Comparing the Gonadotoxicity of Multiple Breast Cancer Regimens: Important Understanding for Managing Breast Cancer in Pre-Menopausal Women

Abstract

Over the last several decades, improvements in breast cancer treatment have contributed to increased cure rates for women diagnosed with this malignancy. Consequently, great importance should be paid to the long-term side effects of systemic therapies. For young women (defined as per guideline ≤40 years at diagnosis) who undergo chemotherapy, one of the most impactful side effects on their quality of life is premature ovarian insufficiency (POI) leading to fertility-related problems and the side effects of early menopause. Regimens, type, and doses of chemotherapy, as well as the age of patients and their ovarian reserve at the time of treatment are major risk factors for treatment-induced POI. For these reasons, childbearing desire and preservation of ovarian function and/or fertility should be discussed with all premenopausal patients before planning the treatments. This manuscript summarizes the available fertility preservation techniques in breast cancer patients, the risk of treatment-induced POI with different anticancer treatments, and the possible procedures to prevent it. A special focus is paid to the role of oncofertility counseling, as a central part of the visit in this setting, during which the patient should receive all the information about the potential consequences of the disease and of the proposed treatment on her future life.

A prospective longitudinal analysis of the predictors of amenorrhea after breast cancer chemotherapy: Impact of BRCA pathogenic variants

“…Twenty‐four percent of the participants in this study were HER2‐positive. Although the use of trastuzumab and other anti‐HER2 treatments do not seem to increase the risk of treatment‐related amenorrhea, further research will be needed to investigate their gonadotoxic potential, if any 27 …”

“…Although the use of trastuzumab and other anti-HER2 treatments do not seem to increase the risk of treatment-related amenorrhea, further research will be needed to investigate their gonadotoxic potential, if any. 27 With the aid of prediction methods developed based on the data presented here, patients with higher risk of postchemotherapy ovarian insufficiency can be offered early counseling and fertility preservation action. That may then enable consecutive ovarian stimulation cycles with aromatase inhibitors to increase the likelihood of success with fertility preservation with oocyte or embryo cryopreservation.…”

The Future of Breast Cancer Research in the Survivorship Field

“…A relevant number of young patients diagnosed with early BC receive gonadotoxic chemotherapy treatments [ 56 ], leading to a potential risk of premature ovarian insufficiency (POI) and consequent infertility [ 57 ].…”

Update on Pregnancy Following Breast Cancer Diagnosis and Treatment

“…Hence, most of the newly diagnosed young women with breast cancer are candidates to receive anticancer treatments that include chemotherapy with subsequent possible negative impact on their short- and long-term quality of life 4 . In this regard, the potential effect of anticancer systemic therapies on their ovarian function and fertility is of great concern: the risk of developing this adverse effect is dependent on patient's age and ovarian reserve, type and dose of chemotherapy, and the possible use of additional anticancer treatments 5,6 …”

“…4 In this regard, the potential effect of anticancer systemic therapies on their ovarian function and fertility is of great concern: the risk of developing this adverse effect is dependent on patient's age and ovarian reserve, type and dose of chemotherapy, and the possible use of additional anticancer treatments. 5,6 As compared with healthy women from the general population, breast cancer patients present lower chances to have a subsequent pregnancy, especially those with a prior history of hormone receptor-positive disease. [7][8][9] In fact, women exposed to adjuvant endocrine therapy are those with the lower rates of posttreatment pregnancies.…”