Study yields ‘vital information’ to guide fertility counseling in breast cancer
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Key takeaways:
- Fertility preservation or assisted reproductive technology did not increase recurrence risk.
- Younger age and cryopreserved embryo transfer appeared associated with greater likelihood of pregnancy.
SAN ANTONIO — Use of fertility preservation or assisted reproductive technology did not increase recurrence risk among patients with hormone receptor-positive breast cancer who paused endocrine therapy to become pregnant, results showed.
The findings from the POSITIVE trial — presented at San Antonio Breast Cancer Symposium — are of “paramount importance” when it comes to oncofertility counseling for young patients with breast cancer, according to researcher Hatem A. Azim Jr., MD, PhD.
“I think a big reason why some physicians are not comfortable having these types of conversations is because we haven’t had high-quality data,” Azim, adjunct professor at the School of Medicine and Breast Cancer Center at Tecnológico de Monterrey in Mexico, told Healio. “Most studies in this area have been retrospective We hope this type of data will reassure the medical community about the safety of this approach.”
Background
As more women wait longer to have children, the likelihood that women will be diagnosed with breast cancer before they have started or completed their families has increased, Azim said.
A considerable percentage of women diagnosed with breast cancer may decide to pursue fertility preservation strategies before beginning cancer treatment or use assisted reproductive technologies to increase their chances of pregnancy, he said.
The international, single-arm, prospective POSITIVE trial assessed safety and pregnancy outcomes of interrupted hormonal therapy among a cohort of young women with breast cancer.
The trial enrolled 518 patients aged 42 years or younger with stage I to stage III hormone receptor-positive breast cancer who received 18 to 30 months of endocrine therapy before enrollment.
As Healio previously reported, results from the prospective POSITIVE trial presented at least year’s SABCS showed young women with early hormone receptor-positive breast cancer could safely pause endocrine therapy for up to 2 years to become pregnant without increasing risk for recurrence.
However, whether use of fertility preservation or assisted reproductive technology had any effect on safety had not been established. There has been concern that use of these approaches — especially if they involve the use of hormones — may have a negative effect on patients with hormone receptor-positive breast cancer, Azim said.
Azim and colleagues performed a secondary analysis of POSITIVE trial outcomes to evaluate the effects of fertility preservation and assisted reproductive technologies.
Findings
The analysis included 497 evaluable participants who paused endocrine therapy to try to become pregnant. After median follow-up of 41 months, nearly three-quarters (75%; n = 368) became pregnant.
Researchers identified 179 patients (36%) who used embryo or oocyte cryopreservation prior to trial enrollment. Another 215 (43.3%) used some form of assisted reproductive technologies, the most common of which was ovarian stimulation for in vitro fertilization (FIVET) or intracytoplasmic sperm injection [ICSI (37.2%; n = 80)].
The majority of those who underwent cryopreserved embryo transfer (82.4%) or FIVET/ICSI (67.5%) became pregnant. Factors most associated with greater likelihood of pregnancy included younger age and cryopreserved embryo transfer.
Multivariate analysis identified cryopreserved embryo transfer as the only assisted reproductive technology independently associated with greater chance of pregnancy (OR = 2.41; 95% CI, 1.75-4.95).
Results showed women who used ovarian stimulation for cryopreservation had a similar likelihood of breast cancer recurrence as those who did not 9.7% vs. 8.7%).
Analyses of women who had amenorrhea at trial entry showed menstrual cycles returned for most within 6 months (85%) of pausing endocrine therapy.
Type of adjuvant endocrine therapy received did not appear associated with time to pregnancy.
Multivariable analysis identified younger age as the only factor associated with shorter time to pregnancy.
Two years after enrollment, 80% of women aged younger than 35 years had become pregnant vs. 50% of those aged older than 40 years.
Researchers reported cumulative incidence of pregnancy at 12 months of 64% among those aged 34 years or younger, 54% for those aged 35 to 39 years, and 38% for those aged 40 to 42 years.
Researchers acknowledged short follow-up time as a study limitation.
“Our data demonstrate the efficacy and short-term safety of different fertility preservation and [assisted reproductive technology] options,” Azim said in a press release. “[The findings provide] vital information for fertility counseling of young [patients with breast cancer].”
References:
- Azim HA, et al. Abstract GS02-11. Presented at: San Antonio Breast Cancer Symposium; Dec. 5-9, 2023; San Antonio.
- Patients with HR-positive breast cancer may use fertility preservation and assisted reproductive technologies without increased risk of recurrence (press release). Available at: Posted Dec. 7, 2023. Accessed Dec. Dec.7, 2023.
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Azim HA, et al. Abstract GS02-11. Presented at: San Antonio Breast Cancer Symposium; Dec. 5-9, 2023; San Antonio.
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