There are new calls for further research since an Australian study has found that certain immunotherapy drugs used during cancer treatments, may impact on fertility.
Researchers say that more research must now be carried out into preventative measures, such as egg freezing procedures.
Experts at Monash University’s Biomedicine Discovery Institute and the Peter MacCallum Cancer Centre have found that the common immunotherapy drugs, known as immune checkpoint inhibitors, can lead to permanent damage to the ovaries and the eggs they contain, albeit so far on mice.
Immune checkpoint inhibitors are used to enhance the body’s ability to fight cancer. But now there’s concerns that they may affect both the immediate and future fertility of women by “reducing the number and quality of eggs, interfering with ovulation, and disrupting the fertility cycle”.
It’s already well-established that chemotherapy and radiotherapy treatments for cancer can negatively affect fertility and cause a premature menopause, these newly discovered potential side effects had been previously unknown.
Lauren Alesi, co-lead author and PhD candidate in the Monash Biomedicine Discovery Institute says, “Initially, these treatments were thought to be less damaging (than chemo and radiotherapy) in the context of off-target effects to the body in general.
“However, it is now clear that inflammatory side effects in other organ systems are quite common with these drugs. Our study highlights that caution should be exercised by clinicians and their patients, for whom fertility may be a concern.”
Sherene Loi, Specialist Medical Oncologist Professor in breast cancer and a senior author of the study says, “Appropriate interventions that can preserve fertility and ovarian function could be implemented before cancer treatment to facilitate pregnancies post-treatment”.
“These interventions need to be implemented in a timely manner so as not to delay anti-cancer treatment.”
“Immunotherapy is now becoming a standard of care for many women with curable early stage breast cancer, due to impressive results in reducing breast cancer recurrences, but further research into the long-term effects of immunotherapy is needed.
Lauren Alesi adds, “Apart from drugs that block hormone production during chemotherapy and strategies to prevent premature menopause in younger women, egg and embryo freezing are the only fertility preservation measures currently available”.
But she also notes, “Embryo freezing is expensive, invasive, and does not prevent ovarian damage, meaning premature menopause could still pose a risk for these women”.
“Therefore, we are now prioritising the investigation of targeted ovarian preservation strategies that aim to prevent the damage to the ovary from occurring in the first place, without interfering with the drug’s ability to fight the cancer.”
“Our results may have implications for other immunotherapies since our results have revealed a close relationship between immune cells, the communication molecules (cytokines) they release, and regulating many aspects of fertility.”
We welcome any further funding and research into such an important area.