Skip to main content

02.05.2024 | Review

Fertility Preservation in Patients with Breast Cancer

verfasst von: Emma Manuel, Nicholas S. Raja, Molly Moravek

Erschienen in: Current Breast Cancer Reports

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

Many breast cancer treatments are gonadotoxic, which can result in infertility in survivors. Patients should be counseled on the impact of cancer treatment on future fertility and their options regarding fertility preservation. The main purpose of this narrative review is to discuss the implications of breast cancer treatment on future fertility and review various strategies for fertility preservation and their safety in this population.

Recent Findings

There is no demonstrated effect of ovarian stimulation, GnRH agonist therapy, or ovarian tissue cryopreservation/transplantation on breast cancer outcomes. In regard to oocyte/embryo cryopreservation, women should be counseled on equivalent fertilization and pregnancy outcomes with frozen and fresh oocytes/embryos. To prevent delaying the start of neoadjuvant chemotherapy, “random start” protocols can be used and are equally effective as conventional protocols. After breast cancer treatment, women should be counseled on equivalent disease outcomes for those who become pregnant vs. those who do not, including those who interrupt adjuvant endocrine therapy to carry pregnancies.

Summary

Fertility preservation should be discussed and offered to reproductive-aged patients with breast cancer, which has demonstrated safety in this population.
Literatur
10.
Zurück zum Zitat Ruddy KJ, Gelber SI, Tamimi RM, et al. Prospective study of fertility concerns and preservation strategies in young women with breast cancer. J Clin Oncol. 2014;32:1151–6.CrossRefPubMedPubMedCentral Ruddy KJ, Gelber SI, Tamimi RM, et al. Prospective study of fertility concerns and preservation strategies in young women with breast cancer. J Clin Oncol. 2014;32:1151–6.CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Kim J, Mersereau JE, Su HI, Whitcomb BW, Malcarne VL, Gorman JR. Young female cancer survivors’ use of fertility care after completing cancer treatment. Support Care Cancer. 2016;24(7):319e9.CrossRef Kim J, Mersereau JE, Su HI, Whitcomb BW, Malcarne VL, Gorman JR. Young female cancer survivors’ use of fertility care after completing cancer treatment. Support Care Cancer. 2016;24(7):319e9.CrossRef
18.
Zurück zum Zitat van Dorp W, Haupt R, Anderson RA, Mulder RL, van den Heuvel-Eibrink MM, van Dulmen-den Broeder E, Su HI, Winther JF, Hudson MM, Levine JM, Wallace WH. Reproductive function and outcomes in female survivors of childhood, adolescent, and young adult cancer: a review. J Clin Oncol. 2018;36(21):2169–80. https://doi.org/10.1200/JCO.2017.76.3441. Erratum in: J Clin Oncol. 2020;38(8):847. van Dorp W, Haupt R, Anderson RA, Mulder RL, van den Heuvel-Eibrink MM, van Dulmen-den Broeder E, Su HI, Winther JF, Hudson MM, Levine JM, Wallace WH. Reproductive function and outcomes in female survivors of childhood, adolescent, and young adult cancer: a review. J Clin Oncol. 2018;36(21):2169–80. https://​doi.​org/​10.​1200/​JCO.​2017.​76.​3441Erratum in: J Clin Oncol. 2020;38(8):847.
19.
Zurück zum Zitat Oktay K, Briggs D, Gosden RG. Ontogeny of follicle-stimulating hormone receptor gene expression in isolated human ovarian follicles. J Clin Endocrinol Metab. 1997;82:3748–51.PubMed Oktay K, Briggs D, Gosden RG. Ontogeny of follicle-stimulating hormone receptor gene expression in isolated human ovarian follicles. J Clin Endocrinol Metab. 1997;82:3748–51.PubMed
22.
Zurück zum Zitat Goldfarb SB, Bedoschi G, Grunblatt E, et al. The impact of adjuvant breast cancer (BC) chemotherapy on ovarian reserve and menses. J Clin Oncol. 2015;33:9522.CrossRef Goldfarb SB, Bedoschi G, Grunblatt E, et al. The impact of adjuvant breast cancer (BC) chemotherapy on ovarian reserve and menses. J Clin Oncol. 2015;33:9522.CrossRef
23.
Zurück zum Zitat • Goldfarb SB, Turan V, Bedoschi G, Taylan E, Abdo N, Cigler T, Bang H, Patil S, Dickler MN, Oktay KH. Impact of adjuvant chemotherapy or tamoxifen-alone on the ovarian reserve of young women with breast cancer. Breast Cancer Res Treat. 2021;185(1):165–73. https://doi.org/10.1007/s10549-020-05933-7. This prospective cohort study of women with breast cancer demonstrates a significant negative impact of anthracycline-cyclophosphamide- and cyclophosphamide-methotrexate + 5-fluorouracil-based chemotherapy regimens on ovarian reserve over a 24-month follow-up period. Tamoxifen-only treatment regimens did not alter ovarian reserve. • Goldfarb SB, Turan V, Bedoschi G, Taylan E, Abdo N, Cigler T, Bang H, Patil S, Dickler MN, Oktay KH. Impact of adjuvant chemotherapy or tamoxifen-alone on the ovarian reserve of young women with breast cancer. Breast Cancer Res Treat. 2021;185(1):165–73. https://​doi.​org/​10.​1007/​s10549-020-05933-7. This prospective cohort study of women with breast cancer demonstrates a significant negative impact of anthracycline-cyclophosphamide- and cyclophosphamide-methotrexate + 5-fluorouracil-based chemotherapy regimens on ovarian reserve over a 24-month follow-up period. Tamoxifen-only treatment regimens did not alter ovarian reserve.
26.
Zurück zum Zitat • Lambertini M, Peccatori FA, Demeestere I, et al. Fertility preservation and posttreatment pregnancies in post-pubertal cancer patients: ESMO Clinical Practice Guidelines†. Ann Oncol. 2020;31(12):1664–78. https://doi.org/10.1016/j.annonc.2020.09.006. These guidelines provide a framework for fertility preservation in post-pubertal cancer patients. Management flowcharts and a discussion of post-treatment pregnancies in cancer survivors are included. • Lambertini M, Peccatori FA, Demeestere I, et al. Fertility preservation and posttreatment pregnancies in post-pubertal cancer patients: ESMO Clinical Practice Guidelines†. Ann Oncol. 2020;31(12):1664–78. https://​doi.​org/​10.​1016/​j.​annonc.​2020.​09.​006. These guidelines provide a framework for fertility preservation in post-pubertal cancer patients. Management flowcharts and a discussion of post-treatment pregnancies in cancer survivors are included.
29.
32.
Zurück zum Zitat • Marklund A, Eloranta S, Wikander I, Kitlinski ML, Lood M, Nedstrand E, Thurin-Kjellberg A, Zhang P, Bergh J, Rodriguez-Wallberg KA. Efficacy and safety of controlled ovarian stimulation using GnRH antagonist protocols for emergency fertility preservation in young women with breast cancer-a prospective nationwide Swedish multicenter study. Hum Reprod. 2020;35(4):929–38. doi: https://doi.org/10.1093/humrep/deaa029. This prospective multicenter study of women with breast cancer demonstrates equal efficacy of letrozole-based and random start protocols compared to conventional controlled ovarian stimulation (COS) protocols. There was no difference in overall survival in women who underwent COS vs. those who did not. • Marklund A, Eloranta S, Wikander I, Kitlinski ML, Lood M, Nedstrand E, Thurin-Kjellberg A, Zhang P, Bergh J, Rodriguez-Wallberg KA. Efficacy and safety of controlled ovarian stimulation using GnRH antagonist protocols for emergency fertility preservation in young women with breast cancer-a prospective nationwide Swedish multicenter study. Hum Reprod. 2020;35(4):929–38. doi: https://​doi.​org/​10.​1093/​humrep/​deaa029. This prospective multicenter study of women with breast cancer demonstrates equal efficacy of letrozole-based and random start protocols compared to conventional controlled ovarian stimulation (COS) protocols. There was no difference in overall survival in women who underwent COS vs. those who did not.
38.
Zurück zum Zitat • Letourneau JM, Wald K, Sinha N, Juarez-Hernandez F, Harris E, Cedars MI, McCulloch CE, Dolezal M, Chien AJ, Rosen MP. 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. Cancer. 2020;126(3):487–95. https://doi.org/10.1002/cncr.32546. This retrospective study of patients with breast cancer demonstrates no difference in disease-free survival in those who underwent fertility preservation prior to cancer treatment vs. those who did not. • Letourneau JM, Wald K, Sinha N, Juarez-Hernandez F, Harris E, Cedars MI, McCulloch CE, Dolezal M, Chien AJ, Rosen MP. 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. Cancer. 2020;126(3):487–95. https://​doi.​org/​10.​1002/​cncr.​32546. This retrospective study of patients with breast cancer demonstrates no difference in disease-free survival in those who underwent fertility preservation prior to cancer treatment vs. those who did not.
39.
43.
44.
Zurück zum Zitat Lambertini M, Moore HCF, Leonard RCF, Loibl S, Munster P, Bruzzone M, Boni L, Unger JM, Anderson RA, Mehta K, Minton S, Poggio F, Albain KS, Adamson DJA, Gerber B, Cripps A, Bertelli G, Seiler S, Ceppi M, Partridge AH, Del Mastro L. Gonadotropin-releasing hormone agonists during chemotherapy for preservation of ovarian function and fertility in premenopausal patients with early breast cancer: a systematic review and meta-analysis of individual patient-level data. J Clin Oncol. 2018;36(19):1981–90. https://doi.org/10.1200/JCO.2018.78.0858.CrossRefPubMedPubMedCentral Lambertini M, Moore HCF, Leonard RCF, Loibl S, Munster P, Bruzzone M, Boni L, Unger JM, Anderson RA, Mehta K, Minton S, Poggio F, Albain KS, Adamson DJA, Gerber B, Cripps A, Bertelli G, Seiler S, Ceppi M, Partridge AH, Del Mastro L. Gonadotropin-releasing hormone agonists during chemotherapy for preservation of ovarian function and fertility in premenopausal patients with early breast cancer: a systematic review and meta-analysis of individual patient-level data. J Clin Oncol. 2018;36(19):1981–90. https://​doi.​org/​10.​1200/​JCO.​2018.​78.​0858.CrossRefPubMedPubMedCentral
50.
Zurück zum Zitat Jensen AK, Macklon KT, Fedder J, Ernst E, Humaidan P, Andersen CY. 86 successful births and 9 ongoing pregnancies worldwide in women transplanted with frozen-thawed ovarian tissue: focus on birth and perinatal outcome in 40 of these children. J Assist Reprod Genet. 2017;34(3):325–36. https://doi.org/10.1007/s10815-016-0843-9. Erratum in: J Assist Reprod Genet. 2017;34(3):337. Jensen AK, Macklon KT, Fedder J, Ernst E, Humaidan P, Andersen CY. 86 successful births and 9 ongoing pregnancies worldwide in women transplanted with frozen-thawed ovarian tissue: focus on birth and perinatal outcome in 40 of these children. J Assist Reprod Genet. 2017;34(3):325–36. https://​doi.​org/​10.​1007/​s10815-016-0843-9. Erratum in: J Assist Reprod Genet. 2017;34(3):337.
53.
Zurück zum Zitat Turner KA, Spurlin EE, Jimenez PT. Disparities in female oncofertility care in the United States: more questions than answers. Life (Basel). 2023;13(7):1547.PubMed Turner KA, Spurlin EE, Jimenez PT. Disparities in female oncofertility care in the United States: more questions than answers. Life (Basel). 2023;13(7):1547.PubMed
55.
Zurück zum Zitat Kelley AS, et al. Disparities in accessing infertility care in the United States: results from the National Health and Nutrition Examination Survey, 2013–2016. Fertil Steril. 2019;112(3):562–8.CrossRefPubMed Kelley AS, et al. Disparities in accessing infertility care in the United States: results from the National Health and Nutrition Examination Survey, 2013–2016. Fertil Steril. 2019;112(3):562–8.CrossRefPubMed
56.
Zurück zum Zitat Missmer SA, Seifer DB, Jain T. Cultural factors contributing to health care disparities among patients with infertility in Midwestern United States. Fertil Steril. 2011;95:1943–9.CrossRefPubMed Missmer SA, Seifer DB, Jain T. Cultural factors contributing to health care disparities among patients with infertility in Midwestern United States. Fertil Steril. 2011;95:1943–9.CrossRefPubMed
57.
Zurück zum Zitat Goodman LR, Balthazar U, Kim J, Mersereau JE. Trends of socioeconomic disparities in referral patterns for fertility preservation consultation. Hum Reprod. 2012;27:2076–81.CrossRefPubMedPubMedCentral Goodman LR, Balthazar U, Kim J, Mersereau JE. Trends of socioeconomic disparities in referral patterns for fertility preservation consultation. Hum Reprod. 2012;27:2076–81.CrossRefPubMedPubMedCentral
58.
Zurück zum Zitat Zebrack B. Information and service needs for young adult cancer survivors. Support Care Cancer. 2009;17:349–57.CrossRefPubMed Zebrack B. Information and service needs for young adult cancer survivors. Support Care Cancer. 2009;17:349–57.CrossRefPubMed
60.
Zurück zum Zitat Mobley EM, Ryan GL, Sparks AE, Monga V, Terry WW. Factors Impacting fertility preservation in adolescents and young adults with cancer: a retrospective study. J Adolesc Young Adult Oncol. 2020;9:208–21.CrossRefPubMedPubMedCentral Mobley EM, Ryan GL, Sparks AE, Monga V, Terry WW. Factors Impacting fertility preservation in adolescents and young adults with cancer: a retrospective study. J Adolesc Young Adult Oncol. 2020;9:208–21.CrossRefPubMedPubMedCentral
62.
Zurück zum Zitat Letourneau JM, Smith JF, Ebbel EE, Craig A, Katz PP, Cedars MI, Rosen MP. Racial, socioeconomic, and demographic disparities in access to fertility preservation in young women diagnosed with cancer. Cancer. 2012;118:4579–88.CrossRefPubMed Letourneau JM, Smith JF, Ebbel EE, Craig A, Katz PP, Cedars MI, Rosen MP. Racial, socioeconomic, and demographic disparities in access to fertility preservation in young women diagnosed with cancer. Cancer. 2012;118:4579–88.CrossRefPubMed
63.
Zurück zum Zitat Quinn GP, Vadaparampil ST, Gwede CK, Miree C, King LM, Clayton HB, Wilson C, Munster P. Discussion of fertility preservation with newly diagnosed patients: oncologists’ views. J Cancer Surviv. 2007;1:146–55.CrossRefPubMed Quinn GP, Vadaparampil ST, Gwede CK, Miree C, King LM, Clayton HB, Wilson C, Munster P. Discussion of fertility preservation with newly diagnosed patients: oncologists’ views. J Cancer Surviv. 2007;1:146–55.CrossRefPubMed
64.
Zurück zum Zitat Forman EJ, Anders CK, Behera MA. A nationwide survey of oncologists regarding treatment-related infertility and fertility preservation in female cancer patients. Fertil Steril. 2010;94:1652–6.CrossRefPubMed Forman EJ, Anders CK, Behera MA. A nationwide survey of oncologists regarding treatment-related infertility and fertility preservation in female cancer patients. Fertil Steril. 2010;94:1652–6.CrossRefPubMed
65.
Zurück zum Zitat Saraf AJ, Stanek J, Audino A, DaJusta D, Hansen-Moore J, McCracken K, Whiteside S, Yeager N, Nahata L. Examining predictors and outcomes of fertility consults among children, adolescents, and young adults with cancer. Pediatr Blood Cancer. 2018;65: e27409.CrossRefPubMed Saraf AJ, Stanek J, Audino A, DaJusta D, Hansen-Moore J, McCracken K, Whiteside S, Yeager N, Nahata L. Examining predictors and outcomes of fertility consults among children, adolescents, and young adults with cancer. Pediatr Blood Cancer. 2018;65: e27409.CrossRefPubMed
71.
Zurück zum Zitat •• Partridge AH, Niman SM, Ruggeri M, Peccatori FA, Azim HA Jr, Colleoni M, Saura C, Shimizu C, Sætersdal AB, Kroep JR, Mailliez A, Warner E, Borges VF, Amant F, Gombos A, Kataoka A, Rousset-Jablonski C, Borstnar S, Takei J, Lee JE, Walshe JM, Ruíz-Borrego M, Moore HCF, Saunders C, Bjelic-Radisic V, Susnjar S, Cardoso F, Smith KL, Ferreiro T, Ribi K, Ruddy K, Kammler R, El-Abed S, Viale G, Piccart M, Korde LA, Goldhirsch A, Gelber RD, Pagani O; International Breast Cancer Study Group; POSITIVE Trial Collaborators. Interrupting endocrine therapy to attempt pregnancy after breast cancer. N Engl J Med. 2023;388(18):1645–56. https://doi.org/10.1056/NEJMoa2212856. This prospective study evaluates the temporary interruption of adjuvant endocrine therapy in breast cancer patients who desire to attempt pregnancy. Results demonstrate no difference in short-term risk of breast cancer events, including distant recurrence, compared to an external control cohort. •• Partridge AH, Niman SM, Ruggeri M, Peccatori FA, Azim HA Jr, Colleoni M, Saura C, Shimizu C, Sætersdal AB, Kroep JR, Mailliez A, Warner E, Borges VF, Amant F, Gombos A, Kataoka A, Rousset-Jablonski C, Borstnar S, Takei J, Lee JE, Walshe JM, Ruíz-Borrego M, Moore HCF, Saunders C, Bjelic-Radisic V, Susnjar S, Cardoso F, Smith KL, Ferreiro T, Ribi K, Ruddy K, Kammler R, El-Abed S, Viale G, Piccart M, Korde LA, Goldhirsch A, Gelber RD, Pagani O; International Breast Cancer Study Group; POSITIVE Trial Collaborators. Interrupting endocrine therapy to attempt pregnancy after breast cancer. N Engl J Med. 2023;388(18):1645–56. https://​doi.​org/​10.​1056/​NEJMoa2212856. This prospective study evaluates the temporary interruption of adjuvant endocrine therapy in breast cancer patients who desire to attempt pregnancy. Results demonstrate no difference in short-term risk of breast cancer events, including distant recurrence, compared to an external control cohort.
72.
Zurück zum Zitat • Condorelli M, De Vos M, Lie Fong S, Autin C, Delvigne A, Vanden Meerschaut F, Wyns C, Imbert R, Cheruy C, Bouziotis J, de Azambuja E, Delbaere A, Lambertini M, Demeestere I. Impact of ARTs on oncological outcomes in young breast cancer survivors. Hum Reprod. 2021;36(2):381–89. https://doi.org/10.1093/humrep/deaa319. This retrospective multicentric matched cohort study demonstrates no negative impact of assisted reproductive technology (ART) on disease-free survival in breast cancer survivors. • Condorelli M, De Vos M, Lie Fong S, Autin C, Delvigne A, Vanden Meerschaut F, Wyns C, Imbert R, Cheruy C, Bouziotis J, de Azambuja E, Delbaere A, Lambertini M, Demeestere I. Impact of ARTs on oncological outcomes in young breast cancer survivors. Hum Reprod. 2021;36(2):381–89. https://​doi.​org/​10.​1093/​humrep/​deaa319. This retrospective multicentric matched cohort study demonstrates no negative impact of assisted reproductive technology (ART) on disease-free survival in breast cancer survivors.
Metadaten
Titel
Fertility Preservation in Patients with Breast Cancer
verfasst von
Emma Manuel
Nicholas S. Raja
Molly Moravek
Publikationsdatum
02.05.2024
Verlag
Springer US
Erschienen in
Current Breast Cancer Reports
Print ISSN: 1943-4588
Elektronische ISSN: 1943-4596
DOI
https://doi.org/10.1007/s12609-024-00551-4

Erhebliches Risiko für Kehlkopfkrebs bei mäßiger Dysplasie

29.05.2024 Larynxkarzinom Nachrichten

Fast ein Viertel der Personen mit mäßig dysplastischen Stimmlippenläsionen entwickelt einen Kehlkopftumor. Solche Personen benötigen daher eine besonders enge ärztliche Überwachung.

15% bedauern gewählte Blasenkrebs-Therapie

29.05.2024 Urothelkarzinom Nachrichten

Ob Patienten und Patientinnen mit neu diagnostiziertem Blasenkrebs ein Jahr später Bedauern über die Therapieentscheidung empfinden, wird einer Studie aus England zufolge von der Radikalität und dem Erfolg des Eingriffs beeinflusst.

Erhöhtes Risiko fürs Herz unter Checkpointhemmer-Therapie

28.05.2024 Nebenwirkungen der Krebstherapie Nachrichten

Kardiotoxische Nebenwirkungen einer Therapie mit Immuncheckpointhemmern mögen selten sein – wenn sie aber auftreten, wird es für Patienten oft lebensgefährlich. Voruntersuchung und Monitoring sind daher obligat.

Costims – das nächste heiße Ding in der Krebstherapie?

28.05.2024 Onkologische Immuntherapie Nachrichten

„Kalte“ Tumoren werden heiß – CD28-kostimulatorische Antikörper sollen dies ermöglichen. Am besten könnten diese in Kombination mit BiTEs und Checkpointhemmern wirken. Erste klinische Studien laufen bereits.

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.