Fertility Preservation May Not Need to Delay Breast Cancer Treatment

Controlled ovarian stimulation (COS) may not be associated with the delayed treatment of early-stage breast cancer (eBC) in the neoadjuvant setting, according to the authors of a study published in ESMO Open.

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“An increasing proportion of [breast cancer (BC)] diagnoses are made in women who have not yet fully or partially fulfilled their reproductive desires,” wrote study authors in the article. “Fertility is a major concern for young patients [with eBC] and must be adequately addressed to ensure comprehensive and patient-centered care, as it affects treatment decisions and adherence.”

COS is a type of fertility crypopreservation (FP) that is available to these young patients. The results of previous studies have suggested that FP does not significantly impact their course of BC treatment, but there are still concerns about the safety in the neoadjuvant treatment (NAT) setting; namely, concerns exist around whether COS fertility preservation could delay treatment of the cancer and a potential increased risk of cancer proliferation in women with hormone receptor-positive (HR+) disease.

Investigators reviewed available literature to determine the safety and feasibility of COS in patients with eBC who were referred to NAT and/or have HR+ disease. Outcomes included time to NAT and survival.

Upon reviewing the literature, investigators could not find clear evidence that COS delays NAT initiation or leads to a worse prognosis. Findings from most of these retrospective studies have determined that COS is safe for patients with eBC, including patients with an HR+ subtype.

The study authors noted that there were concerns about COS for HR+ subtype because COS can increase estrogen levels, which can propel the growth of the tumor. While these findings skew toward positive, there are still limited data on the safety of FP for patients with HR+ eBC in the neoadjuvant setting, so more research is needed.

In a previous meta-analysis, COS in the neoadjuvant setting was not associated with risk of cancer, both in the HR subtype (RR 0.22, 95% CI 0.06-0.80) and overall population (hazard ratio 0.36, 95% CI 0.20-0.65). Further, it did not increase risk of death in any of these patient populations. However, investigators cannot consider it safe for patients with a combination of HR+ status who have started NAT.

BC is the second cause of cancer-related death around the world. In the United States, it is most diagnosed in young adults aged 30 to 39 years, and the rate of incidence has grown to 2.1% annually. The most common types of systemic treatment for eBC include single or combination therapies of chemotherapy, immunotherapy, endocrine therapy, or targeted therapies.

More research is needed to evaluate the safety and feasibility of COS in the neoadjuvant setting for this patient population, and new studies evaluating neoadjuvant therapies for eBC should also include fertility and reproductive clinical outcomes.

“Shared decision making between clinicians and patients is essential to carefully weigh the risks and benefits in each individual case,” study authors wrote.

REFERENCE

Benvenuti C, Laot L, Grinda T, Lambertini M, Pistilli B, Grynberg M. Is controlled ovarian stimulation safe in patients with hormone receptor-positive breast cancer receiving neoadjuvant chemotherapy? ESMO Open. 2024. doi:10.1016/j.esmoop.2023.102228