Fertility preservation before breast cancer treatment appears unlikely to affect disease‐free survival at a median follow‐up of 43 months after fertility‐preservation consultation

Abstract

BACKGROUND:The objective of this study was to determine whether fertility preservation (FP) with oocyte/embryo cryopreservation is associated with differences in disease-free survival (DFS). METHODS: This retrospective study included patients aged 18 to 45 who were diagnosed with invasive breast cancer between 2007 and 2017 and were seen for FP consultation at a university fertility center before cancer treatment. The primary endpoint, DFS, was defined as the time from FP consultation until patients developed a locoregional recurrence, distant metastasis, a contralateral breast tumor, or a new primary malignancy. DFS was compared for FP versus no FP using Kaplan-Meier survival estimates and Cox proportional-hazard regression analysis. RESULTS: The study included 329 women, with 207 (63%) in the FP group and 122 (37%) in the no FP group. Patients who underwent FP had more aggressive initial disease profiles than those in the no FP group. In addition, they were younger (35 vs 37 years; P = .009), more often had stage II or III disease (67% vs 55%; P = .03), and had higher rates of requiring chemotherapy (77% vs 65%; P = .01). Over a median follow-up of 43 months, the rates of DFS were similar among patients in the FP group and the no FP group (93% vs 94%, respectively; hazard ratio [HR] 0.7; 95% CI, 0.3-1.7). Positive ER status (79% vs 83%; P = .38), neoadjuvant chemotherapy (41% vs 48%; P = .32), ER-positive DFS (HR, 0.4; 95% CI, 0.1-1.6), and neoadjuvant chemotherapy DFS (HR, 1.4; 95% CI, 0.2-9.1) were similar in the FP and no FP groups, respectively. CONCLUSIONS: At a median follow-up of 43 months, FP appears unlikely to affect DFS, even in the setting of tumors with positive ER status or treatment with neoadjuvant chemotherapy (in which the tumor remains in situ during FP). Cancer 2020;126:487-495.

Preserving fertility in young women undergoing chemotherapy for early breast cancer; the Maastricht experience

“…FP after diagnosis of breast cancer is considered a safe option [24,42]. Even in women with estrogen receptor-positive breast tumors, small retrospective studies have shown no detrimental effect of FP with the estrogen-positive tumor in situ [28,[42][43][44][45]. Stimulation protocols that add letrozole or tamoxifen have been successfully implemented and keep serum estradiol close to physiologic levels during the cycle [43,46,47].…”

“…Even in women with estrogen receptor-positive breast tumors, small retrospective studies have shown no detrimental effect of FP with the estrogen-positive tumor in situ [28,[42][43][44][45]. Stimulation protocols that add letrozole or tamoxifen have been successfully implemented and keep serum estradiol close to physiologic levels during the cycle [43,46,47]. Live birth after breast cancer, even in endocrine sensitive tumors, is currently considered safe [48][49][50][51].…”

Burning Questions in the Oncofertility Counseling of Young Breast Cancer Patients

“…Also in the subgroup of patients who underwent neoadjuvant chemotherapy, disease-free survival was similar between the two groups (HR, 1.4; 95% CI, 0.2-9.1). 52 Another cross-sectional study of breast cancer patients undergoing COS for fertility preservation before neoadjuvant chemotherapy included 40 women with hormone-receptor positive breast cancer. 53 COS with letrozole and tamoxifen was used in this protocol.…”

Update on fertility preservation for younger women with breast cancer

“…38 Peak estrogen levels during the few days of stimulation are onefifth to onetenth the levels main tained over a period of several months during pregnancy. 39 All studies to date have shown similar or better cancer outcomes for patients with breast cancer who underwent ovarian stimula tion compared to matched patients who did not. [39][40][41][42] However, all these studies had relatively short followup durations (< 7 yr), and, in several, there were potentially important differences between case and control participants.…”

“…39 All studies to date have shown similar or better cancer outcomes for patients with breast cancer who underwent ovarian stimula tion compared to matched patients who did not. [39][40][41][42] However, all these studies had relatively short followup durations (< 7 yr), and, in several, there were potentially important differences between case and control participants. 43 In the only study that included a substantial number of women who underwent ovar ian stimulation before surgical removal of the tumour, no increase in cancer recurrence was seen after a median followup duration of 43 months.…”