Current and emerging data sources for assessment of ovarian toxicity in children, adolescents and young adults with cancer

One in 20 cancers occurs in children, adolescents, and young adults, with some treatments leading to infertility or premature ovarian insufficiency. Cancer survivors and clinicians seek to estimate reproductive risks to guide fertility preservation and manage ovarian health post-treatment. Available data focus more on surrogate outcomes like amenorrhea and ovarian reserve markers than clinical outcomes such as ovarian insufficiency. Tools like the Cancer-Related Infertility Score Predictor (CRISP) and FDA-recommended data sources, including the FDA Adverse Event Reporting System, provide guidance on known ovarian toxicity risks. However, many novel and current cancer treatments lack comprehensive data. Emerging strategies include using real-world administrative data linked with lab results to estimate risks, large language models to streamline systematic reviews, regulatory guidance requiring ovarian toxicity data in new drug trials, and ex vivo ovary models for testing. This review highlights the need for improved methods and consistent assessment to support the reproductive health of young cancer survivors.