Impact of letrozole supplementation during ovarian stimulation for fertility preservation in breast cancer patients

Sonigo, Charlotte; Sermondade, Nathalie; Calvo, J. Domínguez; Benard, Julie; Sifer, C.; Grynberg, Michaël

doi:10.1016/j.eurox.2019.100049

Cited by 22 publications

(35 citation statements)

References 31 publications

(52 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Length of the stimulation was reported in all included studies (24,29,(33)(34)(35)(36)(37)(42)(43)(44)(45). There was no difference between the letrozole and no-letrozole cohorts (MR =1.00, 95% CI = 0.96-1.04, P = 0.939; Figure 3F).…”

Section: Resultsmentioning

confidence: 98%

“…All the analyses were repeated by including only the three articles comparing breast cancer patients in both the letrozole and no-letrozole cohorts (35)(36)(37). Based on data availability, four endpoints (number of MII oocytes, total number of oocytes, length of the stimulation, and peak estradiol levels) could be analyzed.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Therefore, a total of 11 records were selected for the current meta-analysis, including 2,121 patients, of whom 990 underwent COS with letrozole and 1,131 underwent COS without letrozole ( 24 , 29 , 33 – 37 , 42 – 45 ). Six studies were conducted in cancer patients only ( 35 – 37 , 42 , 43 , 45 ); one study in infertile patients only ( 24 ). COS with letrozole in cancer patients was compared to COS without letrozole in infertile controls in two studies ( 29 , 34 ), to COS without letrozole in healthy elective fertility preservation patients in another study ( 33 ), and to both cancer patients and healthy elective fertility preservation patients in another study ( 44 ).…”

Section: Resultsmentioning

confidence: 99%

“…As secondary analysis, the role of COS with or without letrozole was investigated specifically in the breast cancer patient population. All the analyses were repeated by including only the three studies that included breast cancer patients in both the letrozole and no-letrozole cohorts (35)(36)(37).…”

Section: Study Endpointsmentioning

confidence: 99%

See 4 more Smart Citations

Efficacy and Safety of Controlled Ovarian Stimulation With or Without Letrozole Co-administration for Fertility Preservation: A Systematic Review and Meta-Analysis

et al. 2020

View full text Add to dashboard Cite

Background: The co-administration of letrozole during controlled ovarian stimulation (COS) with gonadotropins is used to limit the potentially harmful effects of a supra-physiological rise in estrogen levels on hormone-sensitive cancers. However, the efficacy and safety of adding letrozole to COS remain debated. Methods: This is a systematic review and meta-analysis of published studies that compared the efficacy and safety of COS with co-administration of letrozole vs. COS without letrozole in all patient populations. A secondary analysis was done including only the studies in breast cancer patients. The primary efficacy endpoint was the number of retrieved mature Metaphase II (MII) oocytes. Secondary efficacy and safety endpoints were total number of oocytes, maturation rate, fertilization rate, number of cryopreserved embryos, peak estradiol levels, progesterone levels, and total gonadotropin dose. Data for each endpoint were reported and analyzed thorough mean ratio (MR) with 95% confidence interval (CI). Results: A total of 11 records were selected including 2,121 patients (990 patients underwent COS with letrozole and 1,131 COS without letrozole). The addition of letrozole to COS did not have any negative effect on the number of mature oocytes collected (MR = 1.00, 95% CI = 0.87-1.16; P = 0.967) and the other efficacy endpoints. COS with letrozole was associated with significantly decreased peak estradiol levels (MR = 0.28, 95% CI = 0.24-0.32; P < 0.001). Similar results were observed in the secondary analysis including only breast cancer patients. Bonardi et al. Letrozole for Controlled Ovarian Stimulation Conclusions: These findings are reassuring on the efficacy and safety of COS with gonadotropins and letrozole and are particularly important for fertility preservation in women with hormone-sensitive cancers.

show abstract

Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Study Endpointsmentioning

confidence: 99%

See 3 more Smart Citations

Efficacy and Safety of Controlled Ovarian Stimulation With or Without Letrozole Co-administration for Fertility Preservation: A Systematic Review and Meta-Analysis

et al. 2020

View full text Add to dashboard Cite

show abstract

Is ovarian recovery after chemotherapy in young patients with early breast cancer influenced by controlled ovarian hyperstimulation for fertility preservation or tumor characteristics? Results of a prospective study in 126 patients

Mailliez

Pigny

Bogart

et al. 2022

Intl Journal of Cancer

View full text Add to dashboard Cite

Young individuals, aged <40 years, represent 7% of all patients with early breast cancer (EBC), most of whom receive chemotherapy. Preserving future fertility in these patients has become a major concern. This prospective study assessed ovarian function during and after chemotherapy according to patient and tumor characteristics and evaluated the outcome of controlled ovarian hyperstimulation (COH).Ovarian reserve was evaluated in terms of amenorrhea duration and by longitudinal serum anti-Müllerian hormone (AMH) level variations measured at study entry, during treatment and until 24 months thereafter. COH has been proposed for patients receiving adjuvant chemotherapy. We studied the association between clinical factors and ovarian function using Cox models and logistic regression. In this young population (age < 38 years, median = 32), 85 of 90 evaluable patients (94%) experienced chemo-induced amenorrhea, including six persistent amenorrhea and one chemotherapy-induced definitive ovarian failure. Overall, 33% of patients still had undetectable AMH values 12 months after the end of chemotherapy, although most had recovered spontaneous and regular menstrual function. No specific factor was associated with clinical or biological late ovarian dysfunction, except for age and baseline AMH value. Overall, 58 patients underwent COH. The mean number of total retrieved oocytes and metaphase II oocytes were of 11.7 and 6.9, respectively. Thus, our study confirms the importance of fertility preservation in young patients with EBC. Our findings indicate that sequential chemotherapy is associated with a higher risk of persistent amenorrhea. There was no significant association between tumor characteristics, fertility preservation or recovery of ovarian reserve.

show abstract

Clinical efficacy of dual trigger with human chorionic gonadotropin and a gonadotropin‐releasing hormone agonist for women undergoing fertility preservation

Hong

Kim

Lee

et al. 2022

Reprod Medicine & Biology

View full text Add to dashboard Cite

Purpose To determine the optimal maturation method to increase the yield of mature oocytes, especially for cancer patients with fewer chances of fertility preservation (FP) before gonadotoxic therapy. Methods A total of 373 cycles in 293 patients undergoing controlled ovarian stimulation (COS) for FP using a gonadotropin‐releasing hormone (GnRH) antagonist protocol were enrolled. The control group ( n = 225) received 250 µg of recombinant human chorionic gonadotropin (rhCG) while the study group ( n = 148) received 250 µg of rhCG and 0.2 mg of triptorelin for triggering. Subgroup analyses were performed for stimulation cycles with diminished ovarian reserve (DOR; anti‐Müllerian hormone (AMH) levels <1.1 ng/ml, n = 86), with endometrioma ( n = 104), or with breast cancer and endometrial cancer using 5 mg of letrozole during the COS cycles ( n = 84). Results There was no significant difference in the baseline characteristics or the number of total and mature oocytes between the two groups. Subgroup analyses for women with endometrioma or DOR showed similar results. However, the dual trigger group had a significantly higher number of mature oocytes than the rhCG trigger group in breast and endometrial cancer patients using letrozole during the COS cycles (6.9 ± 6.0 vs. 4.6 ± 3.6, p = 0.034). The maturation rate was higher in the dual trigger group, although the difference was not statistically significant (59.3 ± 26.7 vs. 50.0 ± 28.0, p = 0.124). Conclusions Dual triggering can be an efficient maturation method to maximize the yield of mature oocytes in breast or endometrial cancer patients using letrozole‐combined GnRH antagonist protocol for FP.

show abstract

Impact of letrozole supplementation during ovarian stimulation for fertility preservation in breast cancer patients

Cited by 22 publications

References 31 publications

Efficacy and Safety of Controlled Ovarian Stimulation With or Without Letrozole Co-administration for Fertility Preservation: A Systematic Review and Meta-Analysis

Efficacy and Safety of Controlled Ovarian Stimulation With or Without Letrozole Co-administration for Fertility Preservation: A Systematic Review and Meta-Analysis

Is ovarian recovery after chemotherapy in young patients with early breast cancer influenced by controlled ovarian hyperstimulation for fertility preservation or tumor characteristics? Results of a prospective study in 126 patients

Clinical efficacy of dual trigger with human chorionic gonadotropin and a gonadotropin‐releasing hormone agonist for women undergoing fertility preservation

Contact Info

Product

Resources

About