Fertility Preservation and Assisted Reproduction in Patients With Breast Cancer Interrupting Adjuvant Endocrine Therapy to Attempt Pregnancy

被引：11

作者：

Azim Jr, Hatem A. ^{[1
,2
]}

Niman, Samuel M. ^{[3
,4
]}

Partridge, Ann H. ^{[5
,6
]}

Demeestere, Isabelle ^{[7
,8
]}

Ruggeri, Monica ^{[9
]}

Colleoni, Marco ^{[10
]}

Saura, Cristina ^{[11
,12
]}

Shimizu, Chikako ^{[13
]}

Saetersdal, Anna B. ^{[14
]}

Kroep, Judith R. ^{[15
,16
]}

Mailliez, Audrey ^{[17
]}

Warner, Ellen ^{[18
,19
]}

Borges, Virginia F. ^{[20
]}

Amant, Frederic ^{[21
,22
,23
,24
]}

Gombos, Andrea ^{[25
,26
]}

Kataoka, Akemi ^{[27
]}

Rousset-Jablonski, Christine ^{[28
]}

Borstnar, Simona ^{[29
]}

Takei, Junko ^{[30
]}

Lee, Jeong Eon ^{[31
,32
]}

Walshe, Janice M. ^{[33
,34
,35
]}

Ruiz-Borrego, Manuel ^{[36
,37
]}

Moore, Halle C. F. ^{[38
]}

Saunders, Christobel ^{[39
,40
]}

Bjelic-Radisic, Vesna ^{[41
,42
,43
]}

Susnjar, Snezana ^{[44
]}

Cardoso, Fatima ^{[45
]}

Klar, Natalie J. ^{[46
]}

Spanic, Tanja ^{[47
]}

Ruddy, Kathryn ^{[48
]}

Piccart, Martine ^{[25
,26
]}

Korde, Larissa A. ^{[49
]}

Goldhirsch, Aron ^{[50
,51
]}

Gelber, Richard D. ^{[3
,4
,6
,52
,53
]}

Pagani, Olivia ^{[54
,55
,56
]}

Peccatori, Fedro A. ^{[57
]}

机构：

[1] Cairo Cure Oncol Ctr, Cairo, Egypt

[2] Tecnol Monterrey, Hosp Zambrano Hell, Breast Canc Ctr, Sch Med, San Pedro Garza Garcia, Mexico

[3] Int Breast Canc Study Grp Stat Ctr, Boston, MA USA

[4] Dana Farber Canc Inst, Dept Data Sci, Div Biostat, Boston, MA USA

[5] Dana Farber Canc Inst, Med Oncol, Boston, MA USA

[6] Harvard Med Sch, Boston, MA USA

[7] Univ Libre Bruxelles ULB, Res Lab Human Reprod, Brussels, Belgium

[8] Univ Libre Bruxelles, Erasme Hosp, Gynecol & Obstet Dept, Fertil Clin, Brussels, Belgium

[9] Program Young Patients, Div ETOP IBCSG Partners Fdn, Int Breast Canc Study Grp, Bern, Switzerland

[10] European Inst Oncol, Div Med Senol, IEO, IRCCS, Milan, Italy

[11] Vall dHebron Univ Hosp, Vall dHebron Inst Oncol, Barcelona, Spain

[12] SOLTI Breast Canc Res Grp, Barcelona, Spain

[13] Natl Ctr Global Hlth & Med, Dept Breast & Med Oncol, Tokyo, Japan

[14] Oslo Univ Hosp, Dept Oncol, Div Canc Med, Breast Canc Unit, Oslo, Norway

[15] Leiden Univ, Med Ctr, Dept Med Oncol, Leiden, Netherlands

[16] Dutch Breast Canc Res Grp BOOG, Amsterdam, Netherlands

[17] Ctr Oscar Lambret, Dept Med Oncol, Breast Canc Unit, Lille, France

[18] Sunnybrook Hlth Sci Ctr, Odette Canc Ctr, Toronto, ON, Canada

[19] Canadian Clin Trials Grp CCTG, Toronto, ON, Canada

[20] Univ Colorado, Ctr Canc, Dept Med, Div Med Oncol, Aurora, CO 80045 USA

[21] Katholieke Univ Leuven, Dept Oncol, Leuven, Belgium

[22] Leuven Canc Inst, Leuven, Belgium

[23] Univ Hosp Leuven, Dept Obstet & Gynecol, Leuven, Belgium

[24] Antoni Van Leeuwenhoek Netherlands Gynecol Oncol C, Amsterdam, Netherlands

[25] Inst Jules Bordet, Brussels, Belgium

[26] Univ Libre Bruxelles, Brussels, Belgium

[27] Japanese Fdn Canc Res, Canc Inst Hosp, Breast Oncol Canc, Tokyo, Japan

[28] Leon Berard Canc Ctr, Ctr Leon Berard, Dept Surg, Lyon, France

[29] Inst Oncol, Div Med Oncol, Ljubljana, Slovenia

[30] St Lukes Int Hosp, Breast Ctr, Tokyo, Japan

[31] Sungkyunkwan Univ, Samsung Med Ctr, Sch Med, Dept Surg, Seoul, South Korea

[32] Sungkyunkwan Univ, Dept Clin Res & Evaluat, SAIHST, Seoul, South Korea

[33] Canc Trials Ireland, Dublin, Ireland

[34] St Vincents Univ Hosp, Dept Med Oncol, Dublin, Ireland

[35] Tallaght Univ Hosp, Dublin, Ireland

[36] GEICAM Spanish Breast Canc Grp, Madrid, Spain

[37] Hosp Virgen Rocio Sevilla, Seville, Spain

[38] Cleveland Clin, Taussig Canc Inst, Breast Oncol Program, Cleveland, OH 44106 USA

[39] Univ Melbourne, Dept Surg, Melbourne, Vic, Australia

[40] Royal Melbourne Hosp, Melbourne, Vic, Australia

[41] Univ Witten Herdecke, Helios Univ Hosp Wuppertal, Breast Unit, Wuppertal, Germany

[42] Med Univ Graz, Dept Gynaecol, Graz, Austria

[43] Austrian Breast & Colorectal Study Grp ABCSG, Vienna, Austria

[44] Inst Oncol & Radiol Serbia, Dept Med Oncol, Belgrade, Serbia

[45] Champalimaud Fdn, Champalimaud Clin Ctr, Breast Unit, Lisbon, Portugal

[46] NYU, Perlmutter Canc Ctr, New York, NY USA

[47] Europa Donna, Ljubljana, Slovenia

[48] Mayo Clin, Dept Oncol, Rochester, MN USA

[49] NCI, Canc Therapy Evaluat Program, Breast & Melanoma Therapeut, Bethesda, MD USA

[50] IBCSG Partners Fdn, Int Breast Canc Study Grp, Div ETOP, Bern, Switzerland

来源：

JOURNAL OF CLINICAL ONCOLOGY | 2024年 / 42卷 / 23期

关键词：

YOUNG-WOMEN; IMPACT; STIMULATION; LETROZOLE; SAFETY;

D O I：

10.1200/JCO.23.02292

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

PURPOSE We investigated time to pregnancy, efficacy and safety of fertility preservation, and assisted reproductive technologies (ARTs) in women with early hormone receptor-positive breast cancer (BC) desiring future pregnancy. PATIENTS AND METHODS POSITIVE is an international, single-arm, prospective trial, in which 518 women temporarily interrupted adjuvant endocrine therapy to attempt pregnancy. We evaluated menstruation recovery and factors associated with time to pregnancy and investigated if ART use was associated with achieving pregnancy. The cumulative incidence of BC-free interval (BCFI) events was estimated according to the use of ovarian stimulation at diagnosis. The median follow-up was 41 months. RESULTS Two hundred seventy-three patients (53%) reported amenorrhea at enrollment, of whom 94% resumed menses within 12 months. Among 497 patients evaluable for pregnancy, 368 (74%) reported at least one pregnancy. Young age was the main factor associated with shorter time to pregnancy with cumulative incidences of pregnancy by 1 year of 63.5%, 54.3%, and 37.7% for patients age <35, 35-39, and 40-42 years, respectively. One hundred and seventy-nine patients (36%) had embryo/oocyte cryopreservation at diagnosis, of whom 68 reported embryo transfer after enrollment. Cryopreserved embryo transfer was the only ART associated with higher chance of pregnancy (odds ratio, 2.41 [95% CI, 1.75 to 4.95]). The cumulative incidence of BCFI events at 3 years was similar for women who underwent ovarian stimulation for cryopreservation at diagnosis, 9.7% (95% CI, 6.0 to 15.4), compared with those who did not, 8.7% (95% CI, 6.0 to 12.5). CONCLUSION In POSITIVE, fertility preservation using ovarian stimulation was not associated with short-term detrimental impact on cancer prognosis. Pregnancy rates were highest among those who underwent embryo/oocyte cryopreservation followed by embryo transfer.

引用

页码：2822 / 2832

页数：15

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