Summary
The hypothesis that the “down-regulated” gonad is less vulnerable to the effects of cytotoxic chemotherapy for advanced Hodgkin's disease has been investigated. Thirty men and eighteen women were randomly allocated to receive an agonist analogue of gonadotrophin-releasing hormone prior to, and for the duration of, cytotoxic chemotherapy. Buserelin (d-Ser-[TBU]6 LHRH ethylamide) was prescribed in two different dosage schedules to twenty men, and in a single dosage schedule to eight women. A standard gonadotrophin-releasing hormone test (GnRH 100 μg) was performed 1 week prior to and on day 1 of each cycle of chemotherapy. In all patients peak luteinizing hormone responses to GnRH were suppressed throughout treatment. The higher of the two dosage schedules used in the men caused more effective suppression of luteinizing hormone, and both regimens led to an initial suppression of peak follicle-stimulating hormone responses to GnRH, which was not maintained. At followup assessment up to 3 years from the completion of treatment, all men treated with buserelin were profoundly oligospermic and four of the eight women were amenorrhoeic. All ten male controls were profoundly oligospermic, and six of nine female controls were amenorrhoeic. In the dosages and schedules investigated, buserlin was ineffective in conserving fertility.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Bergquist C, Nillius SJ, Bergh T, Skarin G, Wide L (1979) Inhibitory effects of gonadotrophin secretion and gonadal function in men during chronic treatment with a potent stimulatory luteinizing hormone releasing hormone analogue. Acta Endocrinol 91:601
Bergquist C, Nillius SJ, Wide L (1979) Inhibition of ovulation in women by intranasal treatment with a luteinizing hormone releasing hormone agonist. Contraception 19:497
Blatt J, Poplack DG, Sherins RJ (1981) Testicular function in boys after chemotherapy for acute lymphoblastic leukaemia. N Engl J Med 304:1121
Borgmann V, Hardt W, Schmidt-Gollwitzer M, Adenauer M, Nagel R (1982) Sustained suppression of testosterone production by the luteinizing hormone releasing hormone agonist buserelin in patients with advanced prostatic cancer. A new therapeutic approach? Lancet I:1097
Chapman RM, Sutcliffe SB, Malpas JS (1979) Cytotoxic induced ovarian failure in women with Hodgkin's disease: 1. Hormone function. JAMA 242:1877
Chapman RM, Sutcliffe SB, Malpas JS (1981) Male gonadal dysfunction: a prospective study. JAMA 245:1323
Coy DH, Schally AV (1978) Gonadotrophin-releasing hormone analogues. Ann Clin Res 10:139
Crowley WF, Comite F, Vale W, Rivier J, Loriaux DL, Cutler GB (1981) Therapeutic use of pituitary desensitization with a long-acting LHRH agonist: a potential new treatment for precocious puberty. J Clin Endocrinol Metab 52:370
Delic JI, Shalet SM, Hendrix JH, Morris ID (1985) Influence of age and pubertal status on radiation-induced testicular damage in the rat. Pediatr Res 19:632
De Vita VT, Serpick AA, Carbone PP (1970) Combination chemotherapy in the treatment of advanced Hodgkin's disease. Ann Intern Med 73:881
Fattah DI, Chard T (1981) Method for measuring sex hormone binding globulin. Clin Chem 27:1277
Glode LM, Robinson J, Gould SF (1981) Protection from cyclophosphamide-induced testicular damage with an analogue of gonadotrophin-releasing hormone. Lancet I:1132
Goodpasture JC, Bergstrom K, Waller DP, Vickery B (1984) Interactions between an LHRH analogue and cancer chemotherapeutic agents at the testicular level. In: Labrie F, Belanger A, Dupont A (eds) Proceedings of the International Symposium on LHRH and its Analogues. Elsevier, Amsterdam, p 156
Healy DL, Fraser HM, Lawson SC (1984) Shrinkage of a uterine fibroid after subcutaneous infusion of a LHRH agonist. Br Med J 289:1267
Klijn JGM, de Jong FH (1982) Treatment with a luteinisinghormone-releasing-hormone analogue (buserelin) in premenopausal patients with metastatic breast cancer. Lancet I:1213
Linde R, Doelle G, Alexander N, Kirchner F, Vale W, Rivier J, Rabin D (1981) Reversible inhibition of testicular steroidogenesis and spermatogenesis in normal men. N Engl J Med 305:663
Meldrum DR, Chang RJ, Lu J, Vale W, Rivier J, Judd HL (1982) “Medical oophorectomy” using a long-acting GNRH agonist—A possible new approach to the treatment of endometriosis. J Clin Endocrinol Metab 54:1081
Santoro A, Viviani S, Zucali R, Ragni G, Bonfante V, Valagussa P, Banfi A, Bonadonna G (1983) Comparative results and toxicity of MOPP vs ABVD, combined with radiotherapy (RT) in PS IIB, III (A, B) Hodgkin's disease. Proc ASCO/AACR C871
Shaw RW, Fraser HM (1984) Use of a superactive luteinizing hormone-releasing hormone (LHRH) agonist in the treatment of menorrhagia. Br J Obstet Gynaecol 91:8913
Tolis G, Ackman D, Apostolos S, Mehta A, Labrie F, Fazekas AT, Comaru-Schally AM, Schally AV (1982) Tumour growth inhibition in patients with prostate carcinoma treated with luteinizing hormone-releasing hormone agonists. Proc Natl Acad Sci USA 79:1658
Waxman JH, Terry YA, Wrigley PFM, Malpas JS, Rees LH, Besser GM, Lister TA (1982) Gonadal function in Hodgkin's disease: Long-term follow-up of chemotherapy. Br Med J 285:1612
Waxman JH, Wass JAH, Hendry WF, Whitfield HN, Besser GM, Malpas JS, Oliver RTD (1983) Treatment with gonadotrophin-releasing hormone analogue in advanced prostatic cancer. Br Med J 286:1309
Waxman JH, Hendry WF, Whitfield HN, Wallace DMA, Oliver RTD (1984) Response and relapse in patients with prostatic cancer treated with buserelin. In: Labrie F, Belanger F, Dupont A (eds) Proceedings of the International Symposium on LHRH and its analogues. Elsevier, Amsterdam, p 359
Whitehead E, Shalet SM, Morris Jones PM, Beardwell CG, Deakin DP (1982) Gonadal function after combination chemotherapy for Hodgkin's disease in childhood. Arch Dis Child 47:287
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Waxman, J.H., Ahmed, R., Smith, D. et al. Failure to preserve fertility in patients with Hodgkin's disease. Cancer Chemother. Pharmacol. 19, 159–162 (1987). https://doi.org/10.1007/BF00254570
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00254570