This presentation details the following: 1. Magnitude of Ovarian Failure with different chemotherapy regimens. 2. Methods to prevent chemotherapy induced ovarian failure. 3. Evidence from POEMS-SWOG S0230 and PROMISE-GIM6 study

1. Preventing Chemotherapy Induced Ovarian
Failure
Dr Alok Gupta
MD, DM,
Consultant Medical Oncologist
Max Super Speciality Hospital, Saket
Ex-Asst. Professor, AIIMS, New Delhi

2. Premature Ovarian Failure (POF)
1. Definition
2. Magnitude of problem
3. Implications of POF
4. Methods to Prevent POF

3. Definition of Ovarian Failure
 Amenorrhea & Postmenopausal levels of both FSH & E2
at 1 year after the end of chemotherapy
 Amenorrhea for the preceding 6 months and FSH levels
in the postmenopausal range at 2 years

4. Magnitude of problem
 Majority of pre-menopausal women taking chemotherapy
stop menstruating, at least temporarily.
 However, the risk of POF varies widely depending on
age and treatment regimen and dose of chemotherapy.
 Even after resumption of regular menses after
chemotherapy, patients are still at risk of developing
early menopause

5. Effect of Different Cytotoxic Agents on Ovarian Function

6. Probability of Ovarian Failure with Combination Chemotherapy

7. Implications of Ovarian Failure
1. Menopause tends to come on suddenly, so
symptoms—including vaginal dryness, hot flashes,
sleep disturbance, and mood changes—may be more
intense.
2. Negatively impacts global health of young cancer
survivors
3. Infertility
4. Can also influence treatment decisions

8. Premature Ovarian Failure (POF)
1. Definition
2. Magnitude of problem
3. Implications of POF
4. Methods to Prevent POF

9. Methods to preserve
hormonal function
1. Cryopreservation of ovarian
tissue
2. Temporary ovarian
suppression with LHRHa
during chemotherapy
Methods for fertility
preservation
1. Cryopreservation of embryos
or oocytes
2. Cryopreservation of ovarian
tissue
3. Temporary ovarian
suppression with LHRHa
during chemotherapy

10. Cryopreservation of Ovarian tissue vs
Cryopreservation of embryo/oocyte
1. Ovarian tissue cryopreservation can save not only
fertility but also hormonal gonadal function.
 Expected pregnancy rate – 25%
 Ovarian function recovery > 90% of the cases within 3.5–6.5
months after reimplantation
2. Can be performed at any time during the menstrual
cycle
3. No hormonal stimulation is required, thus no delay in
chemotherapy

11. Drawbacks of Ovarian tissue cryopreservation
1. Expensive technique requiring two surgical procedures
2. Significant high risk of empty follicles (29%)
3. Abnormal/immature oocytes (38%)
4. Low rate (24%) of embryo transfer
5. Potential risk of reintroducing malignant cells when the
tissue is reimplanted

12. Temporary ovarian suppression with GnRHa
 Advantages
 Widely available option
 No delay in the initiation of anticancer treatments
 No surgical procedure

13. Evidence Available
 20 studies [five prospective randomized, controlled trials
(RCTs) and 15 non-RCTs] report benefit
 9 studies not supporting the effectiveness of GnRH-a (6
of them RCT) report no benefit
 Two recent large randomized trials report benefit
 POEMS-SWOG S0230
 PROMISE-GIM6 study

14. Prevention of Early Menopause Study<br />(POEMS)-S0230<br /> Phase III trial of LHRH analog during chemotherapy to reduce ovarian failure in early stage, hormone receptor-
negative breast cancer: an international Intergroup trial of SWOG, IBCSG, ECOG, and CALGB (Alliance)
Presented By Halle Moore at 2014 ASCO Annual Meeting

15. POEMS study design

16. POEMS Objectives and Endpoints
POEMS Outcome Measures

17. POEMS Consort Diagram
POEMS Evaluable Patients

18. POEMS Ovarian Failure
POEMS Ovarian Failure Rate

19. POEMS Pregnancy
POEMS Pregnancy Outcomes

20. POEMS Disease Free Survival
POEMS Disease Free Survival

21. POEMS Overall Survival
POEMS Overall Survival

22. Endocrine Toxicity
POEMS Endocrine Toxicity

23. POEMS
POEMS Critical Analysis

24. Conclusions
POEMS Conclusion

25. PROMISE-GIM6 Study design

33. Thank You
Dr Alok Gupta MD, DM,
Consultant Medical Oncologist
Max Super Speciality Hospital, Saket
Phone No. 9167164364
Email: alokgupta16@yahoo.co.in