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

Greer, Anna; Lanes, Andrea; Poorvu, Philip D.; Kennedy, Patricia; Thomas, Ann; Partridge, Ann H.; Ginsburg, Elizabeth S.

doi:10.1002/cncr.33601

Cited by 17 publications

(16 citation statements)

References 34 publications

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“…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%

“…COS was performed in association with concomitant AI or tamoxifen in all but one study (Moravek et al, 2021), although in some studies only a portion of the included women were treated with concomitant AI or tamoxifen during COS (Rodriguez-Wallberg et al, 2018;Letourneau et al, 2020;Fredriksson et al, 2021;Greer et al, 2021) (Table I).…”

Section: Resultsmentioning

confidence: 99%

“…The timing of COS differed between the included studies, being before or after surgery in one (Kim et al, 2016), before neoadjuvant chemotherapy in one (Chien et al, 2017), before adjuvant therapy in three (Azim et al, 2008;Vriens et al, 2020;Fredriksson et al, 2021) and both before neoadjuvant or adjuvant chemotherapy in the remaining six studies (Rodriguez-Wallberg et al, 2018;Muñoz et al, 2019;Letourneau et al, 2020;Greer et al, 2021;Marklund et al, 2021;Moravek et al, 2021) (Supplementary Fig. S1).…”

Section: Resultsmentioning

confidence: 99%

“…Among the 11 studies included in the analysis, 10 reported recurrence rate (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;Moravek et al, 2021), 7 EFS (4 as relapse-free survival (Azim et al, 2008;Kim et al, 2016;Chien et al, 2017;Fredriksson et al, 2021), 3 disease-free survival (Letourneau et al, 2020;Vriens et al, 2020;Greer et al, 2021)) and 4 mortality rate (Muñoz et al, 2019;Marklund et al, 2020;Greer et al, 2021;Moravek et al, 2021). Sensitivity analyses of all outcomes are available as Supplementary Tables SI, SII, SIII.…”

Section: Safety Of Cos In Breast Cancer Patients Before Starting (Neo...mentioning

confidence: 99%

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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

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Safety Of Cos In Breast Cancer Patients Before Starting (Neo...mentioning

confidence: 99%

See 3 more Smart Citations

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

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Time to cancer treatment and reproductive outcomes after fertility preservation among adolescent and young adult women with cancer

Meernik

Engel

Baggett

et al. 2022

Cancer

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Background: Fertility preservation (FP) may be underused after cancer diagnosis because of uncertainty around delays to cancer treatment and subsequent reproductive success. Methods: Women aged 15 to 39 years diagnosed with cancer between 2004 and 2015 were identified from the North Carolina Central Cancer Registry. Use of assisted reproductive technology (ART) after cancer diagnosis between 2004 and 2018 (including FP) was assessed through linkage to the Society for Assisted Reproductive Technology. Linear regression was used to examine time to cancer treatment among women who did (n = 95) or did not (n = 469) use FP. Modified Poisson regression was used to estimate risk ratios (RRs) and 95% CIs for pregnancy and birth based on timing of ART initiation relative to cancer treatment (n = 18 initiated before treatment for FP vs n = 26 initiated after treatment without FP). Results:The median time to cancer treatment was 9 to 33 days longer among women who used FP compared with women who did not, matched on clinical factors. Women who initiated ART before cancer treatment may be more likely to have Cancer.

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A synopsis of the 2021 International Society of Fertility Preservation bi-annual meeting

Cacciottola

Dolmans

Schattman

2022

J Assist Reprod Genet

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

Cited by 17 publications

References 34 publications

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

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

Time to cancer treatment and reproductive outcomes after fertility preservation among adolescent and young adult women with cancer

A synopsis of the 2021 International Society of Fertility Preservation bi-annual meeting

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