Predictors and outcomes in breast cancer patients who did or did not pursue fertility preservation

Moravek, Molly B.; Confino, Rafael; Lawson, Angela K.; Smith, Kristin; Kazer, Ralph R.; Klock, Susan C.; Gradishar, William J.; Jeruss, Jacqueline S.; Pavone, Mary Ellen

doi:10.1007/s10549-020-06031-4

Cited by 18 publications

(27 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…34 Despite short delays in treatment initiation and elevated peak estrogen levels, we found no statistically significant difference in recurrence or survival outcomes for women with breast cancer undergoing FP, and this bolsters the findings of prior studies. 17,18,21 These findings are consistent with those in a recently published Swedish registry-based cohort study that demonstrated reduced all-cause mortality in women exposed to FP in comparison with women who were not. 18 An improved prognosis among women who underwent FP has no biologically plausible cause.…”

Section: Discussionsupporting

confidence: 89%

“…12 To date, few studies have examined the safety of FP after ovarian stimulation in women with breast cancer before adjuvant chemotherapy. [13][14][15][16][17][18][19][20][21] Furthermore, only a handful of studies have evaluated the impact of FP on the timing of treatment, and a few were limited to the neoadjuvant setting. 13,16,19 This study investigated the safety of ovarian stimulation for FP among young women with estrogen receptorpositive or -negative breast cancer.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The impact of fertility preservation on the timing of breast cancer treatment, recurrence, and survival

Greer

Lanes

Poorvu

et al. 2021

Cancer

View full text Add to dashboard Cite

BACKGROUND: Many young women with breast cancer undergo fertility preservation (FP) before cancer treatment. This study examined the impact of FP on breast cancer outcomes. METHODS: The authors performed a retrospective cohort study of 272 women aged 20 to 45 years with newly diagnosed stage 0 to III breast cancer who underwent an FP consultation between 2005 and 2017. Among these women, 123 (45.2%) underwent FP (fertility preservation-positive [FP+]). The remaining 149 women did not undergo FP (fertility preservation-negative [FP-]). RESULTS: The characteristics at enrollment were similar with the exception of ethnicity (FP+, 87.8% White; FP-, 67.8% White; P = .002) and BRCA status (FP+, 27.7% BRCA+; FP-, 15.5% BRCA+; P = .021). The median follow-up was approximately 4 years. Women who underwent FP had longer times to first treatment (FP+, 37 days; FP-, 31 days; adjusted hazard ratio [aHR], 0.74; confidence interval [CI], 0.56-0.99) and neoadjuvant chemotherapy (FP+, 36 days; FP-, 26 days; aHR, 0.41; CI, 0.24-0.68) and from surgery to adjuvant chemotherapy (FP+, 41 days; FP-, 33 days; aHR, 0.58; CI, 0.38-0.90). Adjusted 3-and 5-year invasive disease-free survival (IDFS) rates were comparable between the 2 groups (3-year IDFS:

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

The impact of fertility preservation on the timing of breast cancer treatment, recurrence, and survival

Greer

Lanes

Poorvu

et al. 2021

Cancer

View full text Add to dashboard Cite

show abstract

“…Finally, 15 studies were included in the present meta-analysis (Azim et al, 2008;Goldrat et al, 2015;Kim et al, 2016;Chien et al, 2017;Rodriguez-Wallberg et al, 2018;Muñoz et al, 2019;Rosenberg et al, 2019;Letourneau et al, 2020;Vriens et al, 2020;Fredriksson et al, 2021;Greer et al, 2021;Marklund et al, 2021;Moravek et al, 2021;Condorelli et al, 2021a,b), of which 11 reporting on the outcomes of patients who underwent COS for fertility preservation before starting chemotherapy (Azim et al, 2008;Kim et al, 2016;Chien et al, 2017;Rodriguez-Wallberg et al, 2018;Muñoz et al, 2019;Letourneau et al, 2020;Vriens et al, 2020;Fredriksson et al, 2021;Greer et al, 2021;Marklund et al, 2021;Moravek et al, 2021) and 4 studies reporting the outcomes of survivors who underwent ART following anticancer treatment completion (Goldrat et al, 2015;Rosenberg et al, 2019;Condorelli et al, 2021a,b). Among the latter group of studies, one (Condorelli et al, 2021a) has been published after the literature search was performed on 30 June 2021, but it has been included because data were propriety of two of the authors (M.C.…”

Section: Resultsmentioning

confidence: 99%

“…Main characteristics of the included studies are reported in Table I. Among them, 2 were prospective nonrandomized controlled studies (Azim et al, 2008;Kim et al, 2016), 1 was a prospective cohort study (Vriens et al, 2020), 1 was ambispective (Muñoz et al, 2019) and 10 were retrospective cohort studies (Goldrat et al, 2015;Chien et al, 2017;Rodriguez-Wallberg et al, 2018;Rosenberg et al, 2019;Letourneau et al, 2020;Fredriksson et al, 2021;Greer et al, 2021;Marklund et al, 2021;Moravek et al, 2021;Condorelli et al, 2021b).…”

Section: Resultsmentioning

confidence: 99%

Safety of fertility preservation techniques before and after anticancer treatments in young women with breast cancer: a systematic review and meta-analysis

et al. 2022

View full text Add to dashboard Cite

STUDY QUESTION Is it safe to perform controlled ovarian stimulation (COS) for fertility preservation before starting anticancer therapies or ART after treatments in young breast cancer patients? SUMMARY ANSWER Performing COS before, or ART following anticancer treatment in young women with breast cancer does not seem to be associated with detrimental prognostic effect in terms of breast cancer recurrence, mortality or event-free survival (EFS). WHAT IS KNOWN ALREADY COS for oocyte/embryo cryopreservation before starting chemotherapy is standard of care for young women with breast cancer wishing to preserve fertility. However, some oncologists remain concerned on the safety of COS, particularly in patients with hormone-sensitive tumors, even when associated with aromatase inhibitors. Moreover, limited evidence exists on the safety of ART in breast cancer survivors for achieving pregnancy after the completion of anticancer treatments. STUDY DESIGN, SIZE, DURATION The present systematic review and meta-analysis was carried out by three blinded investigators using the keywords ‘breast cancer’ and ‘fertility preservation’; keywords were combined with Boolean operators. Eligible studies were identified by a systematic literature search of Medline, Web of Science, Embase and Cochrane library with no language or date restriction up to 30 June 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS To be included in this meta-analysis, eligible studies had to be case-control or cohort studies comparing survival outcomes of women who underwent COS or ART before or after breast cancer treatments compared to breast cancer patients not exposed to these strategies. Survival outcomes of interest were cancer recurrence rate, relapse rate, overall survival and number of deaths. Adjusted relative risk (RR) and hazard ratio (HR) with 95% CI were extracted. When the number of events for each group were available but the above measures were not reported, HRs were estimated using the Watkins and Bennett method. We excluded case reports or case series with <10 patients and studies without a control group of breast cancer patients who did not pursue COS or ART. Quality of data and risk of bias were assessed using the Newcastle-Ottawa Assessment Scale. MAIN RESULTS AND THE ROLE OF CHANCE A total of 1835 records were retrieved. After excluding ineligible publications, 15 studies were finally included in the present meta-analysis (n = 4643). Among them, 11 reported the outcomes of breast cancer patients who underwent COS for fertility preservation before starting chemotherapy, and 4 the safety of ART following anticancer treatment completion. Compared to women who did not receive fertility preservation at diagnosis (n = 2386), those who underwent COS (n = 1594) had reduced risk of recurrence (RR 0.58, 95% CI 0.46–0.73) and mortality (RR 0.54, 95% CI 0.38–0.76). No detrimental effect of COS on EFS was observed (HR 0.76, 95% CI 0.55–1.06). A similar trend of better outcomes in terms of EFS was observed in women with hormone-receptor-positive disease who underwent COS (HR 0.36, 95% CI 0.20–0.65). A reduced risk of recurrence was also observed in patients undergoing COS before neoadjuvant chemotherapy (RR 0.22, 95% CI 0.06–0.80). Compared to women not exposed to ART following completion of anticancer treatments (n = 540), those exposed to ART (n = 123) showed a tendency for better outcomes in terms of recurrence ratio (RR 0.34, 95% CI 0.17–0.70) and EFS (HR 0.43, 95% CI 0.17–1.11). LIMITATIONS, REASONS FOR CAUTION This meta-analysis is based on abstracted data and most of the studies included are retrospective cohort studies. Not all studies had matching criteria between the study population and the controls, and these criteria often differed between the studies. Moreover, rate of recurrence is reported as a punctual event and it is not possible to establish when recurrences occurred and whether follow-up, which was shorter than 5 years in some of the included studies, is adequate to capture late recurrences. WIDER IMPLICATIONS OF THE FINDINGS Our results demonstrate that performing COS at diagnosis or ART following treatment completion does not seem to be associated with detrimental prognostic effect in young women with breast cancer, including among patients with hormone receptor-positive disease and those receiving neoadjuvant chemotherapy. STUDY FUNDING/COMPETING INTEREST(S) Partially supported by the Associazione Italiana per la Ricerca sul Cancro (AIRC; grant number MFAG 2020 ID 24698) and the Italian Ministry of Health—5 × 1000 funds 2017 (no grant number). M.L. acted as consultant for Roche, Pfizer, Novartis, Lilly, AstraZeneca, MSD, Exact Sciences, Gilead, Seagen and received speaker honoraria from Roche, Pfizer, Novartis, Lilly, Ipsen, Takeda, Libbs, Knight, Sandoz outside the submitted work. F.S. acted as consultant for Novartis, MSD, Sun Pharma, Philogen and Pierre Fabre and received speaker honoraria from Roche, Novartis, BMS, MSD, Merck, Sun Pharma, Sanofi and Pierre Fabre outside the submitted work. I.D. has acted as a consultant for Roche, has received research grants from Roche and Ferring, has received reagents for academic clinical trial from Roche diagnostics, speaker’s fees from Novartis, and support for congresses from Theramex and Ferring outside the submitted work. L.D.M. reported honoraria from Roche, Novartis, Eli Lilly, MSD, Pfizer, Ipsen, Novartis and had an advisory role for Roche, Eli Lilly, Novartis, MSD, Genomic Health, Pierre Fabre, Daiichi Sankyo, Seagen, AstraZeneca, Eisai outside the submitted work. The other authors declare no conflict of interest. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript and decision to submit the manuscript for publication. REGISTRATION NUMBER N/A.

show abstract

“…Recent data indicate that having 10–12 oocytes leads to reasonable cumulative live birth rates up to 61.9% and 43.4% in patients <35 years of age and ones >35 years of age, respectively [ 106 , 108 ]. In breast cancer patients, the controlled ovarian stimulation and oocyte cryopreservation before antitumor therapeutics granted 13 successful live births among 332 patients, without increasing the cancer recurrence rate or mortality rate [ 109 ]. In a study including 1073 women (1172 vitrification cycles) diagnosed with cancer undergoing oocyte cryopreservation, after a mean storage time of 4.1 ± 0.9 years, the oocyte survival rate is 81.8%, and after transferring a mean number of 1.4 ± 0.1 embryos, the clinical pregnancy rate and live birth rate are 41.4% and 31.2%, respectively [ 106 ].…”

Section: The Therapeutic Options For Fpmentioning

confidence: 99%

Female Oncofertility: Current Understandings, Therapeutic Approaches, Controversies, and Future Perspectives

Kawamura

2021

JCM

View full text Add to dashboard Cite

Recent advances in early detection and oncological therapies have ameliorated the survival rate of young cancer patients. Yet, ovarian impairment induced by chemotherapy and radiotherapy is still a challenging issue. This review, based on clinical and lab-based studies, summarizes the evidence of gonadotoxicity of chemoradiotherapy, the recent approaches, ongoing controversies, and future perspectives of fertility preservation (FP) in female patients who have experienced chemo- or radio-therapy. Existing data indicate that chemotherapeutic agents induce DNA alterations and massive follicle activation via the phosphoinositide 3-kinase (PI3K)/Akt signaling pathway. Meanwhile, the radiation causes ionizing damage, leading to germ cell loss. In addition to the well-established methods, numerous therapeutic approaches have been suggested, including minimizing the follicle loss in cryopreserved ovarian grafts after transplantation, in vitro activation or in vitro growing of follicles, artificial ovarian development, or fertoprotective adjuvant to prevent ovarian damage from chemotherapy. Some reports have revealed positive outcomes from these therapies, whereas others have demonstrated conflictions. Future perspectives are improving the live birth rate of FP, especially in patients with adverse ovarian reserve, eliminating the risk of malignancy reintroducing, and increasing society’s awareness of FP importance.

show abstract

Predictors and outcomes in breast cancer patients who did or did not pursue fertility preservation

Cited by 18 publications

References 45 publications

The impact of fertility preservation on the timing of breast cancer treatment, recurrence, and survival

The impact of fertility preservation on the timing of breast cancer treatment, recurrence, and survival

Safety of fertility preservation techniques before and after anticancer treatments in young women with breast cancer: a systematic review and meta-analysis

Female Oncofertility: Current Understandings, Therapeutic Approaches, Controversies, and Future Perspectives

Contact Info

Product

Resources

About