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

IF 42.1 1区医学 Q1 ONCOLOGY

Journal of Clinical Oncology Pub Date : 2024-08-10 Epub Date: 2024-05-29 DOI:10.1200/JCO.23.02292

Hatem A Azim, Samuel M Niman, Ann H Partridge, Isabelle Demeestere, Monica Ruggeri, Marco Colleoni, Cristina Saura, Chikako Shimizu, Anna B Saetersdal, Judith R Kroep, Audrey Mailliez, Ellen Warner, Virginia F Borges, Frédéric Amant, Andrea Gombos, Akemi Kataoka, Christine Rousset-Jablonski, Simona Borstnar, Junko Takei, Jeong Eon Lee, Janice M Walshe, Manuel Ruíz-Borrego, Halle C F Moore, Christobel Saunders, Vesna Bjelic-Radisic, Snezana Susnjar, Fatima Cardoso, Natalie J Klar, Tanja Spanic, Kathryn Ruddy, Martine Piccart, Larissa A Korde, Aron Goldhirsch, Richard D Gelber, Olivia Pagani, Fedro A Peccatori

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引用次数: 0

Abstract

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.

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中断内分泌辅助治疗尝试怀孕的乳腺癌患者的生育力保存和辅助生殖。

目的：我们研究了希望将来怀孕的早期激素受体阳性乳腺癌（BC）女性患者的怀孕时间、生育力保存的有效性和安全性以及辅助生殖技术（ART）：POSITIVE是一项国际单臂前瞻性试验，518名妇女暂时中断辅助内分泌治疗，尝试怀孕。我们评估了月经恢复情况以及与怀孕时间相关的因素，并调查了抗逆转录病毒疗法的使用是否与怀孕有关。根据诊断时卵巢刺激的使用情况，估算了无BC间期（BCFI）事件的累积发生率。中位随访时间为 41 个月：273 名患者（53%）在入组时报告闭经，其中 94% 的患者在 12 个月内恢复月经。在可评估怀孕的 497 名患者中，368 人（74%）报告至少有一次怀孕。年龄小是导致怀孕时间缩短的主要因素，1 年后怀孕的累计发生率分别为 63.5%、54.3% 和 37.7%：在 "阳性 "患者中，使用卵巢刺激保留生育能力与癌症预后的短期不利影响无关。胚胎/卵母细胞冷冻保存后再进行胚胎移植的患者妊娠率最高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Oncology 医学-肿瘤学

CiteScore

41.20

自引率

2.20%

发文量

8215

审稿时长

2 months

期刊介绍： The Journal of Clinical Oncology serves its readers as the single most credible, authoritative resource for disseminating significant clinical oncology research. In print and in electronic format, JCO strives to publish the highest quality articles dedicated to clinical research. Original Reports remain the focus of JCO, but this scientific communication is enhanced by appropriately selected Editorials, Commentaries, Reviews, and other work that relate to the care of patients with cancer.