ESPE Yearbook of Paediatric Endocrinology

Brief summary: This is a systematic review on the effects of vincristine-containing regimens, commonly considered to have low gonadotoxicity, on human prepubertal testis, after the reports of testicular tissue abnormalities and severely impaired fertility due to vincristine exposure in prepubertal rodents.

Twenty-four studies were identified that reported testicular development and fertility after treatment with vincristine-containing regimens. Only 9/24 studies included a control group and 4/24 provided a sub-analysis of the relative gonadotoxicity of vincristine-based agents. No study reported a negative association between vincristine and the potential to sire a pregnancy. No significant differences in semen analysis (16 studies) were reported in vincristine-exposed patients versus healthy controls. A single study, using FSH levels and semen analysis, reported no significant impact of vincristine on spermatogenesis.

The evidence presented in this review does not support the hypothesis that vincristine exposure adversely affects future fertility in males. Strengths of the study are the clinical relevance of the topic and its comprehensive search strategy. However, existing studies have significant limitations in establishing the specific contribution of vincristine. In most cases, multiple treatment regimens were used, regimens without vincristine were unavailable for comparison, and the cohorts with adequate assessment of fertility outcomes were very limited.

For an appropriate comparison of interventions, as vincristine is usually part of multi-agent regimens, the specific treatment protocol should be well-defined. It is plausible that vincristine have synergistic adverse effects on fertility when used with other chemotherapy agents.