Reproductive potential can be maintained after ovarian tissue transplant

MADRID — Ovarian tissue preservation, subsequent transplantation and maintenance of reproductive potential may be feasible for women with breast cancer who have BRCA mutations, according to a retrospective analysis presented at the European Society for Medical Oncology Congress.

“This is great news for all of the people working in this field, and we’re happy to report a full-term pregnancy and birth in a BRCA-mutated patient who received ovarian tissue cryopreservation,” Matteo Lambertini, MD, medical oncologist at Institut Jules Bordet in Brussels, told HemOnc Today.

Preclinical evidence suggested a possible negative impact of germline BRCA mutations on female fertility. However, the reproductive potential among women with BRCA mutations, as well as the effectiveness of fertility-preserving procedures for these women, remain largely uncertain.

Lambertini and colleagues assessed fertility outcomes in women with BRCA mutations who underwent oocyte cryopreservation or ovarian tissue cryopreservation before adjuvant chemotherapy.

Between January 2006 and December 2016, researchers evaluated 98 women with breast cancer, of whom 29 (median age, 31 years; range, 29-33) had BRCA mutations and 69 (median age, 30 years; range, 28-33) did not.

Investigators reported no difference between women with BRCA1 mutations and those with BRCA2 mutations for any outcome measures.

Baseline anti-Mullerian hormone levels were 1.8ng/mL among women with BRCA mutations and 2.6ng/mL women without BRCA mutations.

Twenty-seven women underwent oocyte cryopreservation. Although women with BRCA mutations received numerically higher doses of gonadotropins (2,775 vs. 2,150) and longer duration of stimulation (11.5 vs 9), these women tended to retrieve (6.5 vs. 10) and cryopreserve (3.5 vs 6) fewer oocytes than women without BRCA mutations.

Poor response rate — defined as retrieval offour or fewer oocytes — was 40% among women with BRCA mutations and 12.5% among women without them. This difference did not reach statistical significance.

Among 71 women who underwent ovarian tissue cryopreservation, those with BRCA mutations had numerically lower oocyte density per fragment (0.08 vs 0.14) and per mm² (0.33 vs 0.75) than those without BRCA mutations; however, once again, these differences did not reach statistical significance.

Two women with BRCA mutations underwent ovarian tissue transplantation after chemotherapy, and one delivered a healthy baby boy at term.

“In this specific subgroup of patients, it’s very important when we decide to perform an ovarian tissue transplant that the ovarian tissue is grafted to the remaining organs so that, after completing the tissue implant, this patient can receive prophylactic gynecological surgery and remove the tissue that was transplanted,” Lambertini told HemOnc Today.

This is the largest study to address fertility issues among women with breast cancer who harbor BRCA mutations. More research in this field is urgently needed, researchers said.

“The most important take-home message from our presentation is that cryopreservation and preservation of ovarian tissue are feasible,” Lambertini said. “So far, we have very little data to counsel this specific population on this topic, especially for those interested in ovarian tissue preservation. This may require a lot more reproductive studies to investigate if these BRCA patients may require a personalized approach.” – by Chuck Gormley

Reference:

Lambertini M, et al. Abstract 1541O. Presented at: European Society for Medical Oncology Congress; Sept. 8-12, 2017; Madrid.

Disclosures: Lambertini reports no relevant financial disclosures. Please see the abstract for a list of all other researchers’ relevant financial disclosures.