Dr. Eleonora Teplinsky, from Valley Health - The Icahn School of Medicine, Mount Sinai, presents during the 2022 Evolution Conference in Boston, MA.
At this year’s ‘Evolution’ breast cancer educational conference, Dr Eleonora Teplinsky, MD discussed treatment considerations for premenopausal breast cancer patients seeking to maintain their fertility in the face of breast cancer diagnosis. As many cancer therapies can be harmful to the reproductive organs, Dr Teplinsky noted it is important to discuss these risks before therapy is initiated. She notes that it is best for all patients of childbearing age with a newly diagnosed cancer to meet with an infertility specialist or reproductive endocrinologist if they have any fertility concerns. In addition, as fertility preservation takes time and can delay cancer treatment, she emphasizes that such conversations should take place as soon as possible after diagnosis.
Dr Teplinsky cited results from a Swedish study of 425 women who underwent fertility preservation (FP), which showed that FP was associated with a significantly higher number of post-diagnosis live births and assisted reproduction treatments, without an adverse impact on all-cause survival. The results, she notes, show that FP is a safe practice. In addition, she noted a recent study showing that FP with or without hormonal manipulation was not associated with any adverse impact on cancer-specific survival in women with breast cancer. Furthermore, these results were not impacted by the traditional breast cancer prognostic factors like tumor size, estrogen receptor status, or lymph node involvement.
Dr Teplinsky added that clinical guidelines differ in the amount of time after breast cancer treatment at which pregnancy can be attempted, with most recommending 6 to 12 months after treatment, but some even longer. She cited some general guidelines to attempt pregnancy 3 months following cessation of endocrine therapy and seven months after cessation of trastuzumab treatment (the latter being due to the risk for a specific trastuzumab-related event). Dr Teplinsky emphasized the safety of pregnancy following breast cancer treatment, as shown in a large meta-analysis of nearly 113,000 patients with breast cancer (Lambertini et al., 2021), of whom some 7500 had a pregnancy after diagnosis. Overall, results showed that pregnancy after breast cancer did not adversely impact breast cancer survival; she also noted that the results were similar (i.e., no adverse impact) with other cancer types, including cervical cancer and leukemia.
She presented further evidence of no detriment to pregnancy after breast cancer in an analysis from the same study of nearly 5 million pregnant women, of whom 3,240 had a prior breast cancer. Whereas there was an increased risk of C-section, risk for low birth weight, preterm birth, and small for gestational age offspring in patients with breast cancer, there was no difference in pregnancy outcomes or pregnancy complications, and no increased risk for congenital abnormalities among women with breast cancer versus the general population. Interestingly, the maternal outcomes for this study seemed to favor pregnancy following breast cancer, as those with a post-treatment pregnancy had better disease-free, and overall survival as compared to those without a pregnancy. Also important to note, these results were seen regardless of factors such as prior treatment, lymph node or BRCA status, timing of pregnancy post breast cancer, or pregnancy outcome.
As a final thought, Dr Teplinsky emphasized that about one-third of patients 40 and younger with breast cancer cite fertility concerns as a major factor in their decision to undergo endocrine therapy. In this regard, she noted that the forthcoming results of the POSITIVE trial are eagerly awaited (scheduled to be presented at the 2022 San Antonio Breast Cancer Symposium). This trial examines the safety of interrupting endocrine therapy as a means to attempt pregnancy. The trial enrolled women with hormone receptor positive, stage I to III breast cancer, 42 years of age or less who had received endocrine therapy (ET) for at least 18 to 30 months, who wished to interrupt ET to attempt pregnancy. Following a 3-month “washout” period, ET could be interrupted for a period of up to two years to allow for delivery and breast feeding, if feasible. ET would then be resumed to complete a total of 5 to 10 years once pregnancy/breastfeeding was completed, or if it was ensured that conception was not possible. Dr Teplinsky notes that the results of this trial should provide further evidence that fertility after a breast cancer diagnosis is indeed safe and non-detrimental to both mother and child.
See more from the 2022 Evolution Conference here.
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