Failure of ovarian ablation with Leuprolide acetate in a pre-menopausal breast cancer patient with metastasis resulting in pregnancy: a case report

Yıl 2014, , 148 - 151, 01.09.2014

Hüseyin Engin Cemil Bilir Filiz Bilir

https://doi.org/10.5505/sakaryamj.2014.65477

Öz

Ovarian ablation was the main target of systemic therapy for breast cancer. In premenopausal women, the ovaries are the predominant source of estrogen synthesis and by this reason treatment options are oophorectomy, ovarian irradiation and luteinizing hormone releasing hormone (LHRH) analogues such as goserelin acetate (GA) and leuprolide acetate (LA) which act on the hypothalamic-pituitary-ovarian axis to suppress the hormones. Rarely these agents cannot succeed and patient may become pregnant who was under treatment of LHRH analogues. We report a premenopausal patient with breast cancer in whom ovarian ablation failed while on leuprolide acetate treatment. A 34-year-old woman was presented with bone metastatic left breast cancer. Tamoxifen 10 mg twice a day, LA 3.75mg SC every 28 days and zoledronic acid 4mg IV every 28 days were started. In May 2013, receiving LA since 7 months, the patient reported a 3-4 kg weight gain and felt movement in the abdomen due to pregnancy. To date there are 4 published case reports, patients receiving GA due to breast cancer in whom a failure in ovarian ablation. All of four cases failed after at least 15 months of treatment but our case was the earliest failure of LHRH analogues in the literature and it was failure with LA, not GA as like as the other cases. It is essential for clinicians to be aware and suggest to the patients of the potential risk of pregnancy despite using the LHRH analogs.

Anahtar Kelimeler

GnRH analogs, Pregnancy, Breast Cancer

Premenopozal Meme Kanserli Hastada Löprolid Asetat Etkinsizliği Sonucu Gebelik Gelişimi: Vaka Sunumu

Öz

Over ablasyonu meme kanserinin temel hedeflerinden biridir. Premenopozal kadınlarda overler östrojen sentezinin ana kaynağıdır ve bu nedenle tedavi seçenekleri olarak ooferektomi, over radyoterapisi veya hipotalamik- pituiter-overyan aksın baskılayıcı luteinize hormone analogları (löprolid asetat, goseralin asetat gibi) bilinmektedir. Çok nadiren bu ajanlar etkili olmayarak LHRH analogları kullananlarda gebelik gözlenebilir. Biz löprolid asetat (LA) kullanırken gebe kalan meme kanserli bir vaka sunduk. Otuz dört yaşında kadın hasta kemik metastatik meme kanser tanılı tamoksifen 10 mg günde 2 kez ve 28 günde bir LA 3.75 mg cilt altı ve zolendronik asit 4 mg intravenöz uygulama ile takip edilmekteydi. MAyıs 2013'te 7 aydır LA asit kullanmakta iken hastada 3-4 kg kilo artışı, karnında hareket hissi tarifledi ve gebelik tanısı konuldu. Bugüne kadar LHRH analogları ile tedavi altında iken toplam 4 gebelik vakası bildirilmiştir ancak bu vakaların hepsi GA kullanmakta idi. Tüm vakalar en az 15 aydır GA kullanmakta olup bizim vakamız en erken dönemde LHRH kullanırken gözlenen gebelik vakasıydı. Klinisyenler LHRH kullanan hastalarda gebelik açısından dikkatli olmalı ve hastaları olası riskler için bilgilendirmeliler.

Anahtar Kelimeler

GnRH analogları, Gebelik, Meme kanseri

Kaynakça

• Ingle JN, Krook JE, Green SJ et al. Randomized trial of bilateral oophorectomy versus tamoxifen in premenopausal women with metastatic breast cancer. J Clin Oncol 1986;4:178-185.
• Prowell TM, Davidson NE. What is the role of ovarian ablation in the management of primary and metastatic breast cancer today? The Oncologist 2004;9:507-517.
• Jime´nez-Gordo A.M, de las Heras B, Zamora P, Espinosa E, Gonza´lez- Baro´n M. Failure of goserelin ovarian ablation in premenopausal women with breast cancer: Two Case Reports. Gynecologic Oncology 76, 126–127, 2000.
• Tellez C, Craig Jordan V: Hormonal treatment of advanced breast cancer. Surg Oncol Clin North Am 4:751–777, 1995.
• Emons G, Schally A: The use of luteinizing hormone releasing hormone agonists and antagonists in gynaecological cancers. Hum Reprod Update 9:1364 –1379, 1994.
• Vandenput I, Vergote I, Amant F, Neven P, Paridaens R, Christiaens MR. Aromatase inhibitors in premenopausal women: the need for proper contraceptive counseling. Breast J 12(5):507–508, 2006.
• Hill N and Madarnas Y. Failure of ovarian ablation with goserelin in a pre- menopausal breast cancer patient resulting in pregnancy: a case report and review of the literature. Breast Cancer Res Treat (2011) 129:265–268.
• Bajetta E, Celio L, Zilembo N, Bono A, Galluzzo D, Zampino MG, Longhi A, Ferrari L, Buzzoni R: Ovarian function suppression with the gonadotrophin- releasing hormone (GnRH) analogue goserelin in premenopausal advanced breast cancer. Tumori 80:28 –32, 1994.
• Filicori M: Gonadotrophin-releasing hormone agonists. Drugs 48:41– 58,1994.
• Chang SY, Soong YK: Unexpected pregnancies exposed to leuprolide acetate administered after the mid-luteal phase for ovarian stimulation. Hum Reprod 10:204 –206, 1995