How does rhGH therapy for hyposomatotropism (growth hormone deficiency [GHD]) affect the risk for cancer?

Updated: Jan 24, 2019
  • Author: Sunil Kumar Sinha, MD; Chief Editor: Robert P Hoffman, MD  more...
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Answer

GH raises serum concentrations of IGF-1 (insulin-like growth factor-1), which is mitogenic and antiapoptotic in vitro, and adult levels of which have been associated in most studies with risks of subsequent breast, colorectal and prostate cancers, and in some studies with other cancers.

Watanabe and colleagues reported an increased frequency of leukemia in Japanese children who were treated with rhGH. [72]  Several investigators subsequently examined the potential relationship between rhGH therapy and leukemia. Children with GHD have more risk factors that predispose them to develop leukemia than do children in the general population. These factors include the following:

  • Previous episodes of cancer

  • Treatment with modalities such as irradiation and chemotherapy

  • Comorbid conditions, such as, Down syndrome, Bloom syndrome, or Fanconi syndrome

Examination of large databases reveals that the incidence of leukemia is not elevated among rhGH-treated patients without these additional risk factors. In addition, no current evidence suggests that the risk of leukemia or brain-tumor recurrence rises in patients receiving long-term rhGH treatment. [72, 73]

A large cross-European cohort, the SAGhE (Safety and Appropriateness of Growth Hormone Treatments in Europe) study of nearly 24,000 patients treated with rhGH reported results that did not support a carcinogenic effect of rhGH; however, the researchers noted that the unexplained trend in cancer mortality risk in relation to GH dose in patients with previous cancer, and the indication of possible effects on bone cancer, bladder cancer and Hodgkin lymphoma risks, need further investigation. [74]

Patients with cancer in remission who require rhGH should be evaluated carefully. The pediatric endocrinologist and the oncologist should assess the appropriateness of rhGH therapy on an individual basis.


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