Table 1. Potential gonadal toxicity according to the American Society of Clinical Oncology (ASCO) (adapted from Pentheroudakis et al., 2010; Lambertini et al., 2016).
Degree of risk Type of Cancer Treatment
High risk
(>80% risk of permanent amenorrhea)		 HSC transplantation with cyclophosphamide/TBI or cyclophosphamide/busulfan
External beam radiation to a field that includes the ovaries
CMF, CEF, CAF, TAC x 6 cycles in women ≥ 40 years
Melphalan
Chlorambucil
Dacarbazine Procarbazine
Ifosfamide
Thiotepa
Nitrogen mustard
Intermediate risk
(40 % - 60 % risk of permanent amenorrhea)		 BEACOPP
CMF, CEF, CAF, TAC x 6 cycles in women age 30–39
AC x 4 cycles in women≥40 years
AC or EC x 4 → Taxanes
Anthracyclines
Cisplatin
Carboplatina
Ara-C (Cytarabine)
Low risk
(<20 % risk of permanent amenorrhea)		 ABVD in women ≥32 years
CHOP x 4–6 cycles
CVP
AML therapy (anthracycline/cytarabine)
ALL therapy (multi-agent)
CMF, CEF, CAF, TAC x 6 cycles in women≤30 years
AC x 4 cycles in women ≤ 40 years
Bleomycin
Actinomycin D
Vinca alkaloids
Mercaptopurine
Etoposide
Fludarabine
Very low or no risk
(Risk of permanent amenorrhea)		 ABVD in women <32 years
Methotrexate
Fluorouracil
Vincristine
Tamoxifen
Unknown risk
(Risk of permanent amenorrhea)		 Monoclonal antibodies (trastuzumab, bevacizumab, cetuximab)
Tyrosine kinase inhibitors (erlotinib, imatinib)
Taxanes
Oxaliplatin
Irinotecan
HSC: Hematopoietic stem cell; TBI: total body irradiation; CMF: cyclophosphamide, methotrexate, fluorouracil; CEF: cyclophosphamide, epirubicin, fluorouracil; CAF: cyclophosphamide, doxorubicin, fluorouracil; TAC: docetaxel, doxorubicin, cyclophosphamide; BEACOPP: doxorubicin, bleomycin, vincristine, etoposide, cyclophosphamide, procarbazine; AC: doxorubicin, cyclophosphamide; EC: epirubicin, cyclophosphamide; ABVD: doxorubicin, bleomycin, vinblastine, dacarbazine; CHOP: cyclophosphamide, doxorubicin, vincristine, prednisone; CVP: cyclophosphamide, vincristine, prednisone; AML: acute myeloid leukemia; ALL: acute lymphocytic leukemia.