Pregnancy after breast cancer: Are young patients willing to participate in clinical studies?

Pagani, Olivia; Ruggeri, Monica; Manunta, Silvia; Saunders, Christobel; Peccatori, Fedro Alessandro; Cardoso, Fátima; Kaufman, Bella; Paluch‐Shimon, Shani; Gewefel, Hanan; Gallerani, Elisa; Abulkhair, OMalkahi; Pistilli, Barbara; Warner, Ellen; Saloustros, Emmanouil; Perey, L; Zaman, Khalil; Rabaglio, Manuela; Gelber, Shari; Gelber, Richard D.; Goldhirsch, Aron; Korde, Larissa A.; Azim, Hatem A.; Partridge, Ann H.

doi:10.1016/j.breast.2015.01.005

Cited by 94 publications

(68 citation statements)

References 25 publications

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“…Another issue is women with ERpositive breast cancer that are prescribed anti-estrogen therapy for 5-10 years, which will significantly reduce their chance of conception. The safety of a shorter duration of this therapy for an up to 2 years interruption for pregnancy attempts and thereafter a resumption of the antiestrogen therapy for full duration is been shown to be feasible and is underway (NCT02308085, ClinicalTrials.gov) (52). The result of that trial will be very important for the counseling of this large group of women.…”

Section: Discussionmentioning

confidence: 99%

An overview of pregnancy and fertility issues in breast cancer patients

Dabrosin

2015

Annals of Medicine

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Breast cancer is one of the most common malignancies of women in the reproductive years. In the Western world there is a trend towards delaying pregnancy to later in life and in combination with an increased incidence of breast cancer an increased number of women are diagnosed with breast cancer before they have completed their reproductive plans. In addition, breast cancer during pregnancy may affect an increased number of women as the childbearing years are delayed. The survival rate after breast cancer has improved during the last decades and many young breast cancer survivors will consider a pregnancy subsequent to the completion of adjuvant breast cancer therapy. Traditionally, many women are advised against a pregnancy due to a fear of increased risk of recurrence, especially women with estrogen receptor positive breast cancer. Due to feasibility issues, evidence from large prospective randomized trials are missing regarding the safety of pregnancy after breast cancer. Today guidelines are based on cohort studies and population-based registry evidence with its limitations. Overall, data suggest that pregnancy after breast cancer therapy is safe and the current evidence is summarized in this overview.Keywords: breast cancer, mammary cancer, pregnancy, estrogen receptor, fertility 3 Key messages: Despite the lack of high-level evidence all retrospective data report no unfavorable effect on breast cancer outcome of a subsequent pregnancy after adjuvant breast cancer therapy. There are no reasons for proscription in principle against pregnancy for women after breast cancer therapy. The risk of premature menopause, infertility, and the suitability of fertility preservation approaches need to be discussed in a multidisciplinary setting with all eligible women before start of cytotoxic therapies. Women with breast cancer during pregnancy should be given appropriate systemic treatment as closely as possible to general guidelines.4

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Section: Discussionmentioning

confidence: 99%

An overview of pregnancy and fertility issues in breast cancer patients

Dabrosin

2015

Annals of Medicine

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“…The best available retrospective evidence suggests pregnancy after breast cancer does not increase the risk of disease recurrence [73]. Therefore, conception should not, in principle, be discouraged, but prospective data are lacking, particularly in ER-positive patients [74]. Researchers and clinicians need to prospectively study whether interruption of endocrine therapy to enable a pregnancy would impact on disease outcomes.…”

Section: Future Directionsmentioning

confidence: 98%

Navigating the Challenges of Endocrine Treatments in Premenopausal Women with ER-Positive Early Breast Cancer

Colleoni

Munzone

2015

Drugs

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Endocrine therapy is a key component of adjuvant treatment for premenopausal patients with endocrine-responsive tumors. It is commonly well tolerated, although side effects are a main concern in the selection of treatment options. Tamoxifen is still considered an adequate endocrine therapy in a large group of premenopausal patients (e.g. lower-risk patient, presence of co-morbidities, patient preference). Results of the SOFT and TEXT trials addressing new adjuvant endocrine treatment options in premenopausal patients were recently presented. Overall, in the SOFT study the premenopausal population did not benefit from the addition of ovarian function suppression (OFS). Nevertheless, for women at sufficient risk of recurrence to receive adjuvant chemotherapy and who maintained premenopausal estradiol, the addition of OFS to tamoxifen reduced the risk of recurrence. The magnitude of the effect was larger in younger patients. Moreover, in the SOFT and TEXT trials, adjuvant treatment with exemestane plus OFS, as compared with tamoxifen plus OFS, significantly improved disease-free survival, breast cancer-free interval and distant disease-free survival. However, premenopausal patients include heterogeneous subsets of women and tumors where costs and benefits of adjuvant endocrine therapy should be properly weighted. Issues specific for premenopausal patients, related to desire for pregnancy, family planning, safety, quality of life and subjective side effects, should be a priority in the therapeutic algorithm. Therefore, selecting the best-tolerated agent can enhance adherence to therapies and reduce the impact on quality of life and health status for these younger patients.

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“…Несмотря на отсутствие в данном исследовании контрольной группы, этот режим в настоящее время принят в качестве стандарта лечения для пациентов с минимальными HER-2-позитивными опухолями pT1bсN0 [102] Молодые женщины В исследовании HERA возраст не являлся ни прогностическим, ни предсказывающим маркером при тера-пии трастузумабом [103]. Терапия агонистами ЛГРГ во время химиотерапии оказалась эффективным методом защиты от прежде-временного истощения яичников и сохранения фертильности у молодых женщин с ER-отрицательным РМЖ, получавших химиотерапию [4,103]. В настоящее время продолжается крупное исследование по оценке безопасности прерывания эндокрино-терапии при планировании беременности [103] М а м м о л о г и я…”

Section: область и лечение состояние исследований / влияние на тактикunclassified

“…Терапия агонистами ЛГРГ во время химиотерапии оказалась эффективным методом защиты от прежде-временного истощения яичников и сохранения фертильности у молодых женщин с ER-отрицательным РМЖ, получавших химиотерапию [4,103]. В настоящее время продолжается крупное исследование по оценке безопасности прерывания эндокрино-терапии при планировании беременности [103] М а м м о л о г и я…”

Section: область и лечение состояние исследований / влияние на тактикunclassified

General St. Gallen-2015 guidelines for the treatment of early breast cancer (adapted by the experts of the Russian Society of Breast Oncologists)

Семиглазов¹,

Палтуев²,

Семиглазов³

et al. 2015

Tumors of female reproductive system

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Pregnancy after breast cancer: Are young patients willing to participate in clinical studies?

Cited by 94 publications

References 25 publications

An overview of pregnancy and fertility issues in breast cancer patients

An overview of pregnancy and fertility issues in breast cancer patients

Navigating the Challenges of Endocrine Treatments in Premenopausal Women with ER-Positive Early Breast Cancer

General St. Gallen-2015 guidelines for the treatment of early breast cancer (adapted by the experts of the Russian Society of Breast Oncologists)

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