Evaluating the impacts of emerging cancer therapies on ovarian function

Ovarian damage, resulting in oocyte death, loss of endocrine function and infertility, is a well-documented side effect of many traditional, cytotoxic cancer therapies. However, the landscape of cancer therapies is rapidly changing. Women are now also receiving new treatments, such as small-molecule inhibitors and immunotherapies, but little is known about the potential consequences of these drug classes for the ovary and reproductive health. This lack of knowledge is because ovarian function and fertility end points are often not included in clinical trials of cancer treatments, and fertility studies on women can take years or decades to complete. Thus, studies defining the impacts of new treatments on the ovary using animal models should be prioritised. Providing patients and clinicians with evidence regarding the potential impacts on future fertility is vital for them to make informed treatment decisions. Here, we critically evaluate the potential for emerging treatments, including small-molecule inhibitors and immunotherapies, to interfere with ovarian function and fertility. We draw on knowledge of ovarian biology and the drug mechanism of action to highlight the potential mechanisms of ovarian damage.