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Del Mastro L, Lambertini M. Gonadotropin-releasing hormone analogs for ovarian function protection during chemotherapy in young early breast cancer patients: the last piece of the puzzle? Ann Oncol 2018; 28:1683-1685. [PMID: 28838207 DOI: 10.1093/annonc/mdx277] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- L Del Mastro
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, Ospedale Policlinico San Martino, Genova, Italy
| | - M Lambertini
- Department of Medical Oncology and Breast Cancer Translational Research Laboratory, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
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52
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Grynberg M, Raad J, Comtet M, Vinolas C, Cédrin-Durnerin I, Sonigo C. Fertility preservation in BRCA-mutated women: when and how? Future Oncol 2018; 14:483-490. [PMID: 29327596 DOI: 10.2217/fon-2017-0415] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BRCA 1 and 2 genes play a critical role in the safeguarding of DNA integrity. It is now well established that BRCA1 and BRCA2-mutated women are at increased risk of breast and ovarian cancers. However, several lines of evidence indicate that this genetic status may also be associated with ovarian dysfunction, in particular a reduced ovarian reserve. Considering the gonadal toxicity of cancer treatments and the recommendation of prophylactic bilateral salpingo-oophorectomy around 40 years, young BRCA mutation carriers are confronted with difficult family planning decisions. Recent development in fertility preservation offers new possibilities for these women, not only before a potential cancer treatment, but also in healthy carriers. If the pregnancy seems to be safe in this population, oocyte vitrification following ovarian stimulation might help BRCA-mutated patients to conceive after cancer treatment or to undergo prenatal genetic diagnosis in order to avoid the risk of transmitting the genetic abnormality to their offspring. The present article aims to extensively discuss the fertility issues related to BRCA gene mutations and the questions raised by the possibility of fertility in this population.
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Affiliation(s)
- Michaël Grynberg
- Department of Reproductive Medicine & Fertility Preservation, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92140 Clamart, France.,University Paris Sud XI, 94276, Le Kremlin Bicêtre, France.,Unité Inserm U1133, Université Paris-Diderot, 75013 Paris, France
| | - Jade Raad
- Department of Reproductive Medicine & Fertility Preservation, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92140 Clamart, France
| | - Marjorie Comtet
- Department of Reproductive Medicine & Fertility Preservation, Hôpital Jean Verdier, Avenue du 14 Juillet, 93140 Bondy, France.,University Paris XIII, 93017, Bobigny, France
| | - Claire Vinolas
- Department of Reproductive Medicine & Fertility Preservation, Hôpital Jean Verdier, Avenue du 14 Juillet, 93140 Bondy, France
| | - Isabelle Cédrin-Durnerin
- Department of Reproductive Medicine & Fertility Preservation, Hôpital Jean Verdier, Avenue du 14 Juillet, 93140 Bondy, France
| | - Charlotte Sonigo
- Department of Reproductive Medicine & Fertility Preservation, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92140 Clamart, France.,Inserm U1185, Univ Paris-Sud, Université Paris Saclay, Le Kremlin Bicêtre, 94276, France
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53
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Peccatori FA, Lambertini M, Scarfone G, Del Pup L, Codacci-Pisanelli G. Biology, staging, and treatment of breast cancer during pregnancy: reassessing the evidences. Cancer Biol Med 2018; 15:6-13. [PMID: 29545964 PMCID: PMC5842335 DOI: 10.20892/j.issn.2095-3941.2017.0146] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Breast cancer is one of the most frequently diagnosed malignancies during pregnancy. Here, we review the management of women with breast cancer during pregnancy (BCP), focusing on biology, diagnosis and staging, local and systemic treatments, obstetric care and long-term follow-up of children with prenatal exposure to anticancer treatments.
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Affiliation(s)
| | - Matteo Lambertini
- Gynecologic Oncology Department, European Institute of Oncology, Milan 20141, Italy
| | - Giovanna Scarfone
- Gynecologic Oncology Department, European Institute of Oncology, Milan 20141, Italy
| | - Lino Del Pup
- Gynecologic Oncology Department, European Institute of Oncology, Milan 20141, Italy
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54
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A specific controlled ovarian stimulation (COS) protocol for fertility preservation in women with breast cancer undergoing neoadjuvant chemotherapy. Contemp Oncol (Pozn) 2017; 21:290-294. [PMID: 29416435 PMCID: PMC5799704 DOI: 10.5114/wo.2017.72395] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 08/26/2017] [Indexed: 12/30/2022] Open
Abstract
Aim of the study The authors present a novel and specific controlled ovarian stimulation protocol for fertility preservation in women with estrogen-positive receptor breast cancer undergoing neoadjuvant chemotherapy. The protocol foresees random start ovarian stimulation and the use of letrozole associated to tamoxifen. Material and methods Forty breast cancer patients were included in the study. COS was performed either with recombinant FSH or hMG. Concomitantly with COS, letrozole in a dose of 5 mg and tamoxifen in a dose of 20 mg were given orally on a daily basis. The trigger was performed with 0.2 mg of triptorelin, in the presence of follicles ≥ 19 mm. Oocyte retrieval was scheduled 35-36 hours after triptorelin injection. Our main outcome measures were the number of oocytes collected and number of oocytes vitrified, the length of ovarian stimulation, total dose of gonadotropins administered, and levels of estradiol on the day of the trigger. Results The mean age of patients was 30.43 ±4.25 years. Nineteen women commenced COS in the luteal phase, eleven in the early follicular phase and ten in the late follicular phase. The mean number of collected oocytes was 11.78 ±9.12 and the mean number of vitrified oocytes was 9.72 ±7.36. The mean duration of COS was 10.03 ±1.33 days. The mean estradiol concentrations on the triggering day was 623.10 ±441.27, and the mean dose of gonadotropins administered was 2540 ±713.10. Conclusions The authors suggest that the protocol is efficient and may be a safe option for oocyte vitrification in these patients.
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Paluch-Shimon S, Pagani O, Partridge AH, Abulkhair O, Cardoso MJ, Dent RA, Gelmon K, Gentilini O, Harbeck N, Margulies A, Meirow D, Pruneri G, Senkus E, Spanic T, Sutliff M, Travado L, Peccatori F, Cardoso F. ESO-ESMO 3rd international consensus guidelines for breast cancer in young women (BCY3). Breast 2017; 35:203-217. [DOI: 10.1016/j.breast.2017.07.017] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 07/24/2017] [Indexed: 12/11/2022] Open
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Rossi L, Pagani O. The Role of Gonadotropin-Releasing-Hormone Analogues in the Treatment of Breast Cancer. J Womens Health (Larchmt) 2017; 27:466-475. [PMID: 28926289 DOI: 10.1089/jwh.2017.6355] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The prognosis of premenopausal breast cancer patients with early disease has improved over the past decades, particularly in women expressing hormone receptors in their tumors. Tamoxifen, a selective estrogen receptor modulator, has dramatically changed outcomes in these patients and remains one of the standards of care. Ovarian function suppression by gonadotropin-releasing-hormone analogues (GnRHa) represents an additional treatment option. Long-term data are required before firm conclusions can be drawn, whereas recent clinical trials suggest that the use of GnRHa is effective in both adjuvant and metastatic settings, particularly in younger patients (<35 years old). The decision to select the optimal therapy should be individualized according to the biological characteristics of tumors, estimates of disease response, comorbidities, patient preference, and long-term toxicity.
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Affiliation(s)
- Lorenzo Rossi
- 1 Institute of Oncology of Southern Switzerland (IOSI) , Bellinzona, Switzerland .,2 Breast Unit of Southern Switzerland (CSSI) , Lugano, Switzerland .,3 Breast Unit of Southern Switzerland (CSSI) , Bellinzona, Switzerland
| | - Olivia Pagani
- 1 Institute of Oncology of Southern Switzerland (IOSI) , Bellinzona, Switzerland .,2 Breast Unit of Southern Switzerland (CSSI) , Lugano, Switzerland .,3 Breast Unit of Southern Switzerland (CSSI) , Bellinzona, Switzerland
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57
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Fertility and pregnancy issues in BRCA -mutated breast cancer patients. Cancer Treat Rev 2017; 59:61-70. [DOI: 10.1016/j.ctrv.2017.07.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/04/2017] [Accepted: 07/05/2017] [Indexed: 01/08/2023]
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58
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Regan MM, Walley BA, Francis PA, Fleming GF, Láng I, Gómez HL, Colleoni M, Tondini C, Pinotti G, Salim M, Spazzapan S, Parmar V, Ruhstaller T, Abdi EA, Gelber RD, Coates AS, Goldhirsch A, Pagani O. Concurrent and sequential initiation of ovarian function suppression with chemotherapy in premenopausal women with endocrine-responsive early breast cancer: an exploratory analysis of TEXT and SOFT. Ann Oncol 2017; 28:2225-2232. [PMID: 28911092 PMCID: PMC5834112 DOI: 10.1093/annonc/mdx285] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Recent breast cancer treatment guidelines recommend that higher-risk premenopausal patients should receive ovarian function suppression (OFS) as part of adjuvant endocrine therapy. If chemotherapy is also given, it is uncertain whether to select concurrent or sequential OFS initiation. DESIGN AND METHODS We analyzed 1872 patients enrolled in the randomized phase III TEXT and SOFT trials who received adjuvant chemotherapy for hormone receptor-positive, HER2-negative breast cancer and upon randomization to an OFS-containing adjuvant endocrine therapy, initiated gonadotropin-releasing-hormone-agonist triptorelin. Breast cancer-free interval (BCFI) was compared between patients who received OFS concurrently with chemotherapy in TEXT (n = 1242) versus sequentially post-chemotherapy in SOFT (n = 630). Because timing of trial enrollment relative to adjuvant chemotherapy differed, we implemented landmark analysis re-defining BCFI beginning 1 year after final dose of chemotherapy (median, 15.5 and 8.1 months from enrollment to landmark in TEXT and SOFT, respectively). As a non-randomized treatment comparison, we implemented comparative-effectiveness propensity score methodology with weighted Cox modeling. RESULTS Distributions of several clinico-pathologic characteristics differed between groups. Patients who were premenopausal post-chemotherapy in SOFT were younger on average. The median duration of adjuvant chemotherapy was 18 weeks in both groups. There were 231 (12%) BC events after post-landmark median follow-up of about 5 years. Concurrent use of triptorelin with chemotherapy was not associated with a significant difference in post-landmark BCFI compared with sequential triptorelin post-chemotherapy, either in the overall population (HR = 1.11, 95% CI 0.72-1.72; P = 0.72; 4-year BCFI 89% in both groups), or in the subgroup of 692 women <40 years at diagnosis (HR = 1.13, 95% CI 0.69-1.84) who are less likely to develop chemotherapy-induced amenorrhea. CONCLUSION Based on comparative-effectiveness modeling of TEXT and SOFT after about 5 years median follow-up, with limited statistical power especially for the subgroup <40 years, neither detrimental nor beneficial effect of concurrent administration of OFS with chemotherapy on the efficacy of adjuvant therapy that includes chemotherapy was detected. CLINICALTRIALS.GOV NCT00066690 and NCT00066703.
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Affiliation(s)
- M. M. Regan
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston
- International Breast Cancer Study Group Statistical Center, Boston, USA
| | - B. A. Walley
- University of Calgary and Canadian Cancer Trials Group, Calgary, Canada
| | - P. A. Francis
- Division of Cancer Medicine, Peter MacCallum Cancer Center, St Vincent’s Hospital, University of Melbourne, Melbourne
- Australia & New Zealand Breast Cancer Trials Group and International Breast Cancer Study Group, Melbourne, Australia
| | - G. F. Fleming
- The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, USA
| | - I. Láng
- National Institute of Oncology and International Breast Cancer Study Group, Medical Oncology, Budapest, Hungary
| | - H. L. Gómez
- Division of Medicine, Instituto Nacional de Enfermedades Neoplásicas and International Breast Cancer Study Group, Lima, Peru
| | - M. Colleoni
- Division of Medical Senology, European Institute of Oncology and International Breast Cancer Study Group, Milan
| | - C. Tondini
- Medical Oncology, Ospedale Papa Giovanni XXIII and International Breast Cancer Study Group, Bergamo
| | - G. Pinotti
- Medical Oncology, ASST Sette Laghi-Ospedale di Circolo and Fondazione Macchi and International Breast Cancer Study Group, Varese, Italy
| | - M. Salim
- Allan Blair Cancer Center, Regina, Canada
| | - S. Spazzapan
- Medical Oncology, Centro di Riferimento Oncologico and International Breast Cancer Study Group, Aviano, Italy
| | - V. Parmar
- Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre and International Breast Cancer Study Group, Mumbai, India
| | - T. Ruhstaller
- Breast Center St. Gallen, Swiss Group for Clinical Cancer Research (SAKK) , St. Gallen
- International Breast Cancer Study Group, St. Gallen, Switzerland
| | - E. A. Abdi
- Australia & New Zealand Breast Cancer Trials Group and International Breast Cancer Study Group, The Tweed Hospital, Griffith University Gold Coast, Tweed Heads, Australia
| | - R. D. Gelber
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston
- Harvard T.H. Chan School of Public Health, Frontier Science and Technology Research Foundation, Boston, USA
| | - A. S. Coates
- International Breast Cancer Study Group and University of Sydney, Sydney, Australia
| | - A. Goldhirsch
- European Institute of Oncology and International Breast Cancer Study Group, Milan, Italy
| | - O. Pagani
- Oncology Institute of Southern Switzerland, Swiss Group for Clinical Cancer Research (SAKK), Bellinzona
- International Breast Cancer Study Group, Lugano, Viganello, Switzerland
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Miguel F, Lopes LV, Ferreira E, Ribas E, Pelaez AF, Leal C, Amaro T, Lopes P, Santos CM, Lopes C, Santos LL. Breast cancer in Angola, molecular subtypes: a first glance. Ecancermedicalscience 2017; 11:763. [PMID: 28900476 PMCID: PMC5574661 DOI: 10.3332/ecancer.2017.763] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Indexed: 12/27/2022] Open
Abstract
Purpose The aim of this study was to investigate the breast cancer (BC) molecular subtypes according to its surrogate immunohistochemistry (IHC) markers. We conducted a preliminary study, to correlate the clinical pathological profiles and molecular subtypes of breast cancer in Luanda, Angola. Methods From January 2011 to 30 December 2014, 140 consecutive cases of microscopically confirmed invasive breast carcinoma were classified regarding histology and IHC (ER, PR, HER2, and Ki-67). Surrogate molecular subtypes were classified according to ESMO recommendations. Results All patients were female; the median age was 47 years (24–84 years). Invasive carcinoma NST was the most common type (91.4%) and grade 2 was prevalent (70.7%). Most tumours were locally advanced (stage III – 65% and stage IV – 3.6%). In 140 studied cases, 74 (52.8%) malignancies were hormone receptor positive; 25.7% were luminal A like, 19.3% luminal B and HER2 negative like, 7.9% luminal B and HER2-positive like, 15.7% HER2 positive, and 31.4% were triple negative. Conclusion Women’s BC in Luanda-Angola is diagnosed at a young age and at an advanced stage. The two predominant molecular subtypes are HR positive and triple negative. The percentage of HER2-positive BC cases was high. Determining the molecular subtype using surrogate IHC markers has important treatment and prognostic implications for Angolan women with BC. There is an urgent need to study a prospective BC series in order to confirm the present results.
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Affiliation(s)
- Fernando Miguel
- Angolan Institute of Cancer Control, Rua Amílcar Cabral, Luanda, Angola.,These authors contributed equally to this work
| | - Lygia Vieira Lopes
- Sagrada Esperança Clinic, Av Murtala Mohammed, Luanda, Angola.,These authors contributed equally to this work
| | - Eduardo Ferreira
- Eduardo Ferreira Pathology Laboratory, Rua de Camões, 218-5º andar, Porto 4000-000, Portugal.,These authors contributed equally to this work
| | - Emília Ribas
- Sagrada Esperança Clinic, Av Murtala Mohammed, Luanda, Angola
| | | | - Conceição Leal
- Pathology Service, Portuguese Institute of Oncology, Rua António Bernardino de Almeida, Porto 4200-072, Portugal
| | - Teresina Amaro
- Experimental Pathology and Therapeutics Group, Portuguese Institute of Oncology, Rua António Bernardino de Almeida, Porto 4200-072, Portugal
| | - Paula Lopes
- Eduardo Ferreira Pathology Laboratory, Rua de Camões, 218-5º andar, Porto 4000-000, Portugal
| | - Cristina Mendes Santos
- Sagrada Esperança Clinic, Av Murtala Mohammed, Luanda, Angola.,ONCOCIR - Education and Care in Oncology - Lusophone Africa, Rua de Quires 168-10J, Moreira da Maia 4470- 643, Portugal
| | - Carlos Lopes
- Experimental Pathology and Therapeutics Group, Portuguese Institute of Oncology, Rua António Bernardino de Almeida, Porto 4200-072, Portugal
| | - Lúcio Lara Santos
- Experimental Pathology and Therapeutics Group, Portuguese Institute of Oncology, Rua António Bernardino de Almeida, Porto 4200-072, Portugal.,ONCOCIR - Education and Care in Oncology - Lusophone Africa, Rua de Quires 168-10J, Moreira da Maia 4470- 643, Portugal.,Surgical Oncology Department, Portuguese Institute of Oncology, Rua António Bernardino de Almeida, Porto 4200-072, Portugal.,These authors contributed equally to this work
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60
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Gómez-Flores-Ramos L, Álvarez-Gómez RM, Villarreal-Garza C, Wegman-Ostrosky T, Mohar A. Breast cancer genetics in young women: What do we know? MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2017; 774:33-45. [PMID: 29173497 DOI: 10.1016/j.mrrev.2017.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 04/21/2017] [Accepted: 08/17/2017] [Indexed: 12/12/2022]
Abstract
Breast cancer (BC) in young women, generally defined in oncology as women who are 40 years of age or younger, represents 2 out of 10 BC cases in developing countries. Several research studies, including genetic cancer panel tests, genome-wide association studies, expression analyses and polymorphisms reports, have found that young women with BC exhibit a higher genetic susceptibility and specific genomic signature compared to postmenopausal women with BC. Thus, international guidelines recommend genetic counseling for this age population. This review presents the current state of the art of genetics and genomics with regards to young women with BC.
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Affiliation(s)
- Liliana Gómez-Flores-Ramos
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Circuito Mario de la Cueva, Coyoacán, Ciudad Universitaria, C.P. 04510, Mexico City, Mexico; Unidad de Investigación en Epidemiología, Subdivisión de Investigación Básica, Instituto Nacional de Cancerología, Av. San Fernando # 22, Col. Sección XVI, Delegación Tlalpan, C.P. 14080, Mexico City, Mexico
| | - Rosa María Álvarez-Gómez
- Clínica de Cáncer Hereditario, Subdivisión de Investigación Básica, Instituto Nacional de Cancerlogía, Av. San Fernando # 22, Col. Sección XVI, Delegación Tlalpan, C.P. 14080, Mexico City, Mexico
| | - Cynthia Villarreal-Garza
- Clínica de Cáncer Hereditario, Subdivisión de Investigación Básica, Instituto Nacional de Cancerlogía, Av. San Fernando # 22, Col. Sección XVI, Delegación Tlalpan, C.P. 14080, Mexico City, Mexico; Centro de Cáncer de Mama, Tecnológico de Monterrey, Centro Médico Zambrano Hellion, 6° Piso Av. Batallón de San Patricio #112 Col. Real San Agustín, San Pedro Garza García C.P. 66278, Nuevo León, Mexico
| | - Talia Wegman-Ostrosky
- Clínica de Cáncer Hereditario, Subdivisión de Investigación Básica, Instituto Nacional de Cancerlogía, Av. San Fernando # 22, Col. Sección XVI, Delegación Tlalpan, C.P. 14080, Mexico City, Mexico
| | - Alejandro Mohar
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Circuito Mario de la Cueva, Coyoacán, Ciudad Universitaria, C.P. 04510, Mexico City, Mexico; Unidad de Investigación en Epidemiología, Subdivisión de Investigación Básica, Instituto Nacional de Cancerología, Av. San Fernando # 22, Col. Sección XVI, Delegación Tlalpan, C.P. 14080, Mexico City, Mexico.
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61
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Conte B, Poggio F, Del Mastro L. Luteininzing hormone releasing hormones analogs in combination with tamoxifen for the adjuvant treatment of premenopausal women with hormone receptor positive breast cancer. Expert Opin Pharmacother 2017; 18:1357-1362. [DOI: 10.1080/14656566.2017.1363181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Benedetta Conte
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino - IST , Genova, Italy
| | - Francesca Poggio
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino - IST , Genova, Italy
| | - Lucia Del Mastro
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino - IST , Genova, Italy
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Botteri E, Veronesi P, Vila J, Rotmensz N, Galimberti V, Thomazini MV, Viale G, Orecchia R, Goldhirsch A, Gentilini O. Improved prognosis of young patients with breast cancer undergoing breast-conserving surgery. Br J Surg 2017; 104:1802-1810. [PMID: 28791694 DOI: 10.1002/bjs.10658] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/15/2017] [Accepted: 06/24/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND The aim of the present study was to evaluate how breast cancer prognosis has evolved over time in young women treated with breast-conserving surgery (BCS). METHODS Data from patients younger than 40 years who had BCS and whole-breast radiotherapy in a single cancer centre between 1997 and 2010 were analysed. The patients were followed until 2016. Endpoints were local recurrence, any breast cancer-related event and death from any cause. RESULTS A total of 1331 patients were included in the study. After a median follow-up of 9·3 years, 114 local recurrences, 289 breast cancer-related events and 138 deaths had occurred. Women were divided into three groups of similar size based on tertiles of the date of diagnosis: 1997-2002 (524 patients), 2003-2005 (350) and 2006-2010 (457). The risk of local recurrence was 1·42 per 100 person-years in women diagnosed in the first interval, 0·85 per 100 person-years in the second and 0·48 per 100 person-years in the third (P for trend = 0·028). The respective values were 3·01, 2·52 and 2·07 per 100 person-years for any breast cancer-related event (P = 0·004), and 1·59, 1·22 and 0·64 per 100 person-years for death (P = 0·003). Each passing year was associated with a decreasing risk of local recurrence (hazard ratio (HR) 0·93, 95 per cent c.i. 0·87 to 1·00), any breast cancer-related event (HR 0·94, 0·91 to 0·98) and death (HR 0·89, 0·83 to 0·94). A major improvement in prognosis was observed after 2005, when the classification of breast cancer molecular subtypes and use of trastuzumab were implemented in routine clinical practice. CONCLUSION In the past two decades, both local control and overall prognosis have improved significantly in young women (aged less than 40 years) with breast cancer who undergo BCS.
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Affiliation(s)
- E Botteri
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.,National Advisory Unit for Women's Health, Women's Clinic, Oslo University Hospital, Oslo, Norway.,Department of Bowel Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - P Veronesi
- Division of Breast Surgery, European Institute of Oncology, Milan, Italy.,School of Medicine, University of Milan, Milan, Italy
| | - J Vila
- Scientific Directorate, European Institute of Oncology, Milan, Italy.,Department of Breast Surgery, La Fe University Hospital, Valencia, Spain
| | - N Rotmensz
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - V Galimberti
- Division of Breast Surgery, European Institute of Oncology, Milan, Italy
| | - M V Thomazini
- Division of Breast Surgery, European Institute of Oncology, Milan, Italy
| | - G Viale
- Department of Pathology, European Institute of Oncology, Milan, Italy.,School of Medicine, University of Milan, Milan, Italy
| | - R Orecchia
- Scientific Directorate, European Institute of Oncology, Milan, Italy.,Department of Oncology, Haemato-oncology, University of Milan, Milan, Italy
| | - A Goldhirsch
- Scientific Directory and Medical Senology, European Institute of Oncology, Milan, Italy
| | - O Gentilini
- Division of Breast Surgery, European Institute of Oncology, Milan, Italy
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Anti-Müllerian hormone (AMH) levels in premenopausal breast cancer patients treated with taxane-based adjuvant chemotherapy - A translational research project of the SUCCESS A study. Breast 2017; 35:130-135. [PMID: 28732324 DOI: 10.1016/j.breast.2017.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Premenopausal women undergoing chemotherapy are at high risk for premature ovarian failure and its long-term consequences. Data on potential markers to evaluate ovarian reserve pre- and posttreatment are limited. Anti-Müllerian hormone (AMH) known for ovarian reserve in reproductive medicine could be a surrogate marker and was assessed in premenopausal breast cancer patients of the SUCCESS A study (EUDRA-CT no. 2005-000490-21). METHODS We identified 170 premenopausal patients, age ≤ 40 years at trial entry, who received FEC-Doc as taxane-anthracylince based chemotherapy. Blood samples were taken at three time points: Before, four weeks after and two years after adjuvant chemotherapy. Serum AMH-levels were evaluated in a central laboratory by a quantitative immunoassay AMH Gen II ELISA (Beckman Coulter, Brea, USA). RESULTS Median age was 36 years (21-40 years). Median serum AMH-level before chemotherapy was 1.37 ng/ml (range < 0.1-11.3 ng/ml). Four weeks after chemotherapy AMH-levels dropped in 98.6% of the patients to <0.1 ng/ml (range < 0.1-0.21 ng/ml). After two years, 73.3% (n = 101) showed no evidence of ovarian function recovery (AMH <0.1 ng/ml, range < 0.1-3.9 ng/ml). Permanent chemotherapy induced amenorrhea occurred only in 50.6% of the patients. CONCLUSIONS In this analysis, premenopausal patients showed a high rate of ovarian impairment reflected by low AMH-levels after chemotherapy.
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Controversies about fertility and pregnancy issues in young breast cancer patients: current state of the art. Curr Opin Oncol 2017; 29:243-252. [DOI: 10.1097/cco.0000000000000380] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Sopik V, Sun P, Narod SA. The prognostic effect of estrogen receptor status differs for younger versus older breast cancer patients. Breast Cancer Res Treat 2017; 165:391-402. [DOI: 10.1007/s10549-017-4333-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 06/07/2017] [Indexed: 10/19/2022]
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Melatonin and Fertoprotective Adjuvants: Prevention against Premature Ovarian Failure during Chemotherapy. Int J Mol Sci 2017; 18:ijms18061221. [PMID: 28590419 PMCID: PMC5486044 DOI: 10.3390/ijms18061221] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/02/2017] [Accepted: 06/05/2017] [Indexed: 12/22/2022] Open
Abstract
Premature ovarian failure is one of the side effects of chemotherapy in pre-menopausal cancer patients. Preservation of fertility has become increasingly important in improving the quality of life of completely recovered cancer patients. Among the possible strategies for preserving fertility such as ovarian tissue cryopreservation, co-treatment with a pharmacological adjuvant is highly effective and poses less of a burden on the human body. Melatonin is generally produced in various tissues and acts as a universally acting antioxidant in cells. Melatonin is now more widely used in various biological processes including treating insomnia and an adjuvant during chemotherapy. In this review, we summarize the information indicating that melatonin may be useful for reducing and preventing premature ovarian failure in chemotherapy-treated female patients. We also mention that many adjuvants other than melatonin are developed and used to inhibit chemotherapy-induced infertility. This information will give us novel insights on the clinical use of melatonin and other agents as fertoprotective adjuvants for female cancer patients.
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Lambertini M, Anserini P, Fontana V, Poggio F, Iacono G, Abate A, Levaggi A, Miglietta L, Bighin C, Giraudi S, D'Alonzo A, Blondeaux E, Buffi D, Campone F, Merlo DF, Del Mastro L. The PREgnancy and FERtility (PREFER) study: an Italian multicenter prospective cohort study on fertility preservation and pregnancy issues in young breast cancer patients. BMC Cancer 2017; 17:346. [PMID: 28526012 PMCID: PMC5437418 DOI: 10.1186/s12885-017-3348-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 05/12/2017] [Indexed: 12/30/2022] Open
Abstract
Background Fertility and pregnancy issues are of key importance for young breast cancer patients. Despite several advances in the field, there are still multiple unmet needs and barriers in discussing and dealing with these concerns. To address the significant challenges related to fertility and pregnancy issues, the PREgnancy and FERtility (PREFER) study was developed as a national comprehensive program aiming to optimize care and improve knowledge around these topics. Methods The PREFER study is a prospective cohort study conducted across several Italian institution affiliated with the Gruppo Italiano Mammella (GIM) group evaluating patterns of care and clinical outcomes of young breast cancer patients dealing with fertility and pregnancy issues. It is composed of two distinctive studies: PREFER-FERTILITY and PREFER-PREGNANCY. The PREFER-FERTILITY study is enrolling premenopausal patients aged 18–45 years, diagnosed with non-metastatic breast cancer, who are candidates to (neo)adjuvant chemotherapy and not previously exposed to anticancer therapies. The primary objective is to obtain and centralize data about patients’ preferences and choices towards the available fertility preserving procedures. The success and safety of these strategies and the hormonal changes during chemotherapy and study follow-up are secondary objectives. The PREFER-PREGNANCY study is enrolling survivors achieving a pregnancy after prior history of breast cancer and patients diagnosed with pregnancy-associated breast cancer (PABC). The primary objectives are to obtain and centralize data about the management and clinical outcomes of these women. Patients’ survival outcomes, and the fetal, obstetrical and paediatric care of their children are secondary objectives. For both studies, the initial planned recruitment period is 5 years and patients will remain in active follow-up for up to 15 years. The PREFER-FERTILITY study was first activated in November 2012, and the PREFER-PREGNANCY study in May 2013. Discussion The PREFER study is expected to support and improve oncofertility counseling in Italy, to explore the real need of fertility preserving procedures, and to acquire prospectively more robust data on the efficacy and safety of the available strategies for fertility preservation, on the management of breast cancer survivors achieving a pregnancy and of women with PABC (including the possible short- and long-term complications in their children). Trial registration number ClinicalTrials.gov identifier: NCT02895165 (Retrospectively registered in August 2016).
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Affiliation(s)
- Matteo Lambertini
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Largo Rosanna Benzi, 10, 16132, Genova, Italy.,Breast Cancer Translational Research Laboratory, Department of Medicine, Institut Jules Bordet, and l'Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Paola Anserini
- Physiopathology of Human Reproduction Unit, IRCCS AOU San Martino-IST, Genova, Italy
| | - Valeria Fontana
- Department of Epidemiology, Biostatistics and Clinical Trials - IRCCS AOU San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Francesca Poggio
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy
| | - Giuseppina Iacono
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Largo Rosanna Benzi, 10, 16132, Genova, Italy
| | - Annalisa Abate
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Largo Rosanna Benzi, 10, 16132, Genova, Italy
| | - Alessia Levaggi
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Largo Rosanna Benzi, 10, 16132, Genova, Italy
| | - Loredana Miglietta
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy
| | - Claudia Bighin
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy
| | - Sara Giraudi
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Largo Rosanna Benzi, 10, 16132, Genova, Italy
| | - Alessia D'Alonzo
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Largo Rosanna Benzi, 10, 16132, Genova, Italy
| | - Eva Blondeaux
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy
| | - Davide Buffi
- Department of "Alta intensità di Cura e Percorso Nascita", U.O.C. Ostetricia e Ginecologia, UOSD Centro di Medicina Fetale e Perinatale, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Francesco Campone
- Department of "Alta intensità di Cura e Percorso Nascita", U.O.C. Patologia e Terapia Intensiva Neonatale-Assistenza Neonatale, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Domenico F Merlo
- Department of Epidemiology, Biostatistics and Clinical Trials - IRCCS AOU San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Lucia Del Mastro
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Largo Rosanna Benzi, 10, 16132, Genova, Italy.
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Blumenfeld Z. Investigational and experimental GnRH analogs and associated neurotransmitters. Expert Opin Investig Drugs 2017; 26:661-667. [DOI: 10.1080/13543784.2017.1323869] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Zeev Blumenfeld
- Reproductive Endocrinology, Ob/Gyn, Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
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69
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Treatment Decisions and Adherence to Adjuvant Endocrine Therapy in Breast Cancer. CURRENT BREAST CANCER REPORTS 2017. [DOI: 10.1007/s12609-017-0248-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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70
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Rossi L, Pagani O. Adjuvant Endocrine Therapy in Breast Cancer: Evolving Paradigms in Premenopausal Women. Curr Treat Options Oncol 2017; 18:28. [DOI: 10.1007/s11864-017-0473-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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71
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Lambertini M, Dellepiane C, Viglietti G, Del Mastro L. Pharmacotherapy to protect ovarian function and fertility during cancer treatment. Expert Opin Pharmacother 2017; 18:739-742. [PMID: 28399670 DOI: 10.1080/14656566.2017.1316373] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Matteo Lambertini
- a Breast Cancer Translational Research Laboratory , Institut Jules Bordet and l'Université Libre de Bruxelles (U.L.B.) , Brussels , Belgium.,b BrEAST Data Centre, Department of Medicine , Institut Jules Bordet and l'Université Libre de Bruxelles (U.L.B.) , Brussels , Belgium
| | - Chiara Dellepiane
- c Department of Medical Oncology , U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST , Genova , Italy
| | - Giulia Viglietti
- a Breast Cancer Translational Research Laboratory , Institut Jules Bordet and l'Université Libre de Bruxelles (U.L.B.) , Brussels , Belgium
| | - Lucia Del Mastro
- c Department of Medical Oncology , U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST , Genova , Italy
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72
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Villarreal-Garza C, Martinez-Cannon BA, Platas A, Mohar A, Partridge AH, Gil-Moran A, Fonseca A, Vega Y, Bargallo-Rocha E, Cardona-Huerta S, Lopez-Aguirre YE, Barragan-Carrillo R, Castro-Sanchez A. Fertility concerns among breast cancer patients in Mexico. Breast 2017; 33:71-75. [PMID: 28284061 DOI: 10.1016/j.breast.2017.02.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 02/18/2017] [Accepted: 02/20/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Young women represent a high proportion of the total number of breast cancer (BC) patients in Mexico; however, no previous studies addressing their attitudes regarding the risk of chemotherapy-induced infertility and its contributing factors are available. The aim of this study was to evaluate the concerns of young women with BC towards the risk of infertility in two referral centers in Mexico with access to public health services. METHODS A cross-sectional study including women with newly or previously detected BC aged 40 years or younger at diagnosis was conducted. Variables regarding concerns about fertility were collected from an adapted version of the Fertility Issues Survey. RESULTS 134 consecutive eligible women responded to the in-person paper survey. 55% were partnered, 35.1% had no children, and 48% reported willingness to have children prior to BC diagnosis. Only 3% of patients considered to be able to afford extra expenses. At diagnosis, 44% of women expressed some level of concern about infertility risk. The only factor significantly associated with fertility concern was the desire of having children prior to diagnosis (OR 11.83, p = 0.006). Only 30.6% patients recalled having received information regarding infertility risk from their physicians. CONCLUSION A minority of young women with breast cancer in Mexico is informed about the risk of BC treatment-induced infertility, despite substantial interest. Informing all patients about infertility risk and available options for fertility preservation should be an essential aspect of the supportive care of young women with BC, even in low-middle income countries such as Mexico.
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Affiliation(s)
- Cynthia Villarreal-Garza
- Departamento de Investigacion y de Tumores Mamarios, Instituto Nacional de Cancerologia, Mexico City, Mexico; Centro de Cancer de Mama, Tecnologico de Monterrey, Monterrey, N.L., Mexico; Joven y Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico
| | - Bertha Alejandra Martinez-Cannon
- Centro de Cancer de Mama, Tecnologico de Monterrey, Monterrey, N.L., Mexico; Joven y Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico
| | - Alejandra Platas
- Joven y Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico
| | - Alejandro Mohar
- Departamento de Investigacion y de Tumores Mamarios, Instituto Nacional de Cancerologia, Mexico City, Mexico; Joven y Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Arnoldo Gil-Moran
- Centro de Cancer de Mama, Tecnologico de Monterrey, Monterrey, N.L., Mexico
| | - Alan Fonseca
- Joven y Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico
| | - Yoatzin Vega
- Joven y Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico
| | - Enrique Bargallo-Rocha
- Departamento de Investigacion y de Tumores Mamarios, Instituto Nacional de Cancerologia, Mexico City, Mexico; Joven y Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico
| | | | - Yadira Estefany Lopez-Aguirre
- Departamento de Investigacion y de Tumores Mamarios, Instituto Nacional de Cancerologia, Mexico City, Mexico; Joven y Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico
| | - Regina Barragan-Carrillo
- Centro de Cancer de Mama, Tecnologico de Monterrey, Monterrey, N.L., Mexico; Joven y Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico
| | - Andrea Castro-Sanchez
- Joven y Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico; Catedras CONACYT, Instituto Nacional de Cancerologia, Mexico.
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Lambertini M, Falcone T, Unger JM, Phillips KA, Del Mastro L, Moore HC. Debated Role of Ovarian Protection With Gonadotropin-Releasing Hormone Agonists During Chemotherapy for Preservation of Ovarian Function and Fertility in Women With Cancer. J Clin Oncol 2017; 35:804-805. [DOI: 10.1200/jco.2016.69.2582] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Matteo Lambertini
- Matteo Lambertini, Breast Adjuvant Study Team Data Centre, Institut Jules Bordet, and Université Libre de Bruxelles, Brussels, Belgium; Tommaso Falcone, Cleveland Clinic Foundation, Taussig Cancer Institute, Cleveland, OH; Joseph M. Unger, Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Kelly-Anne Phillips, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia; Lucia Del Mastro, Istituto di Ricovero e Cura a Carattere
| | - Tommaso Falcone
- Matteo Lambertini, Breast Adjuvant Study Team Data Centre, Institut Jules Bordet, and Université Libre de Bruxelles, Brussels, Belgium; Tommaso Falcone, Cleveland Clinic Foundation, Taussig Cancer Institute, Cleveland, OH; Joseph M. Unger, Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Kelly-Anne Phillips, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia; Lucia Del Mastro, Istituto di Ricovero e Cura a Carattere
| | - Joseph M. Unger
- Matteo Lambertini, Breast Adjuvant Study Team Data Centre, Institut Jules Bordet, and Université Libre de Bruxelles, Brussels, Belgium; Tommaso Falcone, Cleveland Clinic Foundation, Taussig Cancer Institute, Cleveland, OH; Joseph M. Unger, Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Kelly-Anne Phillips, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia; Lucia Del Mastro, Istituto di Ricovero e Cura a Carattere
| | - Kelly-Anne Phillips
- Matteo Lambertini, Breast Adjuvant Study Team Data Centre, Institut Jules Bordet, and Université Libre de Bruxelles, Brussels, Belgium; Tommaso Falcone, Cleveland Clinic Foundation, Taussig Cancer Institute, Cleveland, OH; Joseph M. Unger, Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Kelly-Anne Phillips, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia; Lucia Del Mastro, Istituto di Ricovero e Cura a Carattere
| | - Lucia Del Mastro
- Matteo Lambertini, Breast Adjuvant Study Team Data Centre, Institut Jules Bordet, and Université Libre de Bruxelles, Brussels, Belgium; Tommaso Falcone, Cleveland Clinic Foundation, Taussig Cancer Institute, Cleveland, OH; Joseph M. Unger, Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Kelly-Anne Phillips, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia; Lucia Del Mastro, Istituto di Ricovero e Cura a Carattere
| | - Halle C.F. Moore
- Matteo Lambertini, Breast Adjuvant Study Team Data Centre, Institut Jules Bordet, and Université Libre de Bruxelles, Brussels, Belgium; Tommaso Falcone, Cleveland Clinic Foundation, Taussig Cancer Institute, Cleveland, OH; Joseph M. Unger, Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Kelly-Anne Phillips, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia; Lucia Del Mastro, Istituto di Ricovero e Cura a Carattere
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Fresneau B, Dourthe ME, Jouin A, Laurence V, de Lambert G, Colas C, Coret M, Laprie A, Rebours C, Orbach D, Demoor-Goldschmidt C. Carcinomes des adolescents et jeunes adultes : quelles spécificités ? Bull Cancer 2017; 104:267-280. [DOI: 10.1016/j.bulcan.2016.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/14/2016] [Accepted: 11/17/2016] [Indexed: 01/23/2023]
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75
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"My choice": breast cancer patients recollect doctors fertility preservation recommendations. Support Care Cancer 2017; 25:2421-2428. [PMID: 28238094 DOI: 10.1007/s00520-017-3648-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/17/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE The increasing rates of early-onset breast cancer (BC) and of woman survival render fertility preservation (FP) a pressing issue. We probe women's experiences of FP counseling and decision making, aiming to identify emergent counseling patterns. METHODS Semi-structured interviews were conducted with 16 women, who had been diagnosed with BC at the ages of 24-38, 1 to 5 years prior to the interview. BC survivors were recruited through posts in online fora, consented to participate, and were invited to tell their FP stories. The transcribed interviews were analyzed thematically, using the phenomenological paradigm. FINDINGS Doctors' FP recommendations belong into three categories: (a) direct clinical rationale-grounding recommendations in the woman's clinical condition by direct reference to tumor characteristics and prognosis, (b) indirect clinical rationale-reference to the woman's clinical condition by outlining a pressing time-frame, and (c) sociodemographic rationale-focus on the woman's family status. Women's responses revealed primarily detachment and compliance alongside initiative and proactivism. CONCLUSION AND IMPLICATIONS FOR CANCER SURVIVORS Beyond its contribution to women's future ability to conceive, FP may constitute an arena of personal autonomy and a coping resource for young BC patients. Raising awareness to this significance may sensitize healthcare providers to the role that FP may play in the moment of cancer diagnosis in adding, alongside sickness and prognosis, a focus on family future planning. As such, FP may affect women's quality of life and even survival.
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Lambertini M, Del Mastro L, Viglietti G, Pondé NF, Solinas C, de Azambuja E. Ovarian Function Suppression in Premenopausal Women with Early-Stage Breast Cancer. Curr Treat Options Oncol 2017; 18:4. [DOI: 10.1007/s11864-017-0442-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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77
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Pagani O. Endocrine Therapies in the Adjuvant and Advanced Disease Settings. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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78
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Andre R, Volovat SR, Cardoso F. Treatment of Advanced Disease: Guidelines. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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79
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Lambertini M, Azim HA, Peccatori FA. Fertility Issues in Patients with Breast Cancer or Survivors. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lambertini M, Pescio MC, Viglietti G, Goldrat O, Del Mastro L, Anserini P, Demeestere I. Methods of controlled ovarian stimulation for embryo/oocyte cryopreservation in breast cancer patients. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/23809000.2017.1270760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Matteo Lambertini
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
- Breast Data Centre, Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Maria Carolina Pescio
- Department of Gynecology, U.O. di Ginecologia, Università di Genova, IRCCS AOU San Martino-IST, Genova, Italy
| | - Giulia Viglietti
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Oranite Goldrat
- Fertility Clinic, Research Laboratory on Human Reproduction Erasme and l’Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Lucia Del Mastro
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Genova, Italy
| | - Paola Anserini
- Department of Gynecology, U.O. di Ginecologia, Università di Genova, IRCCS AOU San Martino-IST, Genova, Italy
| | - Isabelle Demeestere
- Fertility Clinic, Research Laboratory on Human Reproduction Erasme and l’Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
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Lambertini M, Ceppi M, Cognetti F, Cavazzini G, De Laurentiis M, De Placido S, Michelotti A, Bisagni G, Durando A, Valle E, Scotto T, De Censi A, Turletti A, Benasso M, Barni S, Montemurro F, Puglisi F, Levaggi A, Giraudi S, Bighin C, Bruzzi P, Del Mastro L. Dose-dense adjuvant chemotherapy in premenopausal breast cancer patients: A pooled analysis of the MIG1 and GIM2 phase III studies. Eur J Cancer 2016; 71:34-42. [PMID: 27951450 DOI: 10.1016/j.ejca.2016.10.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/11/2016] [Accepted: 10/29/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND No evidence exists to recommend a specific chemotherapy regimen in young breast cancer patients. We performed a pooled analysis of two randomised clinical trials to evaluate the efficacy of adjuvant dose-dense chemotherapy in premenopausal breast cancer patients and its impact on the risk of treatment-induced amenorrhoea. PATIENTS AND METHODS In the MIG1 study, node-positive or high-risk node-negative patients were randomised to 6 cycles of fluorouracil/epirubicin/cyclophosphamide every 2 (dose-dense) or 3 (standard-interval) weeks. In the GIM2 study, node-positive patients were randomised to 4 cycles of dose-dense or standard-interval EC or FEC followed by 4 cycles of dose-dense or standard-interval paclitaxel. Using individual patient data, the hazard ratio (HR) for overall survival by means of a Cox proportional hazards model and the odds ratio for treatment-induced amenorrhoea through a logistic regression model were calculated for each study. A meta-analysis of the two studies was performed using the random effect model to compute the parameter estimates. RESULTS A total of 1,549 patients were included. Dose-dense chemotherapy was associated with a significant improved overall survival as compared to standard-interval chemotherapy (HR, 0.71; 95% confidence intervals [CI], 0.54-0.95; p = 0.021). The pooled HRs were 0.78 (95% CI, 0.54-1.12) and 0.65 (95% CI, 0.40-1.06) for patients with hormone receptor-positive and -negative tumours, respectively (interaction p = 0.330). No increased risk of treatment-induced amenorrhoea was observed with dose-dense chemotherapy (odds ratio, 1.00; 95% CI, 0.80-1.25; p = 0.989). CONCLUSION Dose-dense adjuvant chemotherapy may be considered the preferred treatment option in high-risk premenopausal breast cancer patients.
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Affiliation(s)
- Matteo Lambertini
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino - IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy; Department of Medicine, BrEAST Data Centre, Institut Jules Bordet and l'Université Libre de Bruxelles (U.L.B.), Brussels, Belgium.
| | - Marcello Ceppi
- Epidemiology Unit, IRCCS AOU San Martino - IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.
| | - Francesco Cognetti
- Department of Medical Oncology, Istituto Regina Elena per lo Studio e la Cura dei Tumori, Roma, Italy.
| | | | - Michele De Laurentiis
- Medical Oncology, Istituto Nazionale Tumori-IRCCS Fondazione Pascale, Napoli, Italy.
| | - Sabino De Placido
- Medical Oncology, Azienda Ospedaliera Universitaria Federico II, Napoli, Italy.
| | - Andrea Michelotti
- UO Oncologia Medica I, Ospedale S. Chiara, Dipartimento di oncologia, dei trapianti e delle nuove tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
| | - Giancarlo Bisagni
- Medical Oncology, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy.
| | - Antonio Durando
- Breast Unit, Azienda Ospedaliera Universitaria Città della Salute e delle Scienze, Torino, Italy.
| | - Enrichetta Valle
- Medical Oncology, ASL8-Ospedale Oncologico A. Businco, Cagliari, Italy.
| | | | - Andrea De Censi
- S.C. Oncologia Medica, Medical Oncology Unit, E.O. Ospedali Galliera, Genova, Italy.
| | | | - Marco Benasso
- Medical Oncology, Ospedale San Paolo, Savona, Italy.
| | - Sandro Barni
- Medical Oncology, Azienda Ospedaliera, Caravaggio, Treviglio, Bergamo, Italy.
| | - Filippo Montemurro
- Investigative Clinical Oncology, Fondazione del Piemonte per l'Oncologia/Candiolo Cancer Center (IRCCS), Candiolo, Torino, Italy.
| | - Fabio Puglisi
- Department of Oncology, Azienda Ospedaliera di Udine, Udine, Italy.
| | - Alessia Levaggi
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino - IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.
| | - Sara Giraudi
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino - IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.
| | - Claudia Bighin
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino - IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.
| | - Paolo Bruzzi
- Epidemiology Unit, IRCCS AOU San Martino - IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.
| | - Lucia Del Mastro
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino - IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.
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82
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Temporary ovarian suppression during chemotherapy to preserve ovarian function and fertility in breast cancer patients: A GRADE approach for evidence evaluation and recommendations by the Italian Association of Medical Oncology. Eur J Cancer 2016; 71:25-33. [PMID: 27940355 DOI: 10.1016/j.ejca.2016.10.034] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 10/21/2016] [Indexed: 12/27/2022]
Abstract
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 chemotherapy as a strategy to preserve ovarian function and fertility in breast cancer patients. To answer this question, preservation of ovarian function and fertility were judged as critical outcomes for the decision-making. Three possible outcomes of harm were identified: LHRHa-associated toxicities, potential antagonism between concurrent LHRHa and chemotherapy, and lack of the prognostic impact of chemotherapy-induced premature ovarian failure. According to the GRADE evaluation conducted, the result was a strong positive recommendation in favour of using this option to preserve ovarian function and fertility in breast cancer patients. The present manuscript aims to update and summarise the evidence for the use of this strategy in light of the new data published up to January 2016, according to the GRADE process.
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Louwé L, Stiggelbout A, Overbeek A, Hilders C, van den Berg M, Wendel E, van Dulmen-den Broeder E, ter Kuile M. Factors associated with frequency of discussion of or referral for counselling about fertility issues in female cancer patients. Eur J Cancer Care (Engl) 2016; 27. [DOI: 10.1111/ecc.12602] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 01/18/2023]
Affiliation(s)
- L.A. Louwé
- Department of Gynaecology; Leiden University Medical Centre; Leiden The Netherlands
| | - A.M. Stiggelbout
- Department of Medical Decision Making/Quality of Care; Leiden University Medical Centre; Leiden The Netherlands
| | - A. Overbeek
- Department of Paediatric Oncology/Haematology; VU University Medical Centre; Amsterdam The Netherlands
| | - C.G.J.M. Hilders
- Department of Gynaecology; Reinier de Graaf Hospital; Delft The Netherlands
| | - M.H. van den Berg
- Department of Paediatric Oncology/Haematology; VU University Medical Centre; Amsterdam The Netherlands
| | - E. Wendel
- Department of Paediatric Oncology/Haematology; VU University Medical Centre; Amsterdam The Netherlands
| | - E. van Dulmen-den Broeder
- Department of Paediatric Oncology/Haematology; VU University Medical Centre; Amsterdam The Netherlands
| | - M.M. ter Kuile
- Department of Gynaecology; Leiden University Medical Centre; Leiden The Netherlands
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84
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Peccatori FA, Azim HA. Managing pregnancy-associated breast cancer: Is more really better? Breast 2016; 30:215-216. [PMID: 27371969 DOI: 10.1016/j.breast.2016.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 06/05/2016] [Indexed: 10/21/2022] Open
Affiliation(s)
- Fedro A Peccatori
- European Institute of Oncology, Via Ripamonti, 435-20141 Milan, Italy.
| | - Hatem A Azim
- Institut Jules Bordet, 121 Boulevard de Waterloo, 1000 Brussels, Belgium
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Lambertini M, Poggio F, Vaglica M, Blondeaux E, Del Mastro L. News on the medical treatment of young women with early-stage HER2-negative breast cancer. Expert Opin Pharmacother 2016; 17:1643-55. [DOI: 10.1080/14656566.2016.1199685] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Matteo Lambertini
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino, IST, Genova, Italy
- BrEAST Data Centre, Department of Medicine, Institut Jules Bordet, and l’Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Francesca Poggio
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino, IST, Genova, Italy
| | - Marina Vaglica
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino, IST, Genova, Italy
| | - Eva Blondeaux
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino, IST, Genova, Italy
| | - Lucia Del Mastro
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino, IST, Genova, Italy
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86
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Pagani O, Regan MM, Francis PA. Are SOFT and TEXT results practice changing and how? Breast 2016; 27:122-5. [DOI: 10.1016/j.breast.2016.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 02/08/2016] [Accepted: 02/22/2016] [Indexed: 10/21/2022] Open
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87
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Lambertini M, Del Mastro L. Fertility preservation in BRCA-mutated breast cancer patients. BREAST CANCER MANAGEMENT 2016. [DOI: 10.2217/bmt-2016-0009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A possible side effect of anticancer treatments in premenopausal women is the occurrence of premature ovarian failure and subsequent infertility. The inheritance of a deleterious genetic mutation in the BRCA1 or 2 genes generates the hereditary breast and ovarian cancer syndrome. Additional fertility counseling for breast cancer patients with BRCA mutations is warranted to educate them about the available fertility preservation options in the context of their unique concerns (i.e., prophylactic gynecologic surgery, pre-implantation genetic diagnosis and risk of developing long-term treatment-related premature ovarian failure). In this report we discuss the available options for fertility preservation in women with breast cancer, with a particular focus on the specific issues in breast cancer patients with BRCA mutations.
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Affiliation(s)
- Matteo Lambertini
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Largo Rosanna Benzi 10, 16132, Genova, Italy
- BrEAST Data Centre, Department of Medicine, Institut Jules Bordet, & l'Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - Lucia Del Mastro
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Genova, Italy
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