A pilot study of gonadotropin-releasing hormone agonist combined with aromatase inhibitor as fertility-sparing treatment in obese patients with endometrial cancer

Zhibo Zhang, Huifang Huang, Fengzhi Feng, Jinhui Wang, Ninghai Cheng, Zhibo Zhang, Huifang Huang, Fengzhi Feng, Jinhui Wang, Ninghai Cheng

Abstract

Objective: This study aims to evaluate the effects and pregnancy outcomes of gonadotropin-releasing hormone agonist (GnRH agonist) combined with aromatase inhibitor (AI) in preserving the fertility of obese women with grade 1 endometrial cancer (EC).

Methods: This study recruited obese EC patients who wished to preserve their fertility. The treatment regimen consisted of intramuscular GnRH agonist 3.75 mg every 4 weeks and oral AI 2.5 mg daily. The maintenance regimen was the same as the initial treatment regimen. Primary outcomes included response rate, time to complete response (CR), and time to recurrence; pregnancy outcomes included the time to pregnancy, pregnancy rate and live birth rate.

Results: Six obese patients with EC were included in this study, with the age (mean±standard deviation [SD]) of 30.5±3.3 years and body mass index (mean±SD) of 35.0±1.4 kg/m². CR rate was 100%, and time to CR was 3-6 months. None of the patients had recurrence after a median follow-up of 4.0 years (range, 1.3-7.0 years). The most common side effects were menopause-like symptoms. Among these patients, no weight gain was observed during treatment. The pregnancy rate and live birth rate was 50.0% and 75.0%, respectively, with a median time to pregnancy of 2.4 years (range, 1.0-5.5 years).

Conclusion: The combination of GnRH agonist and AI demonstrated promising long-term effect in young obese EC patients who wished to preserve their fertility. No weight gain side effects were observed. Further studies with a larger sample size are needed to fully evaluate this novel treatment regimen.

Keywords: Aromatase Inhibitors; Endometrial Cancer; Gonadotropin-Releasing Hormone; Obesity; Organ Sparing Treatments.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Copyright © 2019. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology.

Figures

Fig. 1. The main origin of estrogen…
Fig. 1. The main origin of estrogen in obese patients with EC and the possible pathological mechanism of the combined treatment of GnRH agonist and AI.
AI, aromatase inhibitor; EC, endometrial carcinoma; GnRH agonist, gonadotropin-releasing hormone agonist.

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