Super Patient: Lyndsay Sung Catches Her Breast Cancer Just In Time

In 2013, Lyndsay Sung noticed something new on the edge of her right breast. “I felt something weird—an odd thickening along the rib,” she recalls. At the time, her son was only a year old, so she thought it might have been related to breastfeeding. But then she felt it again in September 2014. Lyndsay knew she was at risk for breast cancer because her grandmother had had it, and she also knew her breasts from years of self-exams. So she went to see her family doctor. Continue reading…

Hormonal Therapy May Prevent Ovarian Failure and Preserve Fertility in Breast Cancer

“Young women undergoing chemotherapy for breast cancer may be more likely to remain fertile if they also receive hormonal treatment, according to new research presented to the 2015 European Cancer Congress on Monday and published simultaneously in Annals of Oncology.

“Researchers will tell the Congress that the addition of treatment with a so-called luteinising hormone-releasing hormone analogue, or LHRHa, during , could protect women’s ovaries. The approach may increase the chances of pregnancy after treatment.

“Dr Matteo Lambertini, MD, a medical oncologist at the IRCCS AOU San Martino-IST, Genoa, Italy, will say: ‘Chemotherapy can damage the ovaries and push young women into the menopause. They may experience infertility, sleep disturbance, sexual dysfunction and osteoporosis. It is psychologically distressing, harmful to health, and affects the treatment decisions of many young women.’

” ‘We found that temporary suppression of ovarian function with LHRHa significantly reduces the risk of premature ovarian failure (POF) caused by chemotherapy. It also seems to be associated with a higher pregnancy rate in young breast cancer patients.’ “

Fertility Concerns Impact Breast Cancer Treatment Decisions

“Concerns about fertility kept a third of young women with breast cancer from taking tamoxifen, despite its known benefit in reducing the risk of breast cancer coming back.

“In addition, the study found fertility concerns led a quarter of women who started tamoxifen to stop taking it before the recommended treatment period ended.

“ ‘Our study points toward the importance of fertility to young breast cancer patients. We need to find a way to bridge the gap between this patient survivorship goal and our concerns as physicians to facilitate the best treatment possible for our patients,’ says senior study author Jacqueline Jeruss, M.D., Ph.D., associate professor of surgery and biomedical engineering at the University of Michigan and a breast cancer surgeon at the University of Michigan Comprehensive Cancer Center.”

For Breast Cancer Patients, Goserelin during Chemotherapy Prevents Early Menopause and Preserves Fertility

“Early menopause can be prevented and fertility may be preserved in young women with early stage breast cancer, according to a study published today in The New England Journal of Medicine.

“A major international clinical trial has found that the risk of sudden onset of menopause can be significantly reduced by adding a drug called to the regimen. Women who took goserelin and wanted to have children also were more likely to get pregnant and deliver a healthy baby.

” ‘Some of the most distressing side effects of chemotherapy in young with breast cancer are early and sudden onset of menopause and infertility,’ said Kathy Albain, MD, senior author, medical oncologist and Director of Loyola University Chicago Cardinal Bernardin Cancer Center’s Breast Cancer Clinical Research Program. ‘These findings provide hope for young women with breast cancer who would like to prevent early menopause or still have children.’

“The overall purpose of goserelin is to temporarily put the ovaries ‘at rest’ during chemotherapy. ‘We found that, in addition to reducing the risk of sudden, early menopause, and all of the symptoms that go along with menopause, goserelin was very safe and may even improve survival,’ Dr. Albain said. ‘These findings are changing how we manage with breast cancer.’ “

Mixed Results for Saving Ovaries in Breast Cancer

Editor’s note: This article is about a clinical trial—a research study with volunteer patients. The trial tested whether adding a drug called triptorelin to chemotherapy might help preserve fertility in breast cancer patients. The researchers found a slight increase in pregnancies for patients who took triptorelin, but it was statistically insignificant, meaning it could have been due to chance. However, an earlier trial found more promising results for a similar drug (goserelin). Researchers are still hopeful that drugs like triptorelin and goserelin might help some women preserve fertility after breast cancer treatment.

“Women who received a luteinizing hormone-releasing hormone (LHRH) analog during chemotherapy had a nonsignificant increase in pregnancies and resumption of menstruation, a randomized trial showed.

“The addition of triptorelin to breast cancer chemotherapy did not adversely affect disease control or survival compared with chemotherapy alone, reported Matteo Lambertini, MD, of Azienda Ospedaliera Universitaria San Martino in Genova, Italy, and colleagues.

“The results mean that a previously reported significant reduction in chemotherapy-induced premature menopause in triptorelin-treated women did not translate into a significantly increased likelihood of pregnancy, they said in a presentation at the Breast Cancer Symposium.

“The use of the LHRH analog triptorelin showed a trend towards an increased probability for becoming pregnant and a trend towards an increased probability for menstrual resumption at longer follow-up, although neither finding was significant,” Lambertini said, adding that the lack of difference in 5-year disease-free survival (DFS) between the two arms was “reassuring regarding the safety of the procedure.”

Lymphoma Treatment May Harm, Halt Men's Sperm Production

“Treatment for lymphoma may lower men’s fertility, new research indicates.

“Both Hodgkin lymphoma and non-Hodgkin lymphoma, which are cancers of the body’s white blood cells, often affect young people who are still in their reproductive years. For men, treatment for these cancers can harm or halt sperm production. Although most men regain their fertility within two years of treatment, the researchers cautioned that men should be counseled about the possibility of this significant side effect before treatment begins.

” ‘While many men can look forward to their fertility returning after treatment is over, not all will be so fortunate,’ Dr. Rebecca Sokol, president of the American Society for Reproductive Medicine, said in a society news release. ‘It is imperative that prior to the initiation of therapy, counseling and sperm preservation be made available to all lymphoma patients and their partners who may want to have children in the future.'”

Better Patient–Physician Communication Could Improve Fertility Preservation in Men with Cancer

“Despite technological improvements in sperm banking, many patients undergoing cancer treatments are unaware of their options for fertility preservation and providers are uncomfortable counseling them, according to a presentation at the joint meeting of the International Congress of Endocrinology and the Endocrine Society.

“ ‘Most of us realize that the focus used to be primarily on survival alone, but at this point in time, we’re seeing a change with survivorship issues really taking a foothold not only in the world of oncology but in the overlay with reproduction,’ Robert E. Brannigan, MD, assistant professor of urology at the Feinburg School of Medicine at Northwestern University, Chicago, said in his presentation. ‘Patients are indeed very often living beyond their cancer and they expect to lead full, happy, productive lives. We know, though, that after cancer treatment, male infertility is a common consequence. … Many of these patients before they receive one drop of chemotherapy or one ray of radiation therapy, come to us with presenting with impaired fertility’ .”

“Brannigan presented examples of cases — ranging from an adult man attempting conception after chemotherapy to a teenage male undergoing cancer treatment and no longer producing sperm — that showed the long-lasting effects of oncology treatments on male fertility.

“He listed the excuses often given for not banking sperm: favorable treatment protocols, no time to bank due to acute health issues, poor semen parameters and the priority of survival.”

New Option for Preserving Fertility in Women Being Treated With Chemotherapy for Early-Stage Breast Cancer

“One of the most reported studies emanating from the 2014 ASCO Annual Meeting involves the use of the luteinizing hormone–releasing hormone (LHRH) agonist goserelin (Zoladex) to reduce the risk of ovarian failure among women being treated with chemotherapy for early-stage breast cancer, and to increase the likelihood of a successful pregnancy afterward (see page 22).1 Network and cable television, national and regional newspapers, and international news services covered the study and what it might mean to women concerned about preserving fertility after being treated for cancer.

“In an interview with The ASCO Post, the study’s lead author, Halle Moore, MD, said that she welcomed the media coverage because ‘the more the public is aware of fertility preservation options for patients receiving chemotherapy, the more likely it is that those patients will ask their doctors about [such measures].’ Dr. Moore is a Staff Physician and Chair of the Survivorship Program at the Cleveland Clinic. The study was funded by the National Institutes of Health, and Dr. Moore was hopeful that the extensive media coverage might also help the public see ‘where our dollars are going’ and understand the importance of federally funded research.”

Gleevec May Help Preserve Fertility After Chemotherapy

Women who undergo chemotherapy often lose their fertility because the drugs used damage or kill their oocytes—immature egg cells stored in the ovaries. However, a recent study suggests that adding the cancer drug imatinib mesylate (Gleevec) to chemotherapy treatment may protect oocytes. Researchers treated mouse ovaries with the chemotherapy drug cisplatin (Platinol) either by itself or in combination with Gleevec, then implanted them into host mice. The oocytes from Gleevec-treated ovaries still suffered DNA damage from the Platinol exposure, but unlike oocytes treated with just Platinol, they did not die. Previous research suggests that the surviving oocytes could repair the damage over time after chemotherapy treatment ends. These findings offer the hope that Gleevec may help preserve fertility in chemotherapy patients.