Growth hormone replacement therapy

Growth hormone replacement therapy provides the benefit of optimizing height outcomes among children who have not reached skeletal maturity.[43] The diagnosis requires specialized dynamic testing.[43,72]

Treatment with recombinant growth hormone (rGH) replacement therapy is generally delayed until 12 months after successful completion of cancer or brain tumor treatments and after a multidisciplinary discussion involving the prescribing pediatric endocrinologist, the primary oncologist, and other providers selected by the patient or family.[73]

Safety concerns pertaining to the use of rGH in childhood cancer survivors have primarily been related to the mitogenic potential of the growth hormone stimulating tumor growth in a population with an increased risk of second neoplasms.[74] Most studies that report these outcomes, however, are limited by selection bias and small sample size.

One study evaluated 361 growth hormone–treated cancer survivors enrolled in the CCSS and compared risk of recurrence, risk of subsequent neoplasm, and risk of death among survivors who did and did not receive treatment with growth hormone.[75]

One study evaluated 361 growth hormone–treated cancer survivors enrolled in the CCSS and compared risk of recurrence, risk of subsequent neoplasm, and risk of death among survivors who did and did not receive treatment with growth hormone.[75]

The RR of disease recurrence was 0.83 (95% CI, 0.37–1.86) for growth hormone–treated survivors.

One study evaluated 361 growth hormone–treated cancer survivors enrolled in the CCSS and compared risk of recurrence, risk of subsequent neoplasm, and risk of death among survivors who did and did not receive treatment with growth hormone.[75]

Growth hormone–treated participants were diagnosed with 15 subsequent neoplasms, all solid tumors, for an overall RR of 3.21 (95% CI, 1.88–5.46). This was mainly due to a small excess number of subsequent neoplasms observed in survivors of acute leukemia.[75]

One study evaluated 361 growth hormone–treated cancer survivors enrolled in the CCSS and compared risk of recurrence, risk of subsequent neoplasm, and risk of death among survivors who did and did not receive treatment with growth hormone.[75]

With prolonged follow-up, the elevation of subsequent cancer risk resulting from growth hormone diminished.[76]

One study evaluated 361 growth hormone–treated cancer survivors enrolled in the CCSS and compared risk of recurrence, risk of subsequent neoplasm, and risk of death among survivors who did and did not receive treatment with growth hormone.[75]

Compared with survivors not treated with growth hormone, those who were treated had a twofold excess risk of developing a subsequent neoplasm (RR, 2.15; 95% CI, 1.33–3.47; P < .002). Meningiomas were the most commonly observed neoplasms (9 of 20 tumors).[75]

A study from the CCSS reported on the risk of subsequent CNS neoplasms after a longer period of follow-up.[77]

A study from the CCSS reported on the risk of subsequent CNS neoplasms after a longer period of follow-up.[77]

The adjusted rate ratio of meningioma and gliomas in growth hormone–treated survivors of CNS tumors was 1.0 (95% CI, 0.6–1.8; P = .94), when compared with CNS tumor survivors who were not treated with growth hormone. This finding indicates negligible differences between the two groups for this particular risk.

A review of existing data suggests that treatment with growth hormone is not associated with an increased risk of CNS tumor progression or recurrence, or new or recurrent leukemia.[78]