Ovarian Stimulation in Patients With Cancer: Impact of Letrozole and BRCA Mutations on Fertility Preservation Cycle Outcomes

Turan, Volkan; Bedoschi, Giuliano; Emirdar, Volkan; Moy, Fred; Oktay, Kutluk

doi:10.1177/1933719117728800

Cited by 70 publications

(45 citation statements)

References 45 publications

(62 reference statements)

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“…A prospective study by Turan [20] also confirmed that BRCA1 had lower oocyte yield compared to BRCA negative and untested patients, also reporting the same findings for BRCA2 mutated patients.…”

Section: Discussionmentioning

confidence: 57%

“…It would be of particular interest to assess which is the relevance of these oncologic events as confounding factors in BRCA1/2 women reduced fertility. [13,[15][16][17] The previous six studies related to this topic, addressing ovarian stimulation in BRCA 1/2 subjects, did not analyze in detail the potential role of oncologic history itself, independent of BRCA mutations, as fertility performance determinant [16,[18][19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

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Impact of BRCA1 and BRCA2 mutations on ovarian reserve and fertility preservation outcomes in young women with breast cancer

Porcu

Cillo

Cipriani

et al. 2019

J Assist Reprod Genet

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Purpose To determine the impact of BRCA1 and BRCA2 mutations on ovarian reserve and fertility preservation outcome. The main purpose and research question of the study is to determine the impact of BRCA1 and BRCA2 mutations on ovarian reserve and fertility preservation outcomes. Methods Prospective study: 67 breast cancer patients between 18 and 40 years old, undergoing a fertility preservation by means of oocyte storage were considered. Inclusions criteria for the study were age between 18 and 40 years old, BMI between 18 and 28, breast cancer neoplasm stage I and II according to American Joint Committee on Cancer classification (2017) and no metastasis. Exclusion criteria: age over 40 years old, BMI < 18 and > 28, breast cancer neoplasm stage III and IV and do not performed the BRCA test. A total of 21 patients had not performed the test and were excluded. Patients were divided into four groups: Group A was composed by 11 breast cancer patients with BRCA 1 mutations, Group B was composed by 11 breast cancer patients with BRCA 2 mutations, Group C was composed by 24 women with breast cancer without BRCA mutations, and Group D (control) was composed by 181 normal women. Results Group A showed significant lower AMH levels compared to Group C and D (1.2 ± 1.1 vs 4.5 ± 4.1 p < 0.05 and 1.2 ± 1.1 vs 3.8 ± 2.5 p < 0.05). BRCA1 mutated patients showed a significant lower rate of mature oocytes (MII) compared to Group C (3.1 ± 2.3 vs 7.2 ± 4.4 p < 0,05) and Group D (3.1 ± 2.3 vs 7.3 ± 3.4; p < 0,05). Breast cancer patients needed a higher dose of gonadotropins compared to controls (Group A 2206 ± 1392 Group B2047.5 ± 829.9 Group C 2106 ± 1336 Group D 1597 ± 709 p < 0,05). No significant differences were found among the groups considering basal FSH levels, duration of stimulation, number of developed follicles, and number of total retrieved oocytes. Regarding BRCA2 mutation, no effect on fertility was shown in this study. Conclusions The study showed that BRCA1 patients had a higher risk of premature ovarian insufficiency (POI) confirmed by a diminished ovarian reserve and a lower number of mature oocytes suitable for cryopreservation.

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Section: Discussionmentioning

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Impact of BRCA1 and BRCA2 mutations on ovarian reserve and fertility preservation outcomes in young women with breast cancer

Porcu

Cillo

Cipriani

et al. 2019

J Assist Reprod Genet

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“…Although interruption of adjuvant endocrine therapy is used in daily practice, its safety is still under investigation in the POSITIVE trial (ClinicalTrials.gov Identifier: NCT02308085) [33]. For patients with BRCA 1/2-gene mutations, another argument for embryo or oocyte cryopreservation can be the option of PGD and the possibly shorter reproductive life span in these patients [34][35][36][37].…”

Section: Discussionmentioning

confidence: 99%

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

Vriens

Welle-Butalid

Boer

et al. 2020

Breast Cancer Res Treat

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Purpose We assessed the uptake of fertility preservation (FP), recovery of ovarian function (OFR) after chemotherapy, live birth after breast cancer, and breast cancer outcomes in women with early-stage breast cancer. Methods Women aged below 41 years and referred to our center for FP counseling between 2008 and 2015 were included. Data on patient and tumor characteristics, ovarian function, cryopreservation (embryo/oocyte) and transfer, live birth, and disease-free survival were collected. Kaplan-Meier analyses were performed for time-to-event analyses including competing risk analyses, and patients with versus without FP were compared using the logrank test. Results Of 118 counseled women with a median age of 31 years (range 19-40), 34 (29%) chose FP. Women who chose FP had less often children, more often a male partner and more often favorable tumor characteristics. The 5-year OFR rate was 92% for the total group of counseled patients. In total, 26 women gave birth. The 5-year live birth rate was 27% for the total group of counseled patients. Only three women applied for transfer of their cryopreserved embryo(s), in two combined with preimplantation genetic diagnosis (PGD) because of BRCA1-mutation carrier ship. The 5-year disease-free survival rate was 91% versus 88%, for patients with versus without FP (P = 0.42). Conclusions Remarkably, most women achieved OFR, probably related to the young age at diagnosis. Most pregnancies occurred spontaneously, two of three women applied for embryo transfer because of the opportunity to apply for PGD.

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“…Cancer patients were younger (32.3 AE 3.5 vs. 37.2 AE 4.9 years) and obtained a significantly higher number of vitrified MII oocytes per cycle (8.7 AE 6.9 vs. 7.3 AE 5.6). As shown in the prior study, a significant lower number of cancer patients returned to the fertility clinic for trying to attempt pregnancy ( [28,29].…”

Section: Fertility and Cancer In Young Adult Womenmentioning

confidence: 76%

Fertility, sexuality and cancer in young adult women

Condorelli

Lambertini

Mastro

et al. 2019

Current Opinion in Oncology

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Purpose of review To provide an up-to-date overview on indications, efficacy and safety of the existing fertility preservation strategies as well as on the features and management of sexual dysfunction in young adult women with newly diagnosed cancer. Recent findings Because of the improved life expectancy of cancer survivors, a growing attention should be given to the side effects of anticancer treatments. Among young cancer patients, risk of infertility and sexual dysfunction are of great concern.

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Ovarian Stimulation in Patients With Cancer: Impact of Letrozole and BRCA Mutations on Fertility Preservation Cycle Outcomes

Abstract: In women with cancer undergoing FP, letrozole appears to enhance response to ovarian stimulation while the presence of BRCA mutations is associated with lower oocyte and embryo yield.

Cited by 70 publications

References 45 publications

Impact of BRCA1 and BRCA2 mutations on ovarian reserve and fertility preservation outcomes in young women with breast cancer

Impact of BRCA1 and BRCA2 mutations on ovarian reserve and fertility preservation outcomes in young women with breast cancer

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

Fertility, sexuality and cancer in young adult women

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