Preserving Fertility in Cancer Patients

Associated Press reported story on an American young boy who is presently undergoing a (potentially fertility-threatening) treatment for an uncommon chest cancer and the need to preserve his chances of procreating in future catches my attention for discussion.

It’s story about the plight and possible hope for cancer-inflicted children who are undergoing treatment regimen that carries high potentials to compromise their ability to procreate in future. 

The truth is that most cancer’s treatment is about killing body cells with fast growing ability – a consistent feature of most cancers. Unfortunately, the germinal cells – sperm cells in the male, produced in the testicles, and the eggs that are produced in the ovaries in females are also likely to be attacked by these cancer-killing medications because they are which are also fasting-growing tissues. Thus it is a devil’s option, especially in the young – kill the cancer cells and risk killing the body’s fertility-producing tissues and hence placed the treatment-recipients in a potential situation of not being able to procreate in future.

The human face of the story highlights the case of nine-year-old Dylan Hanlon who has been on cancer treatment, which may also be destroying his chances of fathering his own children when he grows up.

Understandably upset that doctors managing Dylan’s case didn’t make the future infertility-related risk associated with the treatment clear, his mother, Christine, tracked down an experiment that just might salvage Dylan’s future fertility. Between chemotherapy cancer treatment sessions, the pair flew hundreds of miles from their Florida home to try this innovative experimental work.

As hinted above, many of the cancer treatments that can save patients’ lives also may cost their ability to have babies later in life. Unlike in the older males and females - young adults and oldies that have options — bank some sperm, freeze embryos or eggs. Children diagnosed before puberty don’t.

In settings where childhood cancer survival is reportedly reaching 80 percent, there’s a growing need to find ways to preserve these youngsters’ fertility — and patients like Dylan are on the front edge of research that’s banking testicular cells and ovarian tissue.

 “There are viable options, and they are on the doorstep,” says Dr. Kyle Orwig of the University of Pittsburgh. Orwig leads the study Dylan joined to store the stem cells boys harbor that later on will produce their sperm. The idea is to eventually transplant the cells back into testis in future.

It may sound odd to discuss fertility issues still decades away even as parents agonize over whether a child will live or die. Yet it makes sense to think of the future after today’s plight.

“We expect they’ll live that long,” says Dr. Teresa Woodruff of Northwestern University’s Oncofertility Consortium, who works with girls’ ovarian tissue. “If we protect their fertility now as a 9-year-old, we hope ... that tissue we’ve guarded can be used” when they’re grown.
Researchers say several dozen boys and girls, including some babies, so far are part of these early-stage experiments at a handful of medical centers.

And while there are no guarantees, Dylan’s mother rests easier knowing “that I’m doing all I can do” for his future.

In the US alone, about 10 percent of the 1.5 million people diagnosed with cancer last year were younger than 45, more than 15,000 of them under 20. Woodruff says perhaps half of younger patients risk either some immediate fertility damage, or for girls the prospect of menopause in their 20s or 30s. It depends on the type of cancer and treatment. Numerous forms of chemotherapy, high-dose body-wide radiation, radiation aimed at the pelvis and some surgeries can leave patients unable to procreate.

Even young adults too often aren’t told in time about fertility preservation options, despite standard medical guidelines urging doctors to discuss them upfront.

Where does that leave the youngest patients? Boys don’t produce sperm before puberty, ruling out sperm banking. Girls are born with all the eggs they’ll ever have but those are in an immature state, so egg-freezing isn’t an option.

The Cancer Story
The cancer story of Dylan Hanlon started with a lump in the chest, which turned out to be Ewing’s sarcoma, a rare cancer, fortunately caught early. The prescribed nine months of chemotherapy began in September, turning fourth grade into home-schooling. Dylan has struggled with side effects and infections during every-other-week hospitalizations for the chemo. But it seems to be working; his mother was told the prognosis is good.

Then in December, Christine Hanlon stumbled across information from the patient advocacy group Fertile Hope that revealed Dylan’s chemo bears a high risk of infertility. She began hunting options. The first study she found accepts only the newly diagnosed.
Incidentally, the boy is an only child who “loves babies”. “He told me one day he was going to have 10 kids,” the mum said. Learning the risk late “broke my heart. ... He might have lost an opportunity.”

Hope Rising
Finally she tracked down Orwig, who oversees a multi-hospital program called Fertility Preservation in Pittsburgh that offers services to men, women, boys and girls.

Orwig and other researchers have restored fertility in a range of male animals — mice, rats, pigs, dogs — by storing and reimplanting sperm-producing stem cells.

Testing the technique in boys requires biopsy-style removal of a small amount of testicular tissue. No one knows how many stem cells are floating among the millions of other cells frozen from that sample, or how many are necessary. But Orwig says the more tissue collected, the better.

Most of his sample was frozen, for Dylan’s later use if he wants it.
The rest went to Orwig’s lab for research — and two weeks later came the good news that Dylan’s tissue indeed harbored stem cells despite a few months of chemo.

Key to this approach will be multiplying stored stem cells so that many more can be injected back, adds Dr. Jill Ginsberg of Children’s Hospital of Philadelphia, who has banked cells from more than 25 boys in her own study. Her research partner at the University of Pennsylvania is working on that step.

The Girls’ Challenge
Girls pose a different challenge. Some young women have had strips of their ovaries removed and frozen before cancer treatment, and then transplanted back a few years later. It’s considered experimental even for adults, with 13 births reported worldwide so far, says Northwestern’s Woodruff.

Now researchers are banking the same tissue from girls. It requires laparoscopic surgery. Storing enough isn’t the issue: Egg follicles are progressively lost through life, so a girl harbors more than even a 20-something, Woodruff says. A bigger unknown is how long they can be frozen.

Also, there’s a possibility cancer cells could lurk in frozen tissue. So Woodruff is going the next step, researching ways to force those stored follicles to ripen into pure eggs in a lab dish.

A key message here is that what is at stake here is a case of preserving the fertility vigour for the future in spite of the present plights of cancer in children.

Tags: Wellbeing, Featured, Cancer.