The PREgnancy and FERtility (PREFER) study: an Italian multicenter prospective cohort study on fertility preservation and pregnancy issues in young breast cancer patients

Abstract

BackgroundFertility and pregnancy issues are of key importance for young breast cancer patients. Despite several advances in the field, there are still multiple unmet needs and barriers in discussing and dealing with these concerns. To address the significant challenges related to fertility and pregnancy issues, the PREgnancy and FERtility (PREFER) study was developed as a national comprehensive program aiming to optimize care and improve knowledge around these topics.MethodsThe PREFER study is a prospective cohort study conducted across several Italian institution affiliated with the Gruppo Italiano Mammella (GIM) group evaluating patterns of care and clinical outcomes of young breast cancer patients dealing with fertility and pregnancy issues. It is composed of two distinctive studies: PREFER-FERTILITY and PREFER-PREGNANCY. The PREFER-FERTILITY study is enrolling premenopausal patients aged 18–45 years, diagnosed with non-metastatic breast cancer, who are candidates to (neo)adjuvant chemotherapy and not previously exposed to anticancer therapies. The primary objective is to obtain and centralize data about patients’ preferences and choices towards the available fertility preserving procedures. The success and safety of these strategies and the hormonal changes during chemotherapy and study follow-up are secondary objectives. The PREFER-PREGNANCY study is enrolling survivors achieving a pregnancy after prior history of breast cancer and patients diagnosed with pregnancy-associated breast cancer (PABC). The primary objectives are to obtain and centralize data about the management and clinical outcomes of these women. Patients’ survival outcomes, and the fetal, obstetrical and paediatric care of their children are secondary objectives. For both studies, the initial planned recruitment period is 5 years and patients will remain in active follow-up for up to 15 years. The PREFER-FERTILITY study was first activated in November 2012, and the PREFER-PREGNANCY study in May 2013.DiscussionThe PREFER study is expected to support and improve oncofertility counseling in Italy, to explore the real need of fertility preserving procedures, and to acquire prospectively more robust data on the efficacy and safety of the available strategies for fertility preservation, on the management of breast cancer survivors achieving a pregnancy and of women with PABC (including the possible short- and long-term complications in their children).Trial registration numberClinicalTrials.gov identifier: NCT02895165 (Retrospectively registered in August 2016).

Fertility preservation before breast cancer treatment appears unlikely to affect disease‐free survival at a median follow‐up of 43 months after fertility‐preservation consultation

“…Although most high‐risk recurrences in reproductive‐age women occur during the time period covered by our study, it is possible that a delayed second peak could present and that this peak may depend on a different set of biologic circumstances than the first. We look forward to the results of other long‐term follow‐up studies, including the PREFER (PREgnancy and FERtility) study by Lambertini et al, in which patients with newly diagnosed breast cancer will be followed for up to 15 years after FP …”

Contrast-enhanced ultrasound for ovary assessment in a murine model: preliminary findings on the protective role of a gonadotropin-releasing hormone analogue from chemotherapy-induced ovarian damage

“…Chemotherapy-induced ovarian damage may be variable, leading to transient/permanent amenorrhea, infertility or early menopause [8, 9]. In the past the use of temporary ovarian suppression with luteinising hormone-releasing hormone analogues [10] and oral contraceptives during chemotherapy has been recommended to preserve fertility [11].…”

Ovarian Function and Fertility Preservation in Breast Cancer: Should Gonadotropin-Releasing Hormone Agonist be administered to All Premenopausal Patients Receiving Chemotherapy?

“…88 Ongoing prospective studies are currently investigating the hormonal profile including AMH in women receiving temporary ovarian suppression with GnRHa during chemotherapy. [102][103][104] Fourth, particularly important for breast cancer patients, there is lack of data on the efficacy and safety of temporary ovarian suppression with GnRHa during chemotherapy in patients with hereditary cancer syndromes, such as those with pathogenic germline BRCA mutations. 105 To our knowledge, the only piece of information on this regard derives from the case series by Wong and colleagues in which out of 4 BRCAmutated breast cancer patients receiving GnRHa during chemotherapy, 3 resumed menstrual function before undergoing prophylactic gynecological surgery.…”