Comparing the Gonadotoxicity of Multiple Breast Cancer Regimens: Important Understanding for Managing Breast Cancer in Pre-Menopausal Women (original) (raw)
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Clinical Medicine Insights: Reproductive Health
Chemotherapy-induced premature ovarian insufficiency (POI) is one of the potential drawbacks of chemotherapy use of particular concern for newly diagnosed premenopausal breast cancer patients. Temporary ovarian suppression obtained pharmacologically with the administration of a gonadotropin-releasing hormone agonist (GnRHa) during chemotherapy has been specifically developed as a method to counteract chemotherapy-induced gonadotoxicity with the main goal of diminishing the risk of POI. In recent years, important clinical evidence has become available on the efficacy and safety of this strategy that should now be considered a standard option for ovarian function preservation in premenopausal breast cancer patients, including women who are not interested in conceiving after treatment or that would not be candidates for fertility preservation strategies because of their age. Nevertheless, in women interested in fertility preservation, this is not an alternative to gamete cryopreservati...
Fertility and Sterility, 2010
Fertility preservation is an important issue for young women diagnosed with breast cancer. The most well-established options for fertility preservation in cancer patients, embryo and oocyte cryopreservation, have not been traditionally offered to breast cancer patients as estradiol rise during standard stimulation protocols may not be safe for those patients. Potentially safer stimulation protocols using tamoxifen and aromatase inhibitors induce lower levels of estradiol while similar results in terms of number of oocyte and embryo obtained to standard protocols. Cryopreservation of immature oocytes and ovarian cortical tissue, both still experimental methods, are also fertility preservation options for breast cancer patients.
European journal of cancer (Oxford, England : 1990), 2017
The development of premature ovarian failure and subsequent infertility are possible consequences of chemotherapy use in pre-menopausal women with early-stage breast cancer. Among the available strategies for fertility preservation, pharmacological protection of the ovaries using luteinising hormone-releasing hormone analogues (LHRHa) during chemotherapy has the potential to restore ovarian function and fertility after anticancer treatments; however, the possible efficacy and clinical application of this strategy has been highly debated in the last years. Following the availability of new data on this controversial topic, the Panel of the Italian Association of Medical Oncology (AIOM) Clinical Practice Guideline on fertility preservation in cancer patients decided to apply the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methodology around the relevant and current question on the clinical utility of temporary ovarian suppression with LHRHa during chemothe...
Frontiers in Oncology, 2021
BackgroundOffering ovarian function and/or fertility preservation strategies in premenopausal women with newly diagnosed breast cancer candidates to undergo chemotherapy is standard of care. However, few data are available on uptake and main reasons for refusing these options.MethodsThe PREFER study (NCT02895165) is an observational, prospective study enrolling premenopausal women with early breast cancer, aged between 18 and 45 years, candidates to receive (neo)adjuvant chemotherapy. Primary objective is to collect information on acceptance rates and reasons for refusal of the proposed strategies for ovarian function and/or fertility preservation available in Italy.ResultsAt the study coordinating center, 223 patients were recruited between November 2012 and December 2020. Median age was 38 years (range 24 – 45 years) with 159 patients (71.3%) diagnosed at ≤40 years. Temporary ovarian suppression with gonadotropin-releasing hormone agonists (GnRHa) was accepted by 58 out of 64 (90....
Fertility preservation in breast cancer patients
Breast Cancer, 2013
Systemic therapies have been shown to effectively improve prognosis in patients with breast cancer. However, such therapies also become increasingly harmful as their duration increases, and they have adverse effects on fertility and ovarian function. Fertility preservation (FP) is important in young adult cancer survivors who may wish to have children. In Japan, some cancer societies recommend that the potentially serious effects of systemic therapy on ovarian function should be explained to women with cancer, and they should be encouraged to undergo FP prior to commencing treatment. Still, as there are no official guidelines, many oncologists lack the required knowledge and mind-set to advise young breast cancer patients on fertility issues. Counseling of patients and their families might improve their understanding about the influence of such treatment on fertility and ensure effective FP. There are several FP methods that can be selected before beginning treatment, and these methods have both advantages and disadvantages. Young adults with breast cancer who want to bear children in the future must be provided with FP counseling, in addition to advice about breast cancer treatment and prognosis.
South Asian Journal of Cancer
Chemotherapeutic agents used in the treatment of breast cancer (BC) adversely impact growing ovarian follicles and can induce permanent premature ovarian failure or reduce ovarian reserve in younger women. As treatments result in improved survival of BC patients, young survivors face quality of life (QOL) issues, including treatment-related infertility. We conducted a survey to evaluate awareness among patients regarding the impact of cancer-directed therapy on fertility and available options of fertility preservation (FP). We interviewed 350 women with BC under 40 years of age at the start of treatment, of which 321 (91.70%) were in varying stages of follow-up, 8 women (2.30%) were scheduled to start treatment, and 21 (6.00%) women were under treatment. All received chemotherapy or hormone therapy with or without ovarian suppression. Of the 350 women who responded to the survey, 321 (91.70%) women were on follow-up, 8 (2.30%) women were due to start treatment, and 21 (6%) women wer...
Management of young women with early breast cancer – focus on fertility preservation
Libri oncologici, 2019
Management of young women with breast cancer is complex and has several particularities, one of which is fertility preservation, a very important quality of life issue for young breast cancer survivors. Chemotherapy can be gonadotoxic and signifi cantly reduce woman`s reproductive potential and cause premature ovarian insuffi ciency while endocrine therapy requires a delay of pregnancy and indirectly aff ects fertility. Therefore every woman of reproductive age diagnosed with breast cancer should be informed about potential gonadotoxic eff ect of cancer treatment, the risk of premature ovarian insuffi ciency and associated symptoms, available fertility preservation methods, delay of cancer treatment and chances of subsequent pregnancy. If interested in fertility preservation breast cancer patients should be referred as early as possible to a reproductive specialist to further discuss the risk of infertility and available fertility preservation options. Currently established methods for fertility preservation are embryo and oocyte cryopreservation, while ovarian tissue cryopreservation, cryopreservation of immature oocytes and ovarian suppression with gonadotropin-releasing hormone agonists are still considered experimental. The aim of this review is to highlight the importance of fertility preservation as an important quality of life issue for young breast cancer survivors.
The current multidisciplinary approach to fertility preservation for breast cancer patients
The Breast, 2017
B reast cancer is one of the most common cancers affecting women worldwide. Thousands of young women are diagnosed with breast cancer every year [1 , 2]. Over the past four decades as diagnostic and treatment strategies (including surgery, irradiation and systemic therapy) have improved, the long-term outcomes of breast cancer patients have also improved [3]. Many patients with breast cancer can thus expect to live for many more years, and this progress raises important of quality-of-life issues such as fertility, which is particularly important for younger breast cancer patients [4 , 5]. Certain treatments for breast cancer, including chemotherapy and endocrine therapy, may adversely affect fertility [1 , 6]. Breast cancer treatment can have significant side effects including a transient or permanent impairment of gonadal function and subsequent infertility [7]. The duration of adjuvant endocrine therapy may also influence the timing of pregnancy for breast cancer patients. Five years of adjuvant endocrine therapy have traditionally been recommended, and treat-http ://escholarship.lib.okayama-u.ac.jp/amo/