Jamie DePolo: Hello, everyone. Welcome to this edition of the Breastcancer.org Research News podcast. I’m Jamie DePolo your host, the senior editor here at Breastcancer.org and as always, our guest for our Research News podcast is Dr. Brian Wojciechowski, Breastcancer.org’s medical adviser. And today we’re going to talk about a research article that came out in March, and it’s looking at giving Zoladex along with chemotherapy and how that can help preserve fertility in women who are diagnosed with early-stage, hormone-receptor-negative disease. And it preserves their fertility after the treatment is done and they would like to get pregnant.
So, Dr. Brian, I have a couple questions for you about this. Well, first of all, I guess you can tell us a little bit, what is Zoladex? How is it different from chemotherapy? What is it? What does it do? And then how is it given? Is it given at the same time as the chemotherapy? Is it given separately? Is it an injection? Is it pills? How does this all work?
Dr. Brian Wojciechowski: Zoladex is, technically speaking, called a GnRH agonist, so it suppresses a woman’s ovaries and keeps them dormant. In this study, the drug was given a week before chemotherapy and once a month during chemotherapy with the last dose given anywhere in the vicinity of 2 weeks before or after the final dose of chemotherapy. So basically, it was given monthly while the women were on chemotherapy.
Jamie DePolo: Okay. Okay. And Zoladex, if I’m remembering correctly, it basically makes the ovaries stop functioning, and the idea is then that sort of protects them in a way from the effects of chemotherapy?
Dr. Brian Wojciechowski: Yes. It prevents ovulation. So a woman is infertile during the time that she’s on Zoladex.
Jamie DePolo: Okay. Okay. Now, I also want to check. Zoladex, when you stop taking it, it’s not that it necessarily improves fertility. It can help women preserve what fertility they have before chemotherapy starts.
Dr. Brian Wojciechowski: I think that’s accurate, Jamie. It’s really not a booster. It’s a protector.
Jamie DePolo: Okay. Okay. Now, if women are considering doing this to help preserve fertility, it’s always recommended that you not get pregnant while you’re on chemotherapy and while you’re on Zoladex. So I’m assuming that still holds true.
Dr. Brian Wojciechowski: That’s exactly right. It’s certainly undesirable to get pregnant while a woman is on chemotherapy. Zoladex does suppress her fertility, but anything’s possible.
Jamie DePolo: So precautions need to be taken, whether that’s contraceptive or abstinence or whatever method is chosen. A woman should not get pregnant while she’s being treated with the chemotherapy and the Zoladex.
Dr. Brian Wojciechowski: Exactly. That’s right.
Jamie DePolo: Okay. Now, do we know, I know there’s been a little bit of not controversy, but I don’t think it’s in the guidelines. How long should a woman wait after she’s finished treatment with chemotherapy and Zoladex to try and get pregnant?
Dr. Brian Wojciechowski: I don’t think there’s a standard time frame. I don’t think it’s a problem to start soon after she finishes her chemotherapy, but I wouldn’t expect fertility to come back right away after stopping Zoladex.
Jamie DePolo: Okay. So we don’t really know. I would assume that the Zoladex kind of has to get out of a person’s system.
Dr. Brian Wojciechowski: That’s right. And Zoladex is basically a 28-day shot.
Jamie DePolo: Okay. So if we know that, then it probably makes sense to at least wait that month, because fertility’s not going to be back to what it was before anyway.
Dr. Brian Wojciechowski: That’s right. I wouldn’t expect anyone to get pregnant within that first month, and I think most women would probably want to give themselves a little break between chemotherapy and getting pregnant.
Jamie DePolo: Okay. Okay. Now, how common is this type of treatment to preserve fertility? I guess I’m wondering, would a woman who was interested in it specifically have to bring it up with her doctor? Is it something that doctors routinely suggest if they know a woman is concerned about preserving fertility?
Dr. Brian Wojciechowski: I think it’s great for patients to be engaged and to ask their doctors about treatments that they are aware of. When I interact with my patients, I see it as a team approach, and sometimes patients think of things I don’t think of. So I would encourage every woman who’s concerned about fertility to bring this up with her physician.
Having said that, this has been a somewhat controversial treatment in that there’s been mixed data. Some doctors were not sure about the effectiveness or the safety of it. So I don’t think at this moment it’s a standard treatment. Some doctors may not be offering it. So I think it’s a great idea for women listening to this podcast who are concerned about fertility to bring it up with their doctors.
Jamie DePolo: Okay. Okay. Now, one of my last questions is, this study, and also there’s been another study looking at adding Zoladex or another similar type of medicine to chemotherapy to preserve fertility. And both of the studies were done in premenopausal women who were diagnosed with early-stage, hormone-receptor-negative disease, and that is the only group that the results of this study apply to. Why is it specifically hormone-receptor-negative diseases? There’s something about hormone-receptive-positive disease that this type of treatment would not work or would not be recommended?
Dr. Brian Wojciechowski: Yes. Number one, there were studies done in the past in women with hormone-receptor-positive cancer where hormonal therapy and chemotherapy were given at the same time, and there was a suggestion of worse outcomes. So we think that it may not be safe to give it in women with hormone-receptor-positive cancer.
The second thing is that it’s really not desirable to get pregnant after you are treated with chemotherapy for hormone-receptor-positive cancer, because you have to be on drugs like tamoxifen for a long time. And those can have adverse consequences for a pregnant woman and the baby.
Jamie DePolo: Okay. I see. So, if someone is diagnosed with hormone-receptor-positive disease, it’s most likely that after chemo she would be taking tamoxifen -- or in some cases I know that now there’s a suggestion that aromatase inhibitors might be okay for premenopausal women. But with either one of those medications, a woman should not get pregnant.
Dr. Brian Wojciechowski: That’s right. And I’m thinking specifically about tamoxifen in this instance because remember, the new data with Aromasin, aromatase inhibitors, is only given when the ovaries are suppressed, so that you’re really not talking about a state where they could get pregnant anyway.
Jamie DePolo: Okay. Okay. And as you said, a woman should not get pregnant while taking tamoxifen, and in most cases, tamoxifen is being taken for 5 years. So that it’s not really an option for those 5 years.
Dr. Brian Wojciechowski: Yeah, 5 or 10 years now with the new ATLAS and aTTom data.
Jamie DePolo: Okay. Okay. Thank you very much. And if anybody else is interesting in talking to their doctor about this, we always advise people to check with your insurance carrier to see if a treatment like this would be covered. I’m not sure. Brian, you said it’s not the standard of care, but I believe some insurance companies may cover this. But it’s always good to check and make sure, before you get into that.
Dr. Brian Wojciechowski: Yes. I’ve had success getting this covered for patients, but it is an issue because it’s not yet the standard. The other thing I wanted to say, Jamie, is that women shouldn’t be necessarily discouraged even if they’re not getting this treatment or even if they have hormone-receptor-positive disease, because, you know, looking at this study, even the women who did not get the fertility protection only had a 22% rate of failure of the ovaries, and many of those women still got pregnant anyway. So I think even if you don’t get this treatment, your chances of having your fertility preserved are still pretty high.
Jamie DePolo: Okay. Okay. Well that’s good to know. And always, we don’t really have time to get into it today, but there are other methods. There’s egg banking. There are other sorts of treatments and techniques that can be used if a woman is not a good candidate for this type of fertility preservation.
Dr. Brian Wojciechowski: Yeah. That’s it. There’s a lot of new techniques being researched, and I think there’s a great hope for the future.
Jamie DePolo: Excellent. Well, thank you so much, Dr. Brian. We’ll be back in to check with you next month to talk about some other Research News. Thanks everybody for listening.
