarian function by gonadotropin releasing hormone analogs (GnRHa)? Arch Gynecol Obstet 290(6):1051–1053CrossRefPubMed Gerber B, Ortmann O (2014) Prevention of Early Menopause Study (POEMS): is it possible to preserve ovarian function by gonadotropin releasing hormone analogs (GnRHa)? Arch Gynecol Obstet 290(6):1051–1053CrossRefPubMed
Metadaten
Titel
Fertilitätsprotektion vor Chemotherapie bei Brustkrebs: neue Optionen
verfasst von
M. Rodewald
T. Gundelach
V. Geyer
J. Huober
W. Janni
Prof. Dr. K. Hancke
Publikationsdatum
01.04.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Die Gynäkologie / Ausgabe 4/2015
Print ISSN: 2731-7102
Elektronische ISSN: 2731-7110
DOI
https://doi.org/10.1007/s00129-014-3517-7

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