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Dezellus A, Mirallie S, Leperlier F, Sauterey B, Bouet PE, Dessaint A, Duros S, Gremeau AS, Mouret-Reynier MA, Durand LM, Venat L, De Blay P, Robert M, Freour T, Campone M, Blanc-Lapierre A, Bordes V. Use of tamoxifene-controlled ovarian hyperstimulation for fertility preservation before breast cancer treatment: A prospective cohort study with a 5-year follow-up. Breast 2024; 77:103776. [PMID: 39167853 PMCID: PMC11381894 DOI: 10.1016/j.breast.2024.103776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/08/2024] [Accepted: 07/10/2024] [Indexed: 08/23/2024] Open
Abstract
PURPOSE Fertility issues are of great concern for young women undergoing treatment for breast cancer (BC). Fertility preservation (FP) protocols using controlled ovarian stimulation (COS) with letrozole have been widely used with overall good results. However, letrozole cannot be used in every country in this context. This study aimed to assess the efficacy of tamoxifen for COS in women with early BC undergoing FP. METHODS This multicentric prospective study included patients aged 18-40, diagnosed with stage I, II and III invasive BC, undergoing tamoxifen-COS before adjuvant or neoadjuvant chemotherapy (NAC). The primary endpoint was the efficacy of tamoxifen-COS protocol evaluated by the number of oocytes collected and vitrified. Secondary endpoints included the time interval before chemotherapy, breast cancer (BC) recurrence rates, and reproductive outcomes. RESULTS Ninety-five patients were included between 2014 and 2017, aged 31.5 ± 4 years on average. 37.9 % received NAC and 62.1 % received adjuvant chemotherapy. FP procedure was successful in 89.5 % of the cycles. The mean number of collected and vitrified oocytes was 12.8 ± 7.9 and 9.8 ± 6.2, respectively. The mean duration of COS was 10.4 ± 1.9 days. Median time before chemotherapy initiation was 3.6 weeks (IQR 3.1; 4.1) for women receiving NAC. Five-year relapse-free and overall survival rates were in-line with those expected in this population. Twenty-one women had spontaneous full-term pregnancies, while 5 underwent IVF cycles with frozen-thawed oocytes, without pregnancy. CONCLUSION Tamoxifen-COS protocols appear to be feasible before adjuvant or NAC treatment in young BC patients and efficient in terms of oocyte yield.
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Affiliation(s)
- A Dezellus
- Institut de Cancérologie de l'Ouest, Saint Herblain et Angers, France.
| | - S Mirallie
- Service de Médecine et Biologie du Développement et de la Reproduction, CHU de Nantes, France
| | - F Leperlier
- Service de Médecine et Biologie du Développement et de la Reproduction, CHU de Nantes, France
| | - B Sauterey
- Institut de Cancérologie de l'Ouest, Saint Herblain et Angers, France
| | - P-E Bouet
- Service de Médecine et Biologie du Développement et de la Reproduction, CHU Angers, France
| | | | - S Duros
- Service de Médecine et Biologie du Développement et de la Reproduction, CHU de Rennes, France
| | - A S Gremeau
- Service de Médecine et Biologie du Développement et de la Reproduction, CHU de Clermont-Ferrand, France
| | | | - L M Durand
- Service de Médecine et Biologie du Développement et de la Reproduction, CHU de Limoges, France
| | - L Venat
- Service d'oncologie, CHU de Limoges, France
| | - P De Blay
- Service de Gynécologie-Obstétrique CH de Vendée, La Roche-sur-Yon, France
| | - M Robert
- Institut de Cancérologie de l'Ouest, Saint Herblain et Angers, France
| | - T Freour
- Service de Médecine et Biologie du Développement et de la Reproduction, CHU de Nantes, France
| | - M Campone
- Institut de Cancérologie de l'Ouest, Saint Herblain et Angers, France; Université Nantes/Angers, Inserm, CNRS, CRCI2NA, France
| | - A Blanc-Lapierre
- Institut de Cancérologie de l'Ouest, Saint Herblain et Angers, France
| | - V Bordes
- Institut de Cancérologie de l'Ouest, Saint Herblain et Angers, France
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Wallace WH, Kelsey TW, Morrison D, Anderson RA. Live birth and maternity outcome in childhood and adolescent cancer survivors under 18 years at diagnosis: a 40-year population-based cohort study. Br J Cancer 2024:10.1038/s41416-024-02818-0. [PMID: 39266623 DOI: 10.1038/s41416-024-02818-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 07/23/2024] [Accepted: 08/02/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND Survival from childhood and adolescent cancer has increased, but the chance of a livebirth in female survivors under 18 years at diagnosis may be reduced. METHODS We performed a national population-based analysis, including all female cancer survivors diagnosed in Scotland before the age of 18 years between 1981 and 2012. Scottish Cancer Registry records were linked to Scottish maternity records. Females from the exposed group with no pregnancies before cancer diagnosis (n = 2118) were compared with three general population controls matched for age and year of diagnosis. FINDINGS The cumulative incidence of a livebirth for all diagnoses was reduced to 37% (95% CI 33-40%) for cancer survivors at 30 years of age vs 58% (57-60%) for controls. The deficit varying by diagnosis: for lymphoid leukaemia, the cumulative incidence at 30 years was 29% (23-36%) vs 57% (52-61%) for controls with similar deficits in CNS tumours and retinoblastoma. There was a steady improvement in the chance of livebirth in those diagnosed more recently. INTERPRETATION We have shown a reduced chance of livebirth in female survivors of cancer diagnosed before age 18. The deficit is present for all diagnoses.
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Affiliation(s)
- W H Wallace
- Department of Paediatric Haematology and Oncology, Royal Hospital for Children and Young People and University of Edinburgh, Edinburgh, UK.
| | - T W Kelsey
- School of Computer Science, University of St. Andrews, North Haugh, St. Andrews, UK
| | - D Morrison
- Scottish Cancer Registry, Public Health Scotland, 1 South Gyle Crescent, Edinburgh, UK
| | - R A Anderson
- Centre for Reproductive Health, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, UK
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Bahmanpour S, Ameri N, Zareifard N, Karimi F. The Protective Effect of GnRH Agonist Triptorelin on the Histomorphometric Parameters of the Utero-ovarian Tissue in the Doxorubicin- and Cyclophosphamide-treated Mice. Cell Biochem Biophys 2024:10.1007/s12013-024-01487-3. [PMID: 39244688 DOI: 10.1007/s12013-024-01487-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2024] [Indexed: 09/10/2024]
Abstract
One of the common side effects of chemotherapy drugs is ovarian failure and uterine dysfunction, which can occur after the administration of doxorubicin and/or cyclophosphamide. In clinics, gonadotropin-releasing hormone agonists (GnRHa) are used to modulate the toxic effect of chemotherapy and intercept infertility with some controversy and limited histological knowledge. This study aimed to evaluate the serological and histological features of protective effects of triptorelin, (GnRHa), on utero-ovarian tissue in the mice treated with cyclophosphamide and/or doxorubicin. Forty-eight female BALB/c mice were randomly divided into 8 groups as follows: Group I: normal saline; Group II: triptorelin; Group III: cyclophosphamide; Group IV: doxorubicin; Group V: cyclophosphamide + doxorubicin; and Groups VI, VII, and VIII: after injection of cyclophosphamide, doxorubicin, or cyclophosphamide + doxorubicin, administration of triptorelin (1 mg/kg; intraperitoneally) for 15 consecutive days, respectively. On the 21st day, the ovaries and uterine horns were dissected and weighed. Then, tissue processing and staining were performed for further histological and stereological studies. Triptorelin treatment in the damaged groups significantly increased the number of primordial and pre-antral follicles and granulosa cells. It decreased the number of atretic follicles compared to cyclophosphamide and/or doxorubicin-treated groups (P < 0.05). Triptorelin also significantly improved the volume of the ovary, cortex, medulla, oocytes in the primordial and antral follicles, uterus, endometrium, myometrium, uterine glands, and endometrial blood vessels in the damaged groups (P < 0.05). Triptorelin treatment prevents the destructive effects of cyclophosphamide and/or doxorubicin on utero-ovarian tissue.
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Affiliation(s)
- Soghra Bahmanpour
- Anatomy Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Negin Ameri
- Anatomy Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nehleh Zareifard
- Anatomy Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Histomorphometry and Stereology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Karimi
- Anatomy Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Arecco L, Borea R, Magaton IM, Janković K, Mariamizde E, Stana M, Scavone G, Ottonello S, Spinaci S, Genova C, de Azambuja E, Lambertini M. Current practices in oncofertility counseling: updated evidence on fertility preservation and post-treatment pregnancies in young women affected by early breast cancer. Expert Rev Anticancer Ther 2024; 24:803-817. [PMID: 38913581 DOI: 10.1080/14737140.2024.2372337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 06/21/2024] [Indexed: 06/26/2024]
Abstract
INTRODUCTION Anticancer treatments have significantly contributed to increasing cure rates of breast cancer in the last years; however, they can also lead to short- and long-term side effects, including gonadotoxicity, and compromised fertility in young women. Oncofertility is a crucial issue for young patients who have not yet completed their family planning at the time of cancer diagnosis. AREAS COVERED This review aims to cover all the latest available evidence in the field of oncofertility, including the gonadotoxicity of currently adopted anticancer therapies in the curative breast cancer setting, the available strategies for fertility preservation and the feasibility of achieving a pregnancy following anticancer treatment completion. EXPERT OPINION Over the past years, a significant progress has been made in oncofertility care for young women with breast cancer. In the context of the currently available evidence, every young woman with newly diagnosed breast cancer should receive a proper and complete oncofertility counseling before starting any anticancer treatment to increase her chances of future pregnancies.
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Affiliation(s)
- Luca Arecco
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
- Academic Trials Promoting Team, Institut Jules Bordet, Université Libre de Bruxelles (U.L.B.), Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
| | - Roberto Borea
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Isotta Martha Magaton
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
- Division of Gynaecological Endocrinology and Reproductive Medicine, University Women's Hospital, Bern, Switzerland
| | | | - Elene Mariamizde
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Oncology and Hematology, Todua Clinic, Tbilisi, Georgia
| | - Mihaela Stana
- Department of Medical Oncology, Elysee Hospital, Alba Iulia, Romania
| | - Graziana Scavone
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Silvia Ottonello
- Department of Experimental Medicine (DIMES), University of Genova, Genova, Italy
| | - Stefano Spinaci
- ASL3 Breast Unit Department, Division of Breast Surgery, Ospedale Villa Scassi, Genova, Italy
| | - Carlo Genova
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Evandro de Azambuja
- Academic Trials Promoting Team, Institut Jules Bordet, Université Libre de Bruxelles (U.L.B.), Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Massarotti C, Cimadomo D, Spadoni V, Conforti A, Zacà C, Carosso AR, Vaiarelli A, Venturella R, Vitagliano A, Busnelli A, Cozzolino M, Borini A. Female fertility preservation for family planning: a position statement of the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR). J Assist Reprod Genet 2024; 41:2521-2535. [PMID: 39030346 PMCID: PMC11405660 DOI: 10.1007/s10815-024-03197-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 07/03/2024] [Indexed: 07/21/2024] Open
Abstract
PURPOSE This position statement by the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR) aims to establish an optimal framework for fertility preservation outside the standard before oncological therapies. Key topics include the role of fertility units in comprehensive fertility assessment, factors impacting ovarian potential, available preservation methods, and appropriate criteria for offering such interventions. METHODS The SIFES-MR writing group comprises Italian reproductive physicians, embryologists, and scientists. The consensus emerged after a six-month period of meetings, including extensive literature review, dialogue among authors and input from society members. Final approval was granted by the SIFES-MR governing council. RESULTS Fertility counselling transitions from urgent to long-term care, emphasizing family planning. Age, along with ovarian reserve markers, is the primary predictor of female fertility. Various factors, including gynecological conditions, autoimmune disorders, and prior gonadotoxic therapies, may impact ovarian reserve. Oocyte cryopreservation should be the preferred method. Women 30-34 years old and 35-39 years old, without known pathologies impacting the ovarian reserve, should cryopreserve at least 12-13 and 15-20 oocytes to achieve the same chance of a spontaneous live birth they would have if they tried to conceive at the age of cryopreservation (63% and 52%, respectively in the two age groups). CONCLUSIONS Optimal fertility counselling necessitates a long-term approach, that nurtures an understanding of fertility, facilitates timely evaluation of factors that may affect fertility, and explores fertility preservation choices at opportune intervals.
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Affiliation(s)
- Claudia Massarotti
- Physiopathology of Human Reproduction, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi, 10, 16132, Genova, Italy.
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI Department), University of Genova, Genova, Italy.
| | - Danilo Cimadomo
- IVIRMA Global Reseach Alliance, Genera, Clinica Valle Giulia, Rome, Italy
| | | | - Alessandro Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Carlotta Zacà
- IVIRMA Global Research Alliance, 9.Baby, Bologna, Italy
| | - Andrea Roberto Carosso
- Obstetrics and Gynecology 1U, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, Sant'Anna Hospital Città della Salute e della Scienza di Torino, University of Torino, Turin, Italy
| | - Alberto Vaiarelli
- IVIRMA Global Reseach Alliance, Genera, Clinica Valle Giulia, Rome, Italy
| | - Roberta Venturella
- Unit of Obstetrics and Gynecology, University of Catanzaro "Magna Grecia", Catanzaro, Italy
| | - Amerigo Vitagliano
- First Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari, Bari, Italy
| | - Andrea Busnelli
- Department of Obstetrics and Gynecology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Mauro Cozzolino
- IVIRMA Global Research Alliance, IVI Roma, Rome, Italy
- IVIRMA Global Research Alliance, Fundación IVI-IIS la Fe, Valencia, Spain
| | - Andrea Borini
- IVIRMA Global Research Alliance, 9.Baby, Bologna, Italy
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Jimenez-Kurlander L, DeRosa A, Kostrzewa CE, Moskowitz CS, Bogardus K, Antal Z, Wolden S, La Quaglia MP, Basu EM, Cardenas FI, Kramer K, Kushner BH, Cheung NKV, Modak S, Friedman DN. Ovarian function in female survivors of high-risk neuroblastoma. Pediatr Blood Cancer 2024; 71:e31181. [PMID: 38967225 PMCID: PMC11269001 DOI: 10.1002/pbc.31181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 06/14/2024] [Accepted: 06/19/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Data on ovarian function in neuroblastoma survivors are limited. We sought to determine the prevalence of ovarian dysfunction in a cohort of high-risk neuroblastoma survivors and compare outcomes among survivors treated with and without autologous stem cell rescue (ASCR) preceded by myeloablative chemotherapy. METHODS Retrospective review of female survivors of high-risk neuroblastoma ≥5 years from diagnosis, diagnosed between 1982 and 2014, and followed in a tertiary cancer center. Participants were divided into two groups: individuals treated with conventional chemotherapy ± radiation ("non-ASCR") (n = 32) or with chemotherapy ± radiation followed by myeloablative chemotherapy with ASCR ("ASCR") (n = 51). Ovarian dysfunction was defined as follicle-stimulating hormone ≥15 mU/mL, while premature ovarian insufficiency (POI) was defined as persistent ovarian dysfunction requiring hormone replacement therapy. Poisson models were used to determine prevalence ratios of ovarian dysfunction and POI. RESULTS Among 83 females (median attained age: 19 years [range, 10-36]; median follow-up: 15 years [range, 7-36]), 49 (59%) had ovarian dysfunction, and 34 (41%) developed POI. Survivors treated with ASCR were 3.2-fold more likely to develop ovarian dysfunction (95% CI: 1.8-6.0; p < 0.001) and 4.5-fold more likely to develop POI (95% CI: 1.7-11.7; p = 0.002) when compared with those treated with conventional chemotherapy, after adjusting for attained age. Two participants in the non-ASCR group and six in the ASCR group achieved at least one spontaneous pregnancy. DISCUSSION Ovarian dysfunction is prevalent in female high-risk neuroblastoma survivors, especially after ASCR. Longitudinal follow-up of larger cohorts is needed to inform counseling about the risk of impaired ovarian function after neuroblastoma therapy.
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Affiliation(s)
| | - Amelia DeRosa
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Caroline E. Kostrzewa
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chaya S. Moskowitz
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kimberly Bogardus
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Zoltan Antal
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Suzanne Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering, New York, NY, USA
| | | | - Ellen M. Basu
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Kim Kramer
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brian H. Kushner
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Nai-Kong V. Cheung
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Shakeel Modak
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Danielle Novetsky Friedman
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
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Morice P, Scambia G, Abu-Rustum NR, Acien M, Arena A, Brucker S, Cheong Y, Collinet P, Fanfani F, Filippi F, Eriksson AGZ, Gouy S, Harter P, Matias-Guiu X, Pados G, Pakiz M, Querleu D, Rodolakis A, Rousset-Jablonski C, Stepanyan A, Testa AC, Macklon KT, Tsolakidis D, De Vos M, Planchamp F, Grynberg M. Fertility-sparing treatment and follow-up in patients with cervical cancer, ovarian cancer, and borderline ovarian tumours: guidelines from ESGO, ESHRE, and ESGE. Lancet Oncol 2024:S1470-2045(24)00262-6. [PMID: 39216500 DOI: 10.1016/s1470-2045(24)00262-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/19/2024] [Accepted: 05/01/2024] [Indexed: 09/04/2024]
Abstract
The European Society of Gynaecological Oncology, the European Society of Human Reproduction and Embryology, and the European Society for Gynaecological Endoscopy jointly developed clinically relevant and evidence-based guidelines focusing on key aspects of fertility-sparing strategies and follow-up of patients with cervical cancers, ovarian cancers, and borderline ovarian tumours. The developmental process of these guidelines is based on a systematic literature review and critical appraisal involving an international multidisciplinary development group consisting of 25 experts from relevant disciplines (ie, gynaecological oncology, oncofertility, reproductive surgery, endoscopy, imaging, conservative surgery, medical oncology, and histopathology). Before publication, the guidelines were reviewed by 121 independent international practitioners in cancer care delivery and patient representatives. The guidelines comprehensively cover oncological aspects of fertility-sparing strategies during the initial management, optimisation of fertility results and infertility management, and the patient's desire for future pregnancy and beyond.
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Affiliation(s)
- Philippe Morice
- Department of Gynecological Surgery, Gustave Roussy Cancer Campus, Villejuif, France; Université Paris Saclay, Paris, France.
| | - Giovanni Scambia
- Department of Women, Children, and Public Health Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Nadeem R Abu-Rustum
- Gynecologic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maribel Acien
- Institute of Women's Health, University College London, London, UK; Grant Next Generation Department of Gynecology, Miguel Hernandez University, Alicante, Spain
| | - Alessandro Arena
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS, Azienda Ospedaliero-Univeristaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Sara Brucker
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany; Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Ying Cheong
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Pierre Collinet
- Unité de Chirurgie Gynécologique, Hôpital Privé le Bois, Groupe Ramsay Lille Metropole, Lille, France
| | - Francesco Fanfani
- Department of Women, Children, and Public Health Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Francesca Filippi
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ane Gerda Zahl Eriksson
- Department of Gynecologic Oncology, Division of Cancer Medicine, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Sebastien Gouy
- Department of Gynecological Surgery, Gustave Roussy Cancer Campus, Villejuif, France; Université Paris Saclay, Paris, France
| | - Philipp Harter
- Department of Gynaecology and Gynaecologic Oncology, Kliniken Essen Mitte, Essen, Germany
| | - Xavier Matias-Guiu
- Department of Pathology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - George Pados
- Department of Obstetrics and Gynaecology, Papageorgiou General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maja Pakiz
- Department for Gynaecologic and Breast Oncology, University Medical Center Maribor, Maribor, Slovenia
| | - Denis Querleu
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Alexandros Rodolakis
- Unit of Gynaecologic Oncology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christine Rousset-Jablonski
- Department of Surgery, Centre Léon Bérard, Lyon, France; Obstetrics and Gynecology, Hôpital Femme Mère Enfant, Bron, France
| | - Artem Stepanyan
- Gynecologic Oncology Service, Nairi Medical Center, Yerevan, Armenia
| | - Antonia Carla Testa
- Department of Women, Children, and Public Health Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Kirsten Tryde Macklon
- Fertility Clinic, Department of Gynecology, Fertility and Obstetrics Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Dimitrios Tsolakidis
- Department of Obstetrics and Gynaecology, Papageorgiou General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michel De Vos
- Centre for Reproductive Medicine, University Hospital Brussels, Brussels, Belgium; Follicle Biology Laboratory, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Michaël Grynberg
- Université Paris Saclay, Paris, France; Department of Reproductive Medicine and Fertility Preservation, Hopital Antoine Béclère, Clamart, France; Department of Reproductive Medicine and Fertility Preservation, Hopital Jean Verdier, Bondy, France
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8
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Poirel HA, Schittecatte G, Van Aelst F. Policy brief of the Belgian Europe's Beating Cancer Plan mirror group: children, adolescents and young adults with cancer. Arch Public Health 2024; 82:140. [PMID: 39192310 DOI: 10.1186/s13690-024-01366-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 08/12/2024] [Indexed: 08/29/2024] Open
Abstract
Children and Adolescents and Young Adults with cancer represent a young population with specific needs, which need to be addressed in a patient- and cancer-driven way. There is an urgent need to support and extend the ongoing initiatives in Belgium. First, multidisciplinary care programmes dedicated to children need to be reviewed, and those for Adolescents and Young Adults need to be developed with close collaboration between paediatric and adult oncology and haematology teams. This needs to be done considering the entire patient journey; from cancer prevention, diagnosis, treatment, rehabilitation, follow-up of late effects, transition pathways between paediatric and adult wards, and palliative care. Second, national haemato/oncology precision programmes adapted to this young population with rare cancers, including infrastructure to manage cancer gene predisposition in CAYAs with cancers and their relatives, needs to be developed. This multi-level plan aims to ensure improved outcome with high quality of care for the young population with cancer in Belgium in line with Europe's Beating Cancer Plan initiatives.
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Loggers ET, Chugh R, Federman N, Hartner L, Riedel RF, Cho S, Hyslop D, Lim A, Oton AB, Oktay KH. Onset and resolution of ovarian toxicity with nirogacestat treatment in females with desmoid tumors: Updated safety analyses from the DeFi phase 3 study. Cancer 2024; 130:2812-2821. [PMID: 38703010 DOI: 10.1002/cncr.35324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION Nirogacestat is a targeted gamma secretase inhibitor approved in the United States for adults with progressing desmoid tumors. In the phase 3 DeFi study (NCT03785964) of nirogacestat, ovarian toxicity (OT) was identified as a safety signal among females of reproductive potential (FORP). This analysis further describes the incidence, presentation, and resolution of OT. METHODS Patients were randomized to twice-daily oral nirogacestat (150 mg) or placebo, taken in continuous 28-day cycles. Investigator-identified OT in FORP was based on abnormal reproductive hormone values or perimenopausal symptoms (or both). Adverse event follow-up was conducted to assess OT resolution. Post hoc analyses included return of menstruation and return of follicle-stimulating hormone (FSH) to within normal limits (WNL) (≤20.4 mIU/mL). RESULTS Of 92 randomized females, 73 in the safety population were FORP (n = 36 nirogacestat, n = 37 placebo). OT was identified in 75% (27 of 36) receiving nirogacestat and 0% (0 of 37) receiving placebo. As of October 24, 2022, investigators reported OT resolution in 78% (21 of 27) of patients, with median OT duration of 19.1 weeks. Off-treatment resolution was reported in all 11 patients (100%) who stopped nirogacestat treatment; of these, all nine with available menstruation information experienced return of menstruation and eight had FSH WNL at last reported assessment. Resolution was reported in 10 of 14 (71%) while on nirogacestat; of these, all 10 experienced return of menstruation and seven had FSH WNL. Two patients were lost to follow-up. CONCLUSION Most FORP treated with nirogacestat experienced OT, with the majority resolving, including all who stopped treatment, suggesting that OT is transient.
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Affiliation(s)
- Elizabeth T Loggers
- Clinical Research Division, Fred Hutchinson Cancer Center/Division of Hematology and Oncology, University of Washington, Seattle, Washington, USA
| | - Rashmi Chugh
- University of Michigan, Rogel Comprehensive Cancer Center, Ann Arbor, Michigan, USA
| | - Noah Federman
- Departments of Pediatrics and Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Lee Hartner
- University of Pennsylvania, Abramson Cancer Center, Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
| | - Richard F Riedel
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Sunny Cho
- SpringWorks Therapeutics, Inc, Stamford, Connecticut, USA
| | - David Hyslop
- SpringWorks Therapeutics, Inc, Stamford, Connecticut, USA
| | - Allison Lim
- SpringWorks Therapeutics, Inc, Stamford, Connecticut, USA
| | - Ana B Oton
- SpringWorks Therapeutics, Inc, Stamford, Connecticut, USA
| | - Kutluk H Oktay
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA
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10
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Azim HA, Niman SM, Partridge AH, Demeestere I, Ruggeri M, Colleoni M, Saura C, Shimizu C, Saetersdal AB, Kroep JR, Mailliez A, Warner E, Borges VF, Amant F, Gombos A, Kataoka A, Rousset-Jablonski C, Borstnar S, Takei J, Lee JE, Walshe JM, Ruíz-Borrego M, Moore HCF, Saunders C, Bjelic-Radisic V, Susnjar S, Cardoso F, Klar NJ, Spanic T, Ruddy K, Piccart M, Korde LA, Goldhirsch A, Gelber RD, Pagani O, Peccatori FA. Fertility Preservation and Assisted Reproduction in Patients With Breast Cancer Interrupting Adjuvant Endocrine Therapy to Attempt Pregnancy. J Clin Oncol 2024; 42:2822-2832. [PMID: 38810178 DOI: 10.1200/jco.23.02292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/19/2024] [Accepted: 03/12/2024] [Indexed: 05/31/2024] Open
Abstract
PURPOSE We investigated time to pregnancy, efficacy and safety of fertility preservation, and assisted reproductive technologies (ARTs) in women with early hormone receptor-positive breast cancer (BC) desiring future pregnancy. PATIENTS AND METHODS POSITIVE is an international, single-arm, prospective trial, in which 518 women temporarily interrupted adjuvant endocrine therapy to attempt pregnancy. We evaluated menstruation recovery and factors associated with time to pregnancy and investigated if ART use was associated with achieving pregnancy. The cumulative incidence of BC-free interval (BCFI) events was estimated according to the use of ovarian stimulation at diagnosis. The median follow-up was 41 months. RESULTS Two hundred seventy-three patients (53%) reported amenorrhea at enrollment, of whom 94% resumed menses within 12 months. Among 497 patients evaluable for pregnancy, 368 (74%) reported at least one pregnancy. Young age was the main factor associated with shorter time to pregnancy with cumulative incidences of pregnancy by 1 year of 63.5%, 54.3%, and 37.7% for patients age <35, 35-39, and 40-42 years, respectively. One hundred and seventy-nine patients (36%) had embryo/oocyte cryopreservation at diagnosis, of whom 68 reported embryo transfer after enrollment. Cryopreserved embryo transfer was the only ART associated with higher chance of pregnancy (odds ratio, 2.41 [95% CI, 1.75 to 4.95]). The cumulative incidence of BCFI events at 3 years was similar for women who underwent ovarian stimulation for cryopreservation at diagnosis, 9.7% (95% CI, 6.0 to 15.4), compared with those who did not, 8.7% (95% CI, 6.0 to 12.5). CONCLUSION In POSITIVE, fertility preservation using ovarian stimulation was not associated with short-term detrimental impact on cancer prognosis. Pregnancy rates were highest among those who underwent embryo/oocyte cryopreservation followed by embryo transfer.
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Affiliation(s)
- Hatem A Azim
- Cairo Cure Oncology Center, Cairo, Egypt
- Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Samuel M Niman
- International Breast Cancer Study Group Statistical Center, Boston, MA
- Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute, Boston, MA
| | - Ann H Partridge
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - Isabelle Demeestere
- Research Laboratory on Human Reproduction, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Gynecology and Obstetrics Department, Fertility Clinic, HUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Monica Ruggeri
- Program for Young Patients, International Breast Cancer Study Group, A Division of ETOP IBCSG Partners Foundation, Bern, Switzerland
| | - Marco Colleoni
- Division of Medical Senology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Cristina Saura
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
- SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - Chikako Shimizu
- Department of Breast and Medical Oncology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Anna B Saetersdal
- Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Judith R Kroep
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
- Dutch Breast Cancer Research Group (BOOG), Amsterdam, the Netherlands
| | - Audrey Mailliez
- Breast Cancer Unit, Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | - Ellen Warner
- Odette Cancer Center, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Canadian Clinical Trials Group (CCTG), Toronto, ON, Canada
| | - Virginia F Borges
- Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora, CO
| | - Frédéric Amant
- Department of Oncology, KU Leuven and Leuven Cancer Institute, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
- Antoni van Leeuwenhoek-Netherlands Gynecologic Oncology Cancer Institute, Amsterdam, the Netherlands
| | - Andrea Gombos
- Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium
| | - Akemi Kataoka
- Breast Oncology Cancer, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | - Simona Borstnar
- Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Junko Takei
- St Luke's International Hospital, Breast Center, Tokyo, Japan
| | - Jeong Eon Lee
- Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Clinical Research and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Janice M Walshe
- Cancer Trials Ireland, Dublin, Ireland
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
- Tallaght University Hospital, Dublin, Ireland
| | - Manuel Ruíz-Borrego
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
- Hospital Virgen del Rocio Sevilla, Sevilla, Spain
| | - Halle C F Moore
- Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Christobel Saunders
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
- Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Vesna Bjelic-Radisic
- Breast Unit, Helios University Hospital Wuppertal, University Witten/Herdecke, Wuppertal, Germany
- Medical University Graz, Department Gynaecology, Graz, Austria
- Austrian Breast and Colorectal Study Group (ABCSG), Vienna, Austria
| | - Snezana Susnjar
- Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Natalie J Klar
- New York University Langone's Perlmutter Cancer Center, Breast Cancer Center, New York, NY
| | | | | | - Martine Piccart
- Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium
| | - Larissa A Korde
- Breast and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD
| | - Aron Goldhirsch
- International Breast Cancer Study Group, Division of ETOP IBCSG Partners Foundation, Bern, Switzerland
- IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Richard D Gelber
- International Breast Cancer Study Group Statistical Center, Boston, MA
- Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
- Frontier Science Foundation, Boston, MA
- Harvard TH Chan School of Public Health, Boston, MA
| | - Olivia Pagani
- Geneva University Hospitals, Geneva, Switzerland
- Lugano University, Lugano, Switzerland
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - Fedro A Peccatori
- Fertility and Procreation Unit, Gynecologic Oncology Program, IEO, European Institute of Oncology IRCCS, Milan, Italy
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11
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Robalo Cordeiro M, Roque R, Laranjeiro B, Carvalhos C, Figueiredo-Dias M. Menstrual Blood Stem Cells-Derived Exosomes as Promising Therapeutic Tools in Premature Ovarian Insufficiency Induced by Gonadotoxic Systemic Anticancer Treatment. Int J Mol Sci 2024; 25:8468. [PMID: 39126037 PMCID: PMC11312895 DOI: 10.3390/ijms25158468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 07/29/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024] Open
Abstract
Gonadotoxicity resulting from systemic and locoregional cancer treatments significantly threatens women's reproductive health, often culminating in premature ovarian insufficiency. These therapies, particularly alkylating agents and ionizing radiation, induce DNA damage and apoptosis in ovarian follicles, leading to infertility, amenorrhea, and estrogen deficiency, which exacerbate risks of osteoporosis and cardiovascular diseases. Existing fertility preservation methods do not prevent immediate ovarian damage, underscoring the need for innovative protective strategies. Menstrual blood-derived stem cells (MenSC) and their extracellular vesicles (EV) present promising regenerative potential due to their therapeutic cargo delivery and pathway modulation capabilities. Preclinical studies demonstrate that MenSC-derived EV ameliorate premature ovarian insufficiency by inhibiting granulosa cell apoptosis, promoting angiogenesis, and activating pivotal pathways such as SMAD3/AKT/MDM2/P53. However, comprehensive research is imperative to ensure the safety, efficacy, and long-term effects of MenSC-derived EV in clinical practice. In this review, we update the current knowledge and research regarding the use of MenSC-derived EV as a novel therapeutic weapon for ovarian regeneration in the context of gonadotoxicity induced by systemic anticancer treatment.
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Affiliation(s)
- Mariana Robalo Cordeiro
- Faculty of Medicine, Gynecology University Clinic, University of Coimbra, 3000-548 Coimbra, Portugal; (B.L.); (C.C.); (M.F.-D.)
| | - Ricardo Roque
- Portuguese Institute of Oncology of Coimbra, Medical Oncology Department, 3000-075 Coimbra, Portugal;
| | - Bárbara Laranjeiro
- Faculty of Medicine, Gynecology University Clinic, University of Coimbra, 3000-548 Coimbra, Portugal; (B.L.); (C.C.); (M.F.-D.)
| | - Carlota Carvalhos
- Faculty of Medicine, Gynecology University Clinic, University of Coimbra, 3000-548 Coimbra, Portugal; (B.L.); (C.C.); (M.F.-D.)
| | - Margarida Figueiredo-Dias
- Faculty of Medicine, Gynecology University Clinic, University of Coimbra, 3000-548 Coimbra, Portugal; (B.L.); (C.C.); (M.F.-D.)
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12
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Cardoso F, Paluch-Shimon S, Schumacher-Wulf E, Matos L, Gelmon K, Aapro MS, Bajpai J, Barrios CH, Bergh J, Bergsten-Nordström E, Biganzoli L, Cardoso MJ, Carey LA, Chavez-MacGregor M, Chidebe R, Cortés J, Curigliano G, Dent RA, El Saghir NS, Eniu A, Fallowfield L, Francis PA, Franco Millan SX, Gilchrist J, Gligorov J, Gradishar WJ, Haidinger R, Harbeck N, Hu X, Kaur R, Kiely B, Kim SB, Koppikar S, Kuper-Hommel MJJ, Lecouvet FE, Mason G, Mertz SA, Mueller V, Myerson C, Neciosup S, Offersen BV, Ohno S, Pagani O, Partridge AH, Penault-Llorca F, Prat A, Rugo HS, Senkus E, Sledge GW, Swain SM, Thomssen C, Vorobiof DA, Vuylsteke P, Wiseman T, Xu B, Costa A, Norton L, Winer EP. 6th and 7th International consensus guidelines for the management of advanced breast cancer (ABC guidelines 6 and 7). Breast 2024; 76:103756. [PMID: 38896983 PMCID: PMC11231614 DOI: 10.1016/j.breast.2024.103756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
This manuscript describes the Advanced Breast Cancer (ABC) international consensus guidelines updated at the last two ABC international consensus conferences (ABC 6 in 2021, virtual, and ABC 7 in 2023, in Lisbon, Portugal), organized by the ABC Global Alliance. It provides the main recommendations on how to best manage patients with advanced breast cancer (inoperable locally advanced or metastatic), of all breast cancer subtypes, as well as palliative and supportive care. These guidelines are based on available evidence or on expert opinion when a higher level of evidence is lacking. Each guideline is accompanied by the level of evidence (LoE), grade of recommendation (GoR) and percentage of consensus reached at the consensus conferences. Updated diagnostic and treatment algorithms are also provided. The guidelines represent the best management options for patients living with ABC globally, assuming accessibility to all available therapies. Their adaptation (i.e. resource-stratified guidelines) is often needed in settings where access to care is limited.
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Affiliation(s)
- Fatima Cardoso
- Breast Unit, Champalimaud Clinical Centre/Champalimaud Foundation, and ABC Global Alliance, Lisbon, Portugal.
| | - Shani Paluch-Shimon
- Hadassah University Hospital - Sharett Institute of Oncology, Jerusalem, Israel
| | | | - Leonor Matos
- Breast Unit, Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal
| | - Karen Gelmon
- BC Cancer Agency, Department of Medical Oncology, Vancouver, Canada
| | - Matti S Aapro
- Cancer Center, Clinique de Genolier, Genolier, Switzerland
| | | | - Carlos H Barrios
- Latin American Cooperative Oncology Group (LACOG), Grupo Oncoclínicas, Porto Alegre, Brazil
| | - Jonas Bergh
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | | | - Laura Biganzoli
- Department of Oncology, Hospital of Prato - Azienda USL Toscana Centro Prato, Italy and European Society of Breast Cancer Specialists (EUSOMA), Italy
| | - Maria João Cardoso
- Breast Unit, Champalimaud Clinical Centre/Champalimaud Foundation and Lisbon University, Faculty of Medicine, Lisbon, Portugal
| | - Lisa A Carey
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, USA
| | - Mariana Chavez-MacGregor
- Health Services Research, Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, USA and American Society of Clinical Oncology (ASCO), Houston, USA
| | | | - Javier Cortés
- International Breast Cancer Center (IBCC), Madrid and Barcelona, Spain
| | - Giuseppe Curigliano
- European Institute of Oncology, IRCCS, Milano, Italy; Department of Oncology and Hemato-Oncology, University of Milano, Milano, Italy
| | | | - Nagi S El Saghir
- NK Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Alexandru Eniu
- Hôpital Riviera-Chablais, Vaud-Valais Rennaz, Switzerland and European School of Oncology (ESO), United Kingdom
| | - Lesley Fallowfield
- Brighton & Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Prudence A Francis
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
| | | | | | - Joseph Gligorov
- Department of Medical Oncology, Cancer Est APHP Tenon, University Paris VI, Nice/St Paul Guidelines, Paris, France
| | - William J Gradishar
- Northwestern Medicine, Illinois, USA and National Comprehensive Cancer Network (NCCN), USA
| | | | - Nadia Harbeck
- Breast Centre, University of Munich, Munich and Arbeitsgemeinschaft Gynäkologische Onkologie, Kommission Mamma (AGO Guidelines), Germany
| | - Xichun Hu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ranjit Kaur
- Breast Cancer Welfare Association, Petaling Jaya, Malaysia
| | - Belinda Kiely
- NHMRC Clinical Trials Centre, Sydney Medical School, Sydney, Australia
| | - Sung-Bae Kim
- Asan Medical Centre, Department of Oncology, Seoul, South Korea
| | - Smruti Koppikar
- Lilavati Hospital and Research Centre, Bombay Hospital Institute of Medical Sciences, Asian Cancer Institute, Mumbai, India
| | - Marion J J Kuper-Hommel
- Te Whatu Ora Waikato, Midland Regional Cancer Centre, NZ ABC Guidelines, Hamilton, New Zealand
| | - Frédéric E Lecouvet
- Department of Radiology, Institut Roi Albert II and Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Ginny Mason
- Inflammatory Breast Cancer Research Foundation, West Lafayette, USA
| | - Shirley A Mertz
- MBC US Alliance and Metastatic Breast Cancer Network US, Inverness, USA
| | - Volkmar Mueller
- University Medical Center Hamburg-Eppendorf, Hamburg and Arbeitsgemeinschaft Gynäkologische Onkologie, Kommission Mamma (AGO Guidelines), Germany
| | | | - Silvia Neciosup
- Department of Medical Oncology, National Institute of Neoplastic Diseases, Lima, ABC Latin America Guidelines, Peru
| | - Birgitte V Offersen
- Department of Oncology, Aarhus University Hospital, Aarhus, European Society for Radiotherapy and Oncology (ESTRO), Denmark
| | - Shinji Ohno
- Breast Oncology Centre, Cancer Institute Hospital, Tokyo, Japan
| | - Olivia Pagani
- Hôpital Riviera-Chablais, Vaud-Valais Rennaz, Switzerland
| | - Ann H Partridge
- Dana-Farber Cancer Institute, Department of Medical Oncology and Division of Breast Oncology, Boston, USA and American Society of Clinical Oncology (ASCO), USA
| | - Frédérique Penault-Llorca
- Centre Jean Perrin, Université Clermont Auvergne, INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, F-63000, Clermont Ferrand, Nice/St Paul Guidelines, France
| | - Aleix Prat
- Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Hope S Rugo
- Breast Oncology and Clinical Trials Education, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, USA
| | - Elzbieta Senkus
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - George W Sledge
- Division of Oncology, Stanford School of Medicine, Stanford, USA
| | - Sandra M Swain
- Georgetown University Lombardi Comprehensive Cancer Center and MedStar Health, Washington DC, USA
| | - Christoph Thomssen
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle (Saale) and Arbeitsgemeinschaft Gynäkologische Onkologie, Kommission Mamma (AGO Guidelines), Germany
| | | | - Peter Vuylsteke
- University of Botswana, Gaborone, Botswana and CHU UCL Namur Hospital, UCLouvain, Belgium
| | - Theresa Wiseman
- The Royal Marsden NHS Foundation Trust, University of Southampton, United Kingdom and European Oncology Nursing Society (EONS), United Kingdom
| | - Binghe Xu
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Alberto Costa
- European School of Oncology, Milan, Italy and Bellinzona, Switzerland
| | - Larry Norton
- Breast Cancer Programs, Memorial Sloan-Kettering Cancer Centre, New York, USA
| | - Eric P Winer
- Yale Cancer Center, Yale University School of Medicine, New Haven, CT, USA
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13
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Kim M, Ha J. [Factors Influencing Oncofertility in Gynecological Cancer Patients: Application of Mixed Methods Study]. J Korean Acad Nurs 2024; 54:418-431. [PMID: 39248426 DOI: 10.4040/jkan.23151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 05/01/2024] [Accepted: 05/31/2024] [Indexed: 09/10/2024]
Abstract
PURPOSE This study aimed to identify factors influencing oncofertility and to explore the oncofertility experiences of patients with gynecological cancer using quantitative and qualitative methods, respectively. METHODS An explanatory sequential mixed-methods study was conducted. The quantitative study involved 222 patients with gynecological cancer recruited from online cafes and hospitals. Data were analyzed using IBM SPSS Statistics 28. For qualitative research, eight patients with gynecological cancer were interviewed. Data were analyzed using theme analysis method. RESULTS Oncofertility performance was quantitatively assessed in 40 patients (18.0%). Factors that significantly affected oncofertility were fertility preservation awareness (odds ratio [OR] = 14.97, 95% confidence interval [CI]: 4.22~53.08), number of children planned before cancer diagnosis (OR = 6.08, 95% CI: 1.89~19.62; OR = 5.04, 95% CI: 1.56~16.29), monthly income (OR= 3.29, 95% CI: 1.23~8.86), social support (OR = 1.08, 95% CI: 1.01~1.17), and anxiety (OR = 0.79, 95% CI: 0.66~0.95). Qualitative results showed three theme clusters and eight themes: (1) themes for determinant factors affecting oncofertility selection: 'desire to have children' and 'special meaning of the uterus and ovaries;' (2) themes for obstructive factors affecting oncofertility selection: 'fertility preservation fall behind priorities,' 'confusion caused by inaccurate information,' and 'my choice was not supported;' (3) themes for support factors affecting oncofertility selection: 'provide accurate and reasonable information about oncofertility,' 'addressing the healthcare gap,' and 'need financial support for oncofertility.' CONCLUSION Financial support, sufficient information, social support, and anxiety-relief interventions are required for oncofertility in patients with gynecological cancer.
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Affiliation(s)
- Minji Kim
- College of Nursing, Pusan National University, Yangsan, Korea
- Department of Nursing, Pusan National University Hospital, Busan, Korea
| | - Juyoung Ha
- College of Nursing, Pusan National University, Yangsan, Korea.
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14
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Kissel M, Terlizzi M, Giraud N, Alexis A, Cheve M, Vautier J, Bossi A, Morice P, Blanchard P. Prostate radiotherapy may cause fertility issues: a retrospective analysis of testicular dose following modern radiotherapy techniques. Radiat Oncol 2024; 19:101. [PMID: 39090684 PMCID: PMC11293176 DOI: 10.1186/s13014-024-02498-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 07/26/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Prostate cancer in younger men is rare but not exceptional. Radiotherapy is a cornerstone of prostate cancer treatment and yet, its impact on fertility is scarcely reported in literature. Given the radiosensitivity of testicular tissue, this study aimed to determine the testicular dose using modern radiotherapy techniques for definitive prostate irradiation. METHODS One hundred radiotherapy plans were reviewed. Testicles were contoured retrospectively without dosimetric optimization on testicles. RESULTS The median testicular dose was 0.58 Gy: 0.18 Gy in stereotactic plans, 0.62 Gy in Volumetric Modulated Arc Therapy plans and 1.50 Gy in Tomotherapy plans (p < 0.001). Pelvic nodal irradiation increased the median testicular dose to 1.18 Gy versus 0.26 Gy without nodal irradiation (p < 0.001). Weight and BMI were inversely associated with testicular dose (p < 0.005). 65% of patients reached the theoretical dose threshold for transient azoospermia, and 10% received more than 2 Gy, likely causing definitive azoospermia. CONCLUSION Despite being probably lower than doses from older techniques, the testicular dose delivered with modern prostate radiotherapy is not negligible and is often underestimated because the contribution of daily repositioning imaging is not taken into account and most Treatment Planning Systems underestimate the out of field dose. Radiation oncologists should consider the impact on fertility and gonadal endocrine function, counseling men on sperm preservation if they wish to maintain fertility. TRIAL REGISTRATION retrospectively registered.
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Affiliation(s)
- M Kissel
- Radiotherapy Department, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France.
- Radiation Therapy Department, Institut Curie, 26 rue d'Ulm, 75005, Paris, France.
| | - M Terlizzi
- Radiotherapy Department, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France
| | - N Giraud
- Radiotherapy Department, CHU Bordeaux, Avenue de Magellan, 33604, Pessac, France
| | - A Alexis
- Radiophysics Department, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France
| | - M Cheve
- Radiophysics Department, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France
| | - J Vautier
- Radiophysics Department, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France
| | - A Bossi
- Radiotherapy Department, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France
| | - P Morice
- Gynecologic Surgery Department, Gustave Roussy, Villejuif, France
| | - P Blanchard
- Radiotherapy Department, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France
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15
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Fernández-González MJ, Radauer-Plank AC, Borgmann-Staudt A, Geiger W, Goranova I, Klco-Brosius S, Ralla B, Stelzer C, Wilkemeyer I, Balcerek M. An Assessment of Cryopreserved Semen and Testicular Tissue Collected Before and After Cancer Treatment Initiation. Cancer Manag Res 2024; 16:871-882. [PMID: 39077055 PMCID: PMC11284135 DOI: 10.2147/cmar.s460960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 06/04/2024] [Indexed: 07/31/2024] Open
Abstract
Purpose This retrospective cohort study assessed semen and testicular tissue quality from adult and adolescent cancer patients who had samples cryopreserved in the Cryobank of Charité-Universitätsmedizin before and/or after cancer treatment. Methods and Materials Medical and cryopreservation data for all samples stored between 03/2004 and 05/2019 were collected retrospectively. Results We included information on 601 samples cryopreserved from 506 cancer patients for whom oncologic treatment data were available. The majority of the samples were cryopreserved prior to cancer treatment (460/600, 77%, median 5 days before treatment). Semen quality had a predisposed reduction in those collected from adolescents with testicular and/or hematological malignancies. Analyses of the 140 (23%) samples cryopreserved after treatment initiation (median of 84 days) revealed decreased median concentration and motility following high gonadotoxic-risk treatment. Rate of oligoasthenozoospermia was comparable in samples collected prior to treatment with those provided during follow-up spermiograms within 1 year after treatment initiation (45.5% vs 45.5%). However, an increase was seen in samples collected 1-2 (9.1% to 90.9%) and 2-3 (50.0% to 100.0%) years after treatment initiation. Conclusion Cancer diagnosis and treatment may impair spermatogenesis; therefore, patient counseling prior to cancer treatment by an oncologist and/or fertility specialist is crucial.
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Affiliation(s)
- Marta Julia Fernández-González
- Charité-Universitätsmedizin Berlin, Cooperation member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Pediatric Oncology and Hematology, Berlin, Germany
| | - Anne-Catherine Radauer-Plank
- Charité-Universitätsmedizin Berlin, Cooperation member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Pediatric Oncology and Hematology, Berlin, Germany
| | - Anja Borgmann-Staudt
- Charité-Universitätsmedizin Berlin, Cooperation member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Pediatric Oncology and Hematology, Berlin, Germany
| | - Waldemar Geiger
- Charité-Universitätsmedizin Berlin, Cooperate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Clinic for Urology, Berlin, Germany
| | - Irena Goranova
- Charité-Universitätsmedizin Berlin, Cooperate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Clinic for Urology, Berlin, Germany
| | - Stephanie Klco-Brosius
- Charité-Universitätsmedizin Berlin, Cooperation member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Pediatric Oncology and Hematology, Berlin, Germany
| | - Bernhard Ralla
- Charité-Universitätsmedizin Berlin, Cooperate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Clinic for Urology, Berlin, Germany
| | - Cornelia Stelzer
- Charité-Universitätsmedizin Berlin, Cooperate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Clinic for Urology, Berlin, Germany
| | - Ina Wilkemeyer
- Charité-Universitätsmedizin Berlin, Cooperate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Clinic for Urology, Berlin, Germany
| | - Magdalena Balcerek
- Charité-Universitätsmedizin Berlin, Cooperation member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Pediatric Oncology and Hematology, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
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16
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Steinmann M, Rietschin A, Pagano F, Karrer T, Kollár A, Weidlinger S, von Wolff M. Systematic Review of the Gonadotoxicity and Risk of Infertility of Soft Tissue Sarcoma Chemotherapies in Pre- and Postpubertal Females and Males. J Adolesc Young Adult Oncol 2024. [PMID: 38995852 DOI: 10.1089/jayao.2024.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024] Open
Abstract
Increasing awareness of gonadotoxicity in cancer treatments and infertility risk is essential for counseling young cancer patients. While fertility preservation options are available in many countries, limited data on gonadotoxicity hinder recommendations, especially for soft tissue cancers. This review, part of the FertiTOX project (www.fertitox.com), organized by FertiPROTEKT (www.fertiprotekt.com), aims to address this knowledge gap to improve fertility preservation guidance. We performed a systematic literature search on gonadotoxicity in soft tissue sarcoma (STS) cancer treatments. Only patients without metastases or recurrent disease were considered. "Suspected infertility" was defined based on low ovarian reserve parameters, low inhibin B levels, high gonadotropin concentration, gonadal dysfunction, amenorrhea, oligomenorrhea, azoospermia, or oligozoospermia due to limited infertility data. The study quality was assessed using the Newcastle-Ottawa Scale. The search yielded 3309 abstracts, with 138 undergoing full-text analysis. Eight studies on STS were included. Suspected infertility was observed in 20 of 28 females (71.4%, range 0-100%) and 38 of 63 males (60.3%, range 34.8-100%) with STS. Six of the eight studies received high-quality scores on the NOS, while two received a fair score. Our data suggest a high risk of infertility from chemotherapy in pre- and postpubertal STS survivors. This underscores the importance of considering fertility preservation measures when counseling these patients.
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Affiliation(s)
- Marcel Steinmann
- Division of Gynecological Endocrinology and Reproductive Medicine, Wome's Hospital, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Anita Rietschin
- Division of Gynecological Endocrinology and Reproductive Medicine, University Womeńs Hospital, Inselspital Bern, University of Bern, Bern, Switzerland
| | - Flavia Pagano
- Division of Gynecological Endocrinology and Reproductive Medicine, University Womeńs Hospital, Inselspital Bern, University of Bern, Bern, Switzerland
| | - Tanya Karrer
- Medical Library, University Library Bern, University of Bern, Bern, Switzerland
| | - Attila Kollár
- Department of Medical Oncology, Inselspital Bern, University of Bern, Bern, Switzerland
| | - Susanna Weidlinger
- Division of Gynecological Endocrinology and Reproductive Medicine, University Womeńs Hospital, Inselspital Bern, University of Bern, Bern, Switzerland
| | - Michael von Wolff
- Division of Gynecological Endocrinology and Reproductive Medicine, University Womeńs Hospital, Inselspital Bern, University of Bern, Bern, Switzerland
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17
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Gallego A, Beato C, Brozos E, De La Cruz S, García RV. Spanish Society of Medical Oncology recommendations for comprehensive assessment and care of cancer survivors' needs. Clin Transl Oncol 2024:10.1007/s12094-024-03571-9. [PMID: 38976210 DOI: 10.1007/s12094-024-03571-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 07/09/2024]
Abstract
This article reviews the contemporary and inclusive definition of cancer survivorship, including patients with and without disease who have completed or continue to undergo treatment. The Spanish Society of Medical Oncology (SEOM) describes in this article the needs of these patients and outlines a care model based on an estimation of cancer incidence and identification of patient needs, to enable the provision of practical actions to achieve effective care. The objectives of this review are to identify the main effects of cancer on survivors and to establish appropriate ways of measuring these effects, as well as discussing the management of physical, psychological and social, occupational, financial, and other health-related needs. We suggest a multidisciplinary care model and training programs for the different professionals involved in care, and highlight challenges and the future role of the SEOM and health-care policy in ensuring optimum care of cancer survivors.
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Affiliation(s)
- Alejandro Gallego
- Department of Medical Oncology, Cancer Center Clínica Universidad de Navarra (CCUN), Madrid and Pamplona, Calle del Marquesado de Santa Marta, 1, 28027, Madrid, Spain.
| | - Carmen Beato
- Departament of Oncology, University Hospital of Jerez de La Frontera, Cádiz, Spain
| | - Elena Brozos
- Department of Oncology, University Hospital of A Coruña, A Coruña, Spain
| | - Susana De La Cruz
- Department of Oncology, University Hospital of Navarra, Instituto de Investigación Sanitaria de Navarra, IdISNA, Pamplona, Spain
| | - Ruth Vera García
- Department of Oncology, University Hospital of Navarra, Instituto de Investigación Sanitaria de Navarra, IdISNA, Pamplona, Spain
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18
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Russell AC, Reid H, Coleman HG, Santin O. Understanding the treatment experiences of adults diagnosed with early-onset colorectal cancer: A qualitative study. Psychooncology 2024; 33:e6367. [PMID: 38937110 DOI: 10.1002/pon.6367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 06/12/2024] [Accepted: 06/13/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE Early-onset colorectal cancer (CRC) incidence in adults aged under 50 is increasing. There is a critical lack of knowledge regarding the challenges faced by early-onset CRC patients and their experiences of treatment. The aim of this study was to explore the lived experiences of individuals receiving treatment for early-onset CRC, and the resulting impact on their lives. METHODS Semi-structured interviews of patients with early-onset CRC in the UK (n = 21) were conducted from August 2021 to March 2022. Interviews were recorded and transcribed verbatim. Data were analysed using thematic analysis. RESULTS Results identified four key themes: (1) early-onset CRC treatment results in sudden physical, psychological and social impacts in all aspects of life; (2) early-onset CRC patients have unique supportive care needs which are not recognised in current practice; (3) there is a need for tailored information; (4) a lack of support was identified in the areas of mental health, sexual health and fertility. CONCLUSIONS Our study highlights numerous unique issues experienced by the early-onset CRC patient group during treatment. There is a need for change in clinical practice, along with the development of international guidelines and tailored resources for both patients and healthcare professionals, in order to improve care.
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Affiliation(s)
| | - Helen Reid
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | - Helen G Coleman
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Olinda Santin
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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19
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Magaton IM, Arecco L, Mariamidze E, Jankovic K, Stana M, Buzzatti G, Trevisan L, Scavone G, Ottonello S, Fregatti P, Massarotti C, von Wolff M, Lambertini M. Fertility and Pregnancy-Related Issues in Young BRCA Carriers With Breast Cancer. Breast Cancer (Auckl) 2024; 18:11782234241261429. [PMID: 38882447 PMCID: PMC11179469 DOI: 10.1177/11782234241261429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 05/06/2024] [Indexed: 06/18/2024] Open
Abstract
Approximately 10% to 15% of breast cancer cases in young women are diagnosed in patients harbouring germline (g) pathogenic or likely pathogenic variants (PVs) in the BReast CAncer 1 (BRCA1) or BReast CAncer 2 (BRCA2) genes. Preclinical and clinical studies showed a potential negative effect of germline BRCA1/2 (gBRCA1/2) PVs on ovarian reserve and reproductive potential, even before starting anticancer therapies. The aim of this article is to summarize the current literature on the fertility potential of young gBRCA1/2 PVs carriers with breast cancer and the risk of gonadotoxicity associated with anticancer treatments. Moreover, we describe the available evidence on the efficacy of fertility preservation techniques in young gBRCA1/2 PVs carriers and the safety data on having a pregnancy after breast cancer treatment.
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Affiliation(s)
- Isotta Martha Magaton
- Division of Gynaecological Endocrinology and Reproductive Medicine, University Women's Hospital, Inselspital, Bern, Switzerland
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Luca Arecco
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy
| | - Elene Mariamidze
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Medical Oncology & Hematology, Todua Clinic, Tbilisi, Georgien
| | - Kristina Jankovic
- Department of Medical Oncology, University Clinic Center Nis, Nis, Serbia
| | - Mihaela Stana
- Department of Medical Oncology, Elysee Hospital, Alba Iulia, Romania
| | - Giulia Buzzatti
- Department of Medical Oncology, Unit of Hereditary Cancer, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lucia Trevisan
- Department of Medical Oncology, Unit of Hereditary Cancer, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Graziana Scavone
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Silvia Ottonello
- Departent of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - Piero Fregatti
- Department of Surgery, U.O.C. Clinica di Chirurgia Senologica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, Genoa, Italy
| | - Claudia Massarotti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI Department), University of Genoa, Genoa, Italy
- Academic Unit of Obstetrics and Gynecology, Maternal-Child Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Michael von Wolff
- Division of Gynaecological Endocrinology and Reproductive Medicine, University Women's Hospital, Inselspital, Bern, Switzerland
| | - Matteo Lambertini
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy
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20
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Bedoschi G, Ingold C, Navarro PA. Fertility Preservation and Ovarian Hyperstimulation Syndrome Management in Cancer Care: A Pathophysiological Perspective on Gonadotropin-Releasing Hormone Agonists and Antagonists. PATHOPHYSIOLOGY 2024; 31:288-297. [PMID: 38921726 PMCID: PMC11206524 DOI: 10.3390/pathophysiology31020021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/02/2024] [Accepted: 06/04/2024] [Indexed: 06/27/2024] Open
Abstract
This narrative review delves into the evolving landscape of fertility preservation techniques, with a particular focus on their use in patients undergoing oncology treatment that carries a risk of ovarian insufficiency. Advances in established methods such as cryopreservation of oocytes and embryos are highlighted, and the increasing use of gonadotropin-releasing hormone (GnRH) agonists is discussed. The review also addresses the complexities and controversies associated with these approaches, such as the 'flare-up' effect associated with GnRH agonists and the potential of GnRH antagonists to reduce the risk of ovarian hyperstimulation syndrome. Despite advances in fertility preservation, the report highlights the challenges we face, including the need for personalized treatment protocols and the management of associated risks. It calls for continued research and collaboration between healthcare professionals to refine these techniques and ultimately improve reproductive outcomes for patients facing the prospect of fertility-impairing treatment.
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Affiliation(s)
- Giuliano Bedoschi
- Department of Gynecology and Obstetrics, Reproductive Medicine Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, Brazil;
| | - Caroline Ingold
- Department of Collective Health, Sexual, Reproductive Health and Population Genetics, Faculdade de Medicina do ABC, Santo André 09060-870, Brazil;
| | - Paula Andrea Navarro
- Department of Gynecology and Obstetrics, Reproductive Medicine Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, Brazil;
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21
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Massarotti C, Ammar OF, Liperis G, Mincheva M, Fraire-Zamora JJ, Sharma K, Rosario R, Winship AL, Lambertini M, Makieva S. Chemoprotection of the ovary: a leading role or a complementary strategy in fertility preservation? Hum Reprod 2024; 39:1357-1361. [PMID: 38593422 DOI: 10.1093/humrep/deae069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/15/2024] [Indexed: 04/11/2024] Open
Affiliation(s)
- Claudia Massarotti
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- DINOGMI Department, University of Genova, Genova, Italy
| | - Omar F Ammar
- Ar-Razzi Private Hospital, IVF Centre, Ramadi, Iraq
- Department of Obstetrics and Gynaecology, College of Medicine, University of Anbar, Ramadi, Iraq
| | - George Liperis
- Westmead Fertility Centre, Institute of Reproductive Medicine, University of Sydney, Westmead, NSW, Australia
| | | | | | - Kashish Sharma
- HealthPlus Fertility Center, HealthPlus Network of Specialty Centers, Abu Dhabi, United Arab Emirates
| | | | - Amy L Winship
- Department of Anatomy and Developmental Biology, Development and Stem Cells Program, Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Matteo Lambertini
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy
| | - Sofia Makieva
- Kinderwunschzentrum, Klinik für Reproduktions-Endokrinologie, Universitätsspital Zürich, Zurich, Switzerland
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22
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Bjornard K, Close A, Burns K, Chavez J, Chow EJ, Meacham LR. Fertility preservation in pediatric solid tumors: A report from the Children's Oncology Group. Pediatr Blood Cancer 2024; 71:e30960. [PMID: 38532279 PMCID: PMC11104288 DOI: 10.1002/pbc.30960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/30/2024] [Accepted: 02/27/2024] [Indexed: 03/28/2024]
Abstract
Treatment for childhood solid tumors may lead to an increased risk for gonadal dysfunction/infertility. Discussion of risk should occur at diagnosis, any changes in therapy, and during survivorship. Gonadotoxic therapies were abstracted from 32 Children's Oncology Group (COG) phase III, frontline solid tumor protocols, in use from 2000 to 2022. Risk for gonadal dysfunction/infertility was assessed based on gonadotoxic therapies, sex, and pubertal status and assigned as minimal, significant, and high following the Oncofertility Consortium Pediatric Initiative Network (PIN) risk stratification. Most protocols (65.6%, 21/32) contained at least one therapeutic arm with a high level of increased risk. Solid tumor therapies present challenges in risk stratification due to response-adjusted therapy and the need to account for radiation field in the risk assessment. This guide hopes to serve as a tool to assist in standardizing gonadotoxic risk assessments across disciplines and improve referral for fertility services and reproductive health counseling for patients receiving COG-based solid tumor therapy. Internationally, many solid tumor therapies follow similar paradigms to COG studies, and risk stratifications may be generalizable to similar styles of therapy. In addition, this model may be applied to other international groups with the goal of standardizing fertility assessments.
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Affiliation(s)
- Kari Bjornard
- Department of Pediatrics, Division of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, IN, USA; Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Allison Close
- Helen DeVos Children’s Hospital, Division of Hematology/Oncology, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Karen Burns
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Josuah Chavez
- Helen DeVos Children’s Hospital, Division of Hematology/Oncology, Grand Rapids, MI, USA
| | - Eric J. Chow
- Fred Hutchinson Cancer Center, Seattle Children’s Hospital, Seattle, WA, USA
| | - Lillian R. Meacham
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Pediatric Hematology/Oncology/BMT, Emory University Atlanta, GA USA
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23
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Peccatori FA, Florez N, Imbimbo M. From Approximation to Precision: Fertility and Pregnancy Questions in Young Patients With Lung Cancer. J Thorac Oncol 2024; 19:852-854. [PMID: 38849163 DOI: 10.1016/j.jtho.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 06/09/2024]
Affiliation(s)
- Fedro A Peccatori
- Division of Gynaecologic Oncology, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.
| | - Narjust Florez
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Martina Imbimbo
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
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24
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Laguna JC, Tagliamento M, Lambertini M, Hiznay J, Mezquita L. Tackling Non-Small Cell Lung Cancer in Young Adults: From Risk Factors and Genetic Susceptibility to Lung Cancer Profile and Outcomes. Am Soc Clin Oncol Educ Book 2024; 44:e432488. [PMID: 38788188 DOI: 10.1200/edbk_432488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Lung cancer has traditionally been associated with advanced age; however, its increasing incidence among young adults raises concerning questions regarding its etiology and unique considerations for this population. In contrast to the older population, the onset of lung cancer at younger age may be attributed to a complex interplay of incompletely understood individual susceptibility and prevalent environmental risk factors beyond tobacco smoke exposure, such as radon gas and air pollution, which are widespread globally. Consequently, this leads to distinct clinical and molecular profiles, requiring a tailored approach. Furthermore, a diagnosis of cancer represents a threatening event during the prime years of a young person's life, prompting concern about career development, social aspects, fertility aspirations, and physical independence. This poses significant additional challenges for health care professionals in a field that remains underexplored. This comprehensive review recognizes lung cancer in young adults as a distinct entity, exploring its clinical and molecular characteristics, diverse predisposing factors, and priorities in terms of quality of life, with the aim of providing practical support to oncologists and enhancing our understanding of this under-researched population.
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Affiliation(s)
- Juan Carlos Laguna
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain
- Laboratory of Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - Marco Tagliamento
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Laura Mezquita
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain
- Laboratory of Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
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25
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Grimes AC, Sugalski AJ, Nuño MM, Ramakrishnan S, Beauchemin MP, Robinson PD, Santesso N, Walsh AM, Wrightson AR, Yu LC, Parsons SK, Sung L, Dupuis LL. Clinical Practice Guideline-Inconsistent Management of Fertility Preservation in Pediatric Cancer Patients in Community Settings: A Children's Oncology Group Study. J Adolesc Young Adult Oncol 2024. [PMID: 38770790 DOI: 10.1089/jayao.2024.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Background: The primary objective was to measure adherence to clinical practice guideline (CPG) recommendations for fertility preservation (FP) in pediatric cancer patients treated in National Cancer Institute Community Oncology Research Program (NCORP) sites. Secondary objectives were to describe factors such as site size associated with CPG-inconsistent care delivery and cryopreservation completion. Methods: This retrospective, multicenter study included patients 15 to 21 years old with a first cancer diagnosis from January 2014 through December 2015 who were previously enrolled to a Children's Oncology Group (COG) study and received care at a participating NCORP site. Patients were randomly selected from a list generated by the COG for chart review by participating sites. Primary outcome was care delivery that was inconsistent with a strong CPG recommendation on FP, namely discussion and offering of FP options before cancer treatment initiation, as adjudicated centrally by a panel. Results: A total of 129 patients from 25 sites were included. Among these, 48% (62/129) received CPG-inconsistent care. Most CPG-inconsistent care was due to lack of FP discussion documentation (93.5%, 58/62). Small site size, treatment at a pediatric (vs mixed adult/pediatric) site, and female sex were associated with higher odds of CPG-inconsistent care delivery. Conclusions: Newly diagnosed pediatric cancer patients often received CPG-inconsistent care for FP, with disproportionate gaps noted for females, and those treated at smaller or pediatric NCORP sites. The primary reason for CPG-inconsistent care is lack of FP discussion from clinicians. Opportunities to improve FP CPG implementation are highlighted.
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Affiliation(s)
- Allison C Grimes
- University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Aaron J Sugalski
- University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Michelle M Nuño
- Children's Oncology Group, Monrovia, California, USA
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | | | | | | | - Nancy Santesso
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Alexandra M Walsh
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, University of Arizona, Phoenix, Arizona, USA
| | - Andrea R Wrightson
- Clinical Research Nurse Coordinator, Nemours Center for Cancer and Blood Disorders, Wilmington, Delaware, USA
| | - Lolie C Yu
- LSUHSC/Children's Hospital, New Orleans, Louisiana, USA
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies and Division of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Lillian Sung
- Research Institute, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, The Hospital for Sick Children; Faculty of Medicine, University of Toronto, Toronto, Canada
| | - L Lee Dupuis
- Research Institute, The Hospital for Sick Children, Toronto, Canada
- Department of Pharmacy, The Hospital for Sick Children; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
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Tanaka Y, Amano T, Nakamura A, Yoshino F, Takebayashi A, Takahashi A, Yamanaka H, Inatomi A, Hanada T, Yoneoka Y, Tsuji S, Murakami T. Rapamycin prevents cyclophosphamide-induced ovarian follicular loss and potentially inhibits tumour proliferation in a breast cancer xenograft mouse model. Hum Reprod 2024:deae085. [PMID: 38734930 DOI: 10.1093/humrep/deae085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 03/26/2024] [Indexed: 05/13/2024] Open
Abstract
STUDY QUESTION To what extent and via what mechanism does the concomitant administration of rapamycin (a follicle activation pathway inhibitor and antitumour agent) and cyclophosphamide (a highly toxic ovarian anticancer agent) prevent cyclophosphamide-induced ovarian reserve loss and inhibit tumour proliferation in a breast cancer xenograft mouse model? SUMMARY ANSWER Daily concomitant administration of rapamycin and a cyclic regimen of cyclophosphamide, which has sufficient antitumour effects as a single agent, suppressed cyclophosphamide-induced primordial follicle loss by inhibiting primordial follicle activation in a breast cancer xenograft mouse model, suggesting the potential of an additive inhibitory effect against tumour proliferation. WHAT IS KNOWN ALREADY Cyclophosphamide stimulates primordial follicles by activating the mammalian target of the rapamycin (mTOR) pathway, resulting in the accumulation of primary follicles, most of which undergo apoptosis. Rapamycin, an mTOR inhibitor, regulates primordial follicle activation and exhibits potential inhibitory effects against breast cancer cell proliferation. STUDY DESIGN, SIZE, DURATION To assess ovarian follicular apoptosis, 3 weeks after administering breast cancer cells, 8-week-old mice were randomized into three treatment groups: control, cyclophosphamide, and cyclophosphamide + rapamycin (Cy + Rap) (n = 5 or 6 mice/group). Mice were treated with rapamycin or vehicle control for 1 week, followed by a single dose of cyclophosphamide or vehicle control. Subsequently, the ovaries were resected 24 h after cyclophosphamide administration (short-term treatment groups). To evaluate follicle abundance and the mTOR pathway in ovaries, as well as the antitumour effects and impact on the mTOR pathway in tumours, 8-week-old xenograft breast cancer transplanted mice were randomized into three treatment groups: vehicle control, Cy, and Cy + Rap (n = 6 or 7 mice/group). Rapamycin (5 mg/kg) or the vehicle was administered daily for 29 days. Cyclophosphamide (120 mg/kg) or the vehicle was administered thrice weekly (long-term treatment groups). The tumour diameter was measured weekly. Seven days after the last cyclophosphamide treatment, the ovaries were harvested, fixed, and sectioned (for follicle counting) or frozen (for further analysis). Similarly, the tumours were resected and fixed or frozen. PARTICIPANTS/MATERIALS, SETTING, METHODS Terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) was performed to examine ovarian follicular apoptosis in the short-term treatment groups. All subsequent experiments were conducted in the long-term treatment groups. Tumour growth was evaluated using the tumour volume index. The tumour volume index indicates the relative volume, compared to the volume 3 weeks after tumour cell injection (at treatment initiation) set to 100%. Tumour cell proliferation was evaluated by Ki-67 immunostaining. Activation of the mTOR pathway in tumours was assessed using the protein extracts from tumours and analysed by western blotting. Haematoxylin and eosin staining of ovaries was used to perform differential follicle counts for primordial, primary, secondary, antral, and atretic follicles. Activation of the mTOR pathway in ovaries was assessed using protein extracts from whole ovaries and analysed by western blotting. Localization of mTOR pathway activation within ovaries was assessed by performing anti-phospho-S6 kinase (downstream of mTOR pathway) immunohistochemistry. MAIN RESULTS AND THE ROLE OF CHANCE Ovaries of the short-term treatment groups were resected 24 h after cyclophosphamide administration and subjected to TUNEL staining of apoptotic cells. No TUNEL-positive primordial follicles were detected in the control, Cy, and Cy + Rap groups. Conversely, many granulosa cells of growing follicles were TUNEL positive in the Cy group but negative in the control and Cy + Rap groups. All subsequent experimental results were obtained from the long-term treatment groups. The tumour volume index stabilized at a mean of 160-200% in the Cy group and 130% in the Cy + Rap group throughout the treatment period. In contrast, tumours in the vehicle control group grew continuously with a mean tumour volume index of 600%, significantly greater than that of the two treatment groups. Based on the western blot analysis of tumours, the mTOR pathway was activated in the vehicle control group and downregulated in the Cy + Rap group when compared with the control and Cy groups. Ki-67 immunostaining of tumours showed significant inhibition of cell proliferation in the Cy + Rap group when compared with that in the control and Cy groups. The ovarian follicle count revealed that the Cy group had significantly fewer primordial follicles (P < 0.001) than the control group, whereas the Cy + Rap group had significantly higher number of primordial follicles (P < 0.001, 2.5 times) than the Cy group. The ratio of primary to primordial follicles was twice as high in the Cy group than in the control group; however, no significant difference was observed between the control group and the Cy + Rap group. Western blot analysis of ovaries revealed that the mTOR pathway was activated by cyclophosphamide and inhibited by rapamycin. The phospho-S6 kinase (pS6K)-positive primordial follicle rate was 2.7 times higher in the Cy group than in the control group. However, this effect was suppressed to a level similar to the control group in the Cy + Rap group. LARGE SCALE DATA None. LIMITATIONS, REASONS FOR CAUTION The combinatorial treatment of breast cancer tumours with rapamycin and cyclophosphamide elicited inhibitory effects on cell proliferative potential compared to cyclophosphamide monotherapy. However, no statistically significant additive effect was observed on tumour volume. Thus, the beneficial antitumour effect afforded by rapamycin administration on breast cancer could not be definitively proven. Although rapamycin has ovarian-protective effects, it does not fully counteract the ovarian toxicity of cyclophosphamide. Nevertheless, rapamycin is advantageous as an ovarian protective agent as it can be used in combination with other ovarian protective agents, such as hormonal therapy. Hence, in combination with other agents, mTOR inhibitors may be sufficiently ovario-protective against high-dose and cyclic cyclophosphamide regimens. WIDER IMPLICATIONS OF THE FINDINGS Compared with a cyclic cyclophosphamide regimen that replicates human clinical practice under breast cancer-bearing conditions, the combination with rapamycin mitigates the ovarian follicle loss of cyclophosphamide without interfering with the anticipated antitumour effects. Hence, rapamycin may represent a new non-invasive treatment option for cyclophosphamide-induced ovarian dysfunction in breast cancer patients. STUDY FUNDING/COMPETING INTEREST(S) This work was not financially supported. The authors declare that they have no conflict of interest.
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Affiliation(s)
- Yuji Tanaka
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
| | - Tsukuru Amano
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
| | - Akiko Nakamura
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
| | - Fumi Yoshino
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
| | - Akie Takebayashi
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
| | - Akimasa Takahashi
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
| | - Hiroyuki Yamanaka
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
| | - Ayako Inatomi
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
| | - Tetsuro Hanada
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
| | - Yutaka Yoneoka
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
| | - Shunichiro Tsuji
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
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Saddi J, Barcellini A, Gotti M, Mazzacane A, Tolva A, Lazic T, Arcaini L, Zecca M, Orlandi E, Filippi AR. Future perspectives of radiation therapy for Hodgkin Lymphoma: Risk-adapted, response-adapted, and safer than before. Hematol Oncol 2024; 42:e3269. [PMID: 38650534 DOI: 10.1002/hon.3269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 04/25/2024]
Abstract
Classical Hodgkin lymphoma is a lymphoproliferative disease with a good prognosis mainly seen in young people. Nevertheless secondary malignancy, cardiac disease and infertility may affect the long survivors with significant impact on quality of life, morbidity and overall survival. In the last decades several treatment strategies were evaluated to reduce the toxicity of first line treatment such as avoiding radiotherapy or its reduction in terms of dosage and extension. Many trials including interim Positron Emission Tomography evaluation fail to compare efficacy between combined modality treatment versus chemotherapy alone in particular in early stage disease. In this review we analyze which subset of patients could take advantage from proton therapy in terms of toxicity and cost effectiveness.
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Affiliation(s)
- Jessica Saddi
- Radiation Oncology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Amelia Barcellini
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Manuel Gotti
- Division of Hematology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | | | - Alessandra Tolva
- Pediatric Hematology/Oncology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Tanja Lazic
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Luca Arcaini
- Division of Hematology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Marco Zecca
- Pediatric Hematology/Oncology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Ester Orlandi
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Andrea Riccardo Filippi
- Radiation Oncology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Oncology, University of Milan, Milan, Italy
- Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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28
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Barral Y, Borrás A, Carrillo P, Agustí I, Peralta S, Casals G, Fàbregues F, Guimerà M, Corral JM, Calafell JM, Redondo M, Glickman A, Rovira M, Adamo B, Ricart E, Trullàs DM. Current status of fertility preservation in a Spanish tertiary public hospital: multidisciplinary approach and experience in over 1500 patients. Clin Transl Oncol 2024; 26:1129-1138. [PMID: 37872422 DOI: 10.1007/s12094-023-03330-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/03/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE Currently, 15% of gynaecological and 9% of haematological malignancies are diagnosed before the age of 40. The increased survival rates of cancer patients who are candidates for gonadotoxic treatments, the delay in childbearing to older ages, and the optimization of in vitro fertilisation techniques have all contributed to an increased interest in fertility preservation (FP) treatments. This study reviews the experience of the Fertility Preservation Programme (FPP) of a tertiary public hospital with a multidisciplinary approach. METHODS This retrospective study included all the available (FP) treatments, performed in patients of childbearing age between 2006 and 2022. RESULTS 1556 patients were referred to the FPP: 332 oocyte vitrification cycles, 115 ovarian cortex cryopreservation with 11 orthotopic autotransplantations, 175 gonadotropin-releasing hormone (GnRH) agonist treatments, 109 fertility-sparing treatments for gynaecological cancer, and 576 sperm cryopreservation were performed. Malignancy was the main indication for FP (the main indications being breast cancer in women and haematological malignancies in men), although non-oncological pathologies, such as endometriosis and autoimmune diseases, have increased in recent years. Currently, the most widely used FP technique is oocyte vitrification, the increase of which has been associated with a decrease in the use of cortex CP and GnRH agonists. CONCLUSIONS The increase in FP treatment reflects the implementation of reproductive counselling in oncology programmes. A multidisciplinary approach in a tertiary public hospital allows individualised FP treatment for each patient. In recent years, there has been a change in trend with the introduction of new indications for FP and a change in techniques due to their optimisation.
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Affiliation(s)
- Yasmina Barral
- Assisted Reproduction Unit, Clinical Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Aina Borrás
- Assisted Reproduction Unit, Clinical Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Pilar Carrillo
- Assisted Reproduction Unit, Clinical Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Inés Agustí
- Assisted Reproduction Unit, Clinical Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Sara Peralta
- Assisted Reproduction Unit, Clinical Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Gemma Casals
- Assisted Reproduction Unit, Clinical Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Francesc Fàbregues
- Assisted Reproduction Unit, Clinical Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Marta Guimerà
- Assisted Reproduction Unit, Clinical Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Juan Manuel Corral
- Assisted Reproduction Unit, Clinical Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Josep Maria Calafell
- Assisted Reproduction Unit, Clinical Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Miriam Redondo
- Assisted Reproduction Unit, Clinical Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Ariel Glickman
- Gynecologic Oncology Unit, Clinical Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Montserrat Rovira
- Department of Hematology, Clinical Institute of Hematological and Oncological Diseases, Hospital Clinic de Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Bárbara Adamo
- Department of Medical Oncology, Hospital Clínic, Clinical Institute of Hematological and Oncological Diseases, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Elena Ricart
- Gastroenterology Department, Clinical Institute of Digestive and Metabolic Diseases, Hospital Clinic de Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Dolors Manau Trullàs
- Assisted Reproduction Unit, Clinical Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, C/Villarroel 170, 08036, Barcelona, Spain.
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
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29
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Helgadottir H, Matikas A, Fernebro J, Frödin JE, Ekman S, Rodriguez-Wallberg KA. Fertility and reproductive concerns related to the new generation of cancer drugs and the clinical implication for young individuals undergoing treatments for solid tumors. Eur J Cancer 2024; 202:114010. [PMID: 38520926 DOI: 10.1016/j.ejca.2024.114010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/03/2024] [Accepted: 03/05/2024] [Indexed: 03/25/2024]
Abstract
The treatment landscape of solid tumors has changed markedly in the last years. Molecularly targeted treatments and immunotherapies have been implemented and have, in many cancers, lowered the risk of relapse and prolonged survival. Patients with tumors harboring specific targetable molecular alterations or mutations are often of a younger age, and hence future fertility and family building can be important concerns in this group. However, there are great uncertainties regarding the effect of the new drugs on reproductive functions, including fertility, pregnancy and lactation and how young patients with cancers, both women and men should be advised. The goal with this review is to gather the current knowledge regarding oncofertility and the different novel therapies, including immune checkpoint inhibitors, antibody-drug conjugates, small molecules and monoclonal antibody targeted therapies. The specific circumstances and reproductive concerns in different patient groups where novel treatments have been broadly introduced are also discussed, including those with melanoma, lung, breast, colorectal and gynecological cancers. It is clear, that more awareness is needed regarding potential drug toxicity on reproductive tissues, and it is of essence that individuals are informed based on current expertise and on available fertility preservation methods.
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Affiliation(s)
- Hildur Helgadottir
- Department of Oncology and Pathology, Karolinska Institutet, 171 77 Stockholm, Sweden; Skin Cancer Centrum, Theme Cancer, Karolinska University Hospital, 171 76 Stockholm, Sweden.
| | - Alexios Matikas
- Department of Oncology and Pathology, Karolinska Institutet, 171 77 Stockholm, Sweden; Breast Center, Karolinska Comprehensive Cancer Center and Karolinska University Hospital, Stockholm, Sweden
| | - Josefin Fernebro
- Department of Oncology and Pathology, Karolinska Institutet, 171 77 Stockholm, Sweden; Division of Gynecological Cancer, Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Jan-Erik Frödin
- Department of Oncology and Pathology, Karolinska Institutet, 171 77 Stockholm, Sweden; Division of Gastrointestinal Oncology, Department of Upper abdomen, Karolinska University Hospital, Sweden
| | - Simon Ekman
- Department of Oncology and Pathology, Karolinska Institutet, 171 77 Stockholm, Sweden; Thoracic Oncology Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Kenny A Rodriguez-Wallberg
- Department of Oncology and Pathology, Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Reproductive Medicine, Division of Gynecology and Reproduction Karolinska University Hospital, Stockholm, Sweden
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30
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Link-Rachner CS, Göbel A, Jaschke NP, Rachner TD. Endocrine health in survivors of adult-onset cancer. Lancet Diabetes Endocrinol 2024; 12:350-364. [PMID: 38604215 DOI: 10.1016/s2213-8587(24)00088-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 04/13/2024]
Abstract
Long-term survivors of cancer (ie, the patient who is considered cured or for whom the disease is under long-term control and unlikely to recur) are at an increased risk of developing endocrine complications such as hypothalamic-pituitary dysfunctions, hypogonadisms, osteoporosis, or metabolic disorders, particularly when intensive tumour-directed therapies are applied. Symptom severity associated with these conditions ranges from mild and subclinical to highly detrimental, affecting individual health and quality of life. Although they are usually manageable, many of these endocrine pathologies remain underdiagnosed and untreated for years. To address this challenge, a higher degree of awareness, standardised screening tools, comprehensible treatment algorithms, and a close collaborative effort between endocrinologists and oncologists are essential to early identify patients who are at risk, and to implement appropriate treatment protocols. This Review highlights common symptoms and conditions related to endocrine disorders among survivors of adult-onset cancer, provides a summary of the currently available practice guidelines, and proposes a practical approach to diagnose affected patients among this group.
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Affiliation(s)
- Cornelia S Link-Rachner
- Division of Haematology and Oncology, Department of Medicine I, Technische Universität Dresden, Dresden, Germany
| | - Andy Göbel
- Division of Endocrinology, Diabetes, and Bone Diseases, Department of Medicine III, Technische Universität Dresden, Dresden, Germany; German Cancer Consortium (DKTK), partner site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nikolai P Jaschke
- Division of Endocrinology, Diabetes, and Bone Diseases, Department of Medicine III, Technische Universität Dresden, Dresden, Germany; German Cancer Consortium (DKTK), partner site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Tilman D Rachner
- Division of Endocrinology, Diabetes, and Bone Diseases, Department of Medicine III, Technische Universität Dresden, Dresden, Germany; German Cancer Consortium (DKTK), partner site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany.
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31
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Charpentier P, Cavalieri M, Desmoulins I, Coutant C. [Live birth rates after breast cancer among women who desired a child]. Bull Cancer 2024; 111:463-472. [PMID: 38580527 DOI: 10.1016/j.bulcan.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 01/15/2024] [Accepted: 02/01/2024] [Indexed: 04/07/2024]
Abstract
INTRODUCTION In France, the breast cancer is the most common cancer among women under the age of 40. From 38 to 70% of women have not fulfilled their parental plans at the time of diagnosis. The gonadotoxicity of the treatments and the follicular physiological decline linked to age can become an obstacle to this project. METHODS Among the patients, 386 were treated for breast cancer at the Centre Georges-François-Leclerc in Dijon between January 2011 and December 2018 were identified. 192 patients aged under 39 met the inclusion criteria. We excluded metastatic cancers, cancer in situ and pregnant patients at diagnosis. A total of 124 patients agreed to participate in the study. The included patients filled out a self-questionnaire. Data were collected from the patient's electronic medical. The primary endpoint of this study was the live birth rate. RESULT Among women who desired a child after breast cancer, the overall rate of live births was 36.2 % (21/58). Most achieved pregnancies were spontaneous (90.5 %). No factor was significantly associated with the absence of obtaining birth. Fertility was preserved by oocyte cryopreservation in 13.8 % of patients (17/124). The median time to conception in patients who received chemotherapy was 8 months [1.0-60.0] vs 2 months [1.0-7.0] in women who did not receive chemotherapy. DISCUSSION The non-negligible proportion of live births following spontaneous pregnancy after breast cancer allows us to be reassuring for patients. However, the emergence of new chemotherapy protocols whose consequences on long-term gonadotoxicity are still not well known requires further studies and prompts the promotion of fertility preservation as a precautionary measure.
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Affiliation(s)
- Pauline Charpentier
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU François-Mitterrand, Cote d'Or, Dijon, France.
| | - Mathilde Cavalieri
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU François-Mitterrand, Cote d'Or, Dijon, France
| | - Isabelle Desmoulins
- Centre Francois-Leclerc, 1, rue du Professeur-Marion, Cote d'Or, 21000 France
| | - Charles Coutant
- Centre Francois-Leclerc, 1, rue du Professeur-Marion, Cote d'Or, 21000 France
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32
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Blondeaux E, Partridge AH, Lambertini M. Breast Cancer and Pregnancy in Young BRCA Carriers-Reply. JAMA 2024; 331:1234. [PMID: 38592390 DOI: 10.1001/jama.2024.2517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Affiliation(s)
- Eva Blondeaux
- U. O. Epidemiologia Clinica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DIMI), University of Genova, Genova, Italy
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Rashidian P. An update on oncofertility in prepubertal females. J Gynecol Obstet Hum Reprod 2024; 53:102742. [PMID: 38341083 DOI: 10.1016/j.jogoh.2024.102742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/12/2024]
Abstract
Cancer is a life-threatening event for pediatric patients. Treatment advancements in pediatric cancer have improved prognosis, but some of these treatments have gonadotoxic potential and may affect fertility in different ways. Due to the growing interest of the research community in the life prospects of young cancer survivors, there has been a demand to intersect reproductive medicine and oncology, which is referred to as "oncofertility". There are various fertility preservation options according to gender and pubertal status, and shared decisions must take place at the time of diagnosis. This study aims to provide a critical review of current and emerging strategies for preserving and restoring fertility in prepubertal females, ranging from established methods to experimental approaches that can be offered before, during, and after anticancer therapies. Additionally, the author aims to review how clinicians' awareness of oncofertility options and the latest advancements in this field, timely referral, and proper consultations with patients and their families are vital in addressing their concerns, providing emotional support, and guiding them through the decision-making process, as well as potential barriers that may hinder the fertility preservation process.
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Affiliation(s)
- Pegah Rashidian
- Reproductive Health Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
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34
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Molinelli C, Jacobs F, Nader-Marta G, Borea R, Scavone G, Ottonello S, Fregatti P, Villarreal-Garza C, Bajpai J, Kim HJ, Puglisi S, de Azambuja E, Lambertini M. Ovarian Suppression: Early Menopause and Late Effects. Curr Treat Options Oncol 2024; 25:523-542. [PMID: 38478329 PMCID: PMC10997548 DOI: 10.1007/s11864-024-01190-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 04/06/2024]
Abstract
OPINION STATEMENT Around 90% of breast tumours are diagnosed in the early stage, with approximately 70% being hormone receptor-positive. The cornerstone of adjuvant therapy for early-stage hormone receptor-positive breast cancer is endocrine therapy, tailored according to disease stage, biological characteristics of the tumour, patient's comorbidities, preferences and age. In premenopausal patients with hormone receptor-positive breast cancer, ovarian function suppression is a key component of the adjuvant endocrine treatment in combination with an aromatase inhibitor or tamoxifen. Moreover, it can be used during chemotherapy as a standard strategy for ovarian function preservation in all breast cancer subtypes. In the metastatic setting, ovarian function suppression should be used in all premenopausal patients with hormone receptor-positive breast cancer to achieve a post-menopausal status. Despite its efficacy, ovarian function suppression may lead to several side effects that can have a major negative impact on patients' quality of life if not properly managed (e.g. hot flashes, depression, cognitive impairment, osteoporosis, sexual dysfunction, weight gain). A deep knowledge of the side effects of ovarian function suppression is necessary for clinicians. A correct counselling in this regard and proactive management should be considered a fundamental part of survivorship care to improve treatment adherence and patients' quality of life.
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Affiliation(s)
- Chiara Molinelli
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinical Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Flavia Jacobs
- Humanitas Clinical and Research Center - IRCCS, Humanitas Cancer Center, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Guilherme Nader-Marta
- Academic Trials Promoting Team, Institut Jules Bordet and l'Université Libre de Bruxelles (U.L.B), 90, Rue Meylemeersch, 1070, Anderlecht, Brussels, Belgium
| | - Roberto Borea
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinical Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Graziana Scavone
- Department of Medical Oncology, U.O. Clinical Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Silvia Ottonello
- Department of Medical Oncology, U.O. Clinical Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Piero Fregatti
- Department of Surgery, U.O. Senologia Chirurgica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132, Genoa, Italy
| | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion - TecSalud, Tecnologico de Monterrey, Monterrey, Mexico
| | - Jyoti Bajpai
- Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Ernest Borges Rd, Parel East, Parel, Mumbai, Maharashtra, 400012, India
| | - Hee Jeong Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, South Korea
| | - Silvia Puglisi
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Evandro de Azambuja
- Academic Trials Promoting Team, Institut Jules Bordet and l'Université Libre de Bruxelles (U.L.B), 90, Rue Meylemeersch, 1070, Anderlecht, Brussels, Belgium
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy.
- Department of Medical Oncology, U.O. Clinical Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
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Hickey M, Basu P, Sassarini J, Stegmann ME, Weiderpass E, Nakawala Chilowa K, Yip CH, Partridge AH, Brennan DJ. Managing menopause after cancer. Lancet 2024; 403:984-996. [PMID: 38458217 DOI: 10.1016/s0140-6736(23)02802-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/18/2023] [Accepted: 12/11/2023] [Indexed: 03/10/2024]
Abstract
Globally, 9 million women are diagnosed with cancer each year. Breast cancer is the most commonly diagnosed cancer worldwide, followed by colorectal cancer in high-income countries and cervical cancer in low-income countries. Survival from cancer is improving and more women are experiencing long-term effects of cancer treatment, such as premature ovarian insufficiency or early menopause. Managing menopausal symptoms after cancer can be challenging, and more severe than at natural menopause. Menopausal symptoms can extend beyond hot flushes and night sweats (vasomotor symptoms). Treatment-induced symptoms might include sexual dysfunction and impairment of sleep, mood, and quality of life. In the long term, premature ovarian insufficiency might increase the risk of chronic conditions such as osteoporosis and cardiovascular disease. Diagnosing menopause after cancer can be challenging as menopausal symptoms can overlap with other common symptoms in patients with cancer, such as fatigue and sexual dysfunction. Menopausal hormone therapy is an effective treatment for vasomotor symptoms and seems to be safe for many patients with cancer. When hormone therapy is contraindicated or avoided, emerging evidence supports the efficacy of non-pharmacological and non-hormonal treatments, although most evidence is based on women older than 50 years with breast cancer. Vaginal oestrogen seems safe for most patients with genitourinary symptoms, but there are few non-hormonal options. Many patients have inadequate centralised care for managing menopausal symptoms after cancer treatment, and more information is needed about cost-effective and patient-focused models of care for this growing population.
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Affiliation(s)
- Martha Hickey
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and the Royal Women's Hospital, Melbourne, VIC, Australia.
| | - Partha Basu
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, WHO, Lyon, France
| | - Jenifer Sassarini
- Department of Obstetrics and Gynaecology, School of Gynaecology, University of Glasgow, Glasgow, UK
| | - Mariken E Stegmann
- Department of Primary and Long-term Care, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | | | - Cheng-Har Yip
- Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Donal J Brennan
- Gynaecological Oncology Group, UCD School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland; Systems Biology Ireland, UCD School of Medicine, Dublin, Ireland
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Lehmann V, Vlooswijk C, van der Graaf WTA, Bijlsma R, Kaal SEJ, Kerst JM, Tromp JM, Bos MEMM, van der Hulle T, Lalisang RI, Nuver J, Kouwenhoven MCM, Lok CAR, Beerendonk CCM, Dinkelman-Smit M, Husson O. Pre-treatment fertility preservation and post-treatment reproduction in long-term survivors of adolescent and young adult (AYA) cancer. J Cancer Surviv 2024:10.1007/s11764-024-01538-x. [PMID: 38316726 DOI: 10.1007/s11764-024-01538-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/17/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE To describe recall of fertility-related consultations and cryopreservation and to examine reproductive goals and reproduction post-treatment in long-term survivors of adolescent and young adult (AYA) (age, 18-39 years) cancer. METHODS This study included n = 1457 male and n = 2112 female long-term survivors (Mage = 43-45 years; 5-22 years from diagnosis) who provided self-report. Clinical data were supplied by the Netherlands Cancer Registry. RESULTS Most male survivors (72.7%) recalled fertility-related consultations and 22.6% completed sperm cryopreservation. Younger age (OR = 2.8; 95%CI [2.2-3.6]), not having children (OR = 5.0; 95%CI [3.2-7.7]), testicular cancer or lymphoma/leukemia (OR = 2.8/2.5 relative to "others"), and more intense treatments (OR = 1.5; 95%CI [1.1-2.0]) were associated with higher cryopreservation rates. Time since diagnosis had no effect. Of men who cryopreserved, 12.1% utilized assisted reproductive technologies (ART). Most men (88.5%) felt their diagnosis did not affect their reproductive goals, but 7.6% wanted no (additional) children due to cancer. Half of female survivors (55.4%; n = 1171) recalled fertility-related consultations. Rates of cryopreservation were very low (3.6%), but increased after 2013 when oocyte cryopreservation became non-experimental. Of women who cryopreserved, 13.2% successfully utilized ART. Most women (74.8%) experienced no effects of cancer on reproductive goals, but 17.8% wanted no (additional) children due to cancer. CONCLUSIONS Cryopreservation in men varied by patient/clinical factors and was very low in women, but data of more recently treated females are needed. Utilizing cryopreserved material through ART was rare, which questions its cost-effectiveness, but it may enhance survivors' well-being. IMPLICATIONS FOR CANCER SURVIVORS The extent to which cryopreservation positively affects survivors' well-being remains to be tested. Moreover, effects of cancer on reproductive goals require further attention, especially in women who refrain from having children due to cancer.
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Affiliation(s)
- Vicky Lehmann
- Department of Medical Psychology, Amsterdam University Medical Center/University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Cancer Center Amsterdam (CCA), Amsterdam, The Netherlands.
| | - Carla Vlooswijk
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Winette T A van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Medical Oncology, ErasmusMC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Rhodé Bijlsma
- Department of Medical Oncology, UMC Utrecht Cancer Center, Utrecht, The Netherlands
| | - Suzanne E J Kaal
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan Martijn Kerst
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - Jacqueline M Tromp
- Department of Medical Oncology, Amsterdam University Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Monique E M M Bos
- Department of Medical Oncology, ErasmusMC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tom van der Hulle
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Roy I Lalisang
- Department of Internal Medicine, GROW-School of Oncology and Reproduction, Maastricht UMC, Maastricht, The Netherlands
| | - Janine Nuver
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - Mathilde C M Kouwenhoven
- Cancer Center Amsterdam (CCA), Amsterdam, The Netherlands
- Department of Neurology, Amsterdam University Medical Centers/University of Amsterdam, Amsterdam, The Netherlands
| | - Christianne A R Lok
- Department of Gynecologic Oncology, Center Gynaecologic Oncology Amsterdam, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - Catharina C M Beerendonk
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marij Dinkelman-Smit
- Department of Urology, ErasmusMC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Olga Husson
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Medical Oncology, ErasmusMC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
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Melin J, Holopainen E, Savolainen‐Peltonen H. Fertility counselling and fertility preservation among early onset female cancer patients-A Finnish register-based study. Cancer Med 2024; 13:e7034. [PMID: 38400669 PMCID: PMC10891448 DOI: 10.1002/cam4.7034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/24/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Advances in multimodality cancer treatments have increased long-term survival rates for early onset cancer patients, with 5-year survival rates reaching 80% in Northern Europe. According to recent recommendations, clinicians should, as early as possible, inform cancer patients about the impact that cancer treatment may have on their fertility. Still, there is limited published data on fertility counselling (FC) and fertility preservation (FP) for cancer patients. METHODS This register-based study used hospital records to identify female cancer patients in the hospital district (n = 192) who received FC at the age of 16-42 years between 2011 and 2019. RESULTS Altogether, 97 (50.5%) cancer patients were eligible for FP. Of these, 55 (56.7%) underwent FP, whereas 42 (43.3%) declined. Women undergoing FP were recommended cancer treatments with a higher risk of infertility (p = 0.01), and women with breast cancer were more prone to undergo FP than women with lymphoma (p = 0.043). In FP treatment cycles, the mean number of oocytes retrieved (13.9 ± 7.7 vs. 12.0 ± 6.5, p = 0.04) and transferrable embryos (4.7 ± 2.9 vs. 3.7 ± 2.8, p = 0.002) was higher among cancer patients compared to age-matched comparisons with male or tubal factor infertility. The total mean gonadotropin dose used was higher among cancer patients (2243 ± 963 IU vs. 1679 ± 765 IU, p < 0.001). CONCLUSION We conclude that a good ovarian response during FP can be achieved in female cancer patients.
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Affiliation(s)
- Johanna Melin
- Department of Obstetrics and GynecologyUniversity of Helsinki, Helsinki University HospitalHelsinkiFinland
- Monash Centre for Health Research and ImplementationSchool of public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Elina Holopainen
- Department of Obstetrics and GynecologyUniversity of Helsinki, Helsinki University HospitalHelsinkiFinland
| | - Hanna Savolainen‐Peltonen
- Department of Obstetrics and GynecologyUniversity of Helsinki, Helsinki University HospitalHelsinkiFinland
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Salama M, Jayasinghe Y. Editorial: Fertility preservation in the pediatric and adolescent populations, volume II. Front Endocrinol (Lausanne) 2024; 15:1372225. [PMID: 38362279 PMCID: PMC10867634 DOI: 10.3389/fendo.2024.1372225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/25/2024] [Indexed: 02/17/2024] Open
Affiliation(s)
- Mahmoud Salama
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, East Lansing, MI, United States
| | - Yasmin Jayasinghe
- Department of Obstetrics and Gynecology, University of Melbourne, Royal Women’s Hospital, Parkville, VIC, Australia
- Oncofertility Program, Royal Children’s Hospital, Melbourne, VIC, Australia
- Murdoch Children’s Research Institute, Melbourne, VIC, Australia
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Benvenuti C, Laot L, Grinda T, Lambertini M, Pistilli B, Grynberg M. Is controlled ovarian stimulation safe in patients with hormone receptor-positive breast cancer receiving neoadjuvant chemotherapy? ESMO Open 2024; 9:102228. [PMID: 38232611 PMCID: PMC10803916 DOI: 10.1016/j.esmoop.2023.102228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/19/2024] Open
Abstract
INTRODUCTION Controlled ovarian stimulation (COS) for oocyte/embryo cryopreservation is the method of choice for fertility preservation (FP) in young patients diagnosed with early-stage breast cancer (eBC). Nevertheless, some challenges still question its role, particularly in the neoadjuvant setting, where concerns arise about potential delay in the onset of anticancer treatment, and in hormone receptor-positive (HR+) disease, as cancer cells may proliferate under the estrogenic peak associated with stimulation. Therefore, this review aims to examine the available evidence on the safety of COS in eBC patients eligible for neoadjuvant treatment (NAT), particularly in HR+ disease. METHODS A comprehensive literature search was conducted to identify studies evaluating the feasibility and safety of COS in eBC and including patients referred to NAT and/or with HR+ disease. Time to NAT and survival outcomes were assessed. RESULTS Of the three matched cohort studies assessing the impact of COS on time to start NAT, only one reported a significant small delay in the cohort undergoing COS compared with the control group, whereas the other studies found no difference. Regarding survival outcomes, overall, no increased risk of recurrence or death was found, either in patients undergoing COS in the neoadjuvant setting regardless of HR expression or in HR+ disease regardless of the timing of COS relative to surgery. However, there are no data on the safety of COS in the specific combined scenario of HR+ disease undergoing NAT. CONCLUSION Neither the indication to NAT nor the HR positivity constitutes per se an a priori contraindication to COS. Shared decision making between clinicians and patients is essential to carefully weigh the risks and benefits in each individual case. Prospective studies designed to specifically investigate this issue are warranted.
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Affiliation(s)
- C Benvenuti
- Department of Medical Oncology, Gustave Roussy, Villejuif, France; Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - L Laot
- Department of Reproductive Medicine and Fertility Preservation, Université Paris-Saclay, Assistance Publique, Hôpitaux de Paris, Antoine Beclere Hospital, Clamart, France
| | - T Grinda
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova; Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - B Pistilli
- Department of Medical Oncology, Gustave Roussy, Villejuif, France.
| | - M Grynberg
- Department of Reproductive Medicine and Fertility Preservation, Université Sorbonne Paris Nord, Assistance Publique-Hôpitaux de Paris, Jean Verdier Hospital, Bondy, France
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Manning-Geist B, Grace MA, Sonoda Y. Trachelectomy and fertility-sparing procedures for early-stage cervical cancer: A state of the science review. Gynecol Oncol 2024; 181:179-182. [PMID: 38271868 DOI: 10.1016/j.ygyno.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Affiliation(s)
- Beryl Manning-Geist
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA.
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Kimmins S, Anderson RA, Barratt CLR, Behre HM, Catford SR, De Jonge CJ, Delbes G, Eisenberg ML, Garrido N, Houston BJ, Jørgensen N, Krausz C, Lismer A, McLachlan RI, Minhas S, Moss T, Pacey A, Priskorn L, Schlatt S, Trasler J, Trasande L, Tüttelmann F, Vazquez-Levin MH, Veltman JA, Zhang F, O'Bryan MK. Frequency, morbidity and equity - the case for increased research on male fertility. Nat Rev Urol 2024; 21:102-124. [PMID: 37828407 DOI: 10.1038/s41585-023-00820-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 10/14/2023]
Abstract
Currently, most men with infertility cannot be given an aetiology, which reflects a lack of knowledge around gamete production and how it is affected by genetics and the environment. A failure to recognize the burden of male infertility and its potential as a biomarker for systemic illness exists. The absence of such knowledge results in patients generally being treated as a uniform group, for whom the strategy is to bypass the causality using medically assisted reproduction (MAR) techniques. In doing so, opportunities to prevent co-morbidity are missed and the burden of MAR is shifted to the woman. To advance understanding of men's reproductive health, longitudinal and multi-national centres for data and sample collection are essential. Such programmes must enable an integrated view of the consequences of genetics, epigenetics and environmental factors on fertility and offspring health. Definition and possible amelioration of the consequences of MAR for conceived children are needed. Inherent in this statement is the necessity to promote fertility restoration and/or use the least invasive MAR strategy available. To achieve this aim, protocols must be rigorously tested and the move towards personalized medicine encouraged. Equally, education of the public, governments and clinicians on the frequency and consequences of infertility is needed. Health options, including male contraceptives, must be expanded, and the opportunities encompassed in such investment understood. The pressing questions related to male reproductive health, spanning the spectrum of andrology are identified in the Expert Recommendation.
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Affiliation(s)
- Sarah Kimmins
- Department of Pharmacology and Therapeutics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- The Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- The Département de Pathologie et Biologie Cellulaire, Université de Montréal, Montreal, Quebec, Canada
| | - Richard A Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Christopher L R Barratt
- Division of Systems Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Hermann M Behre
- Center for Reproductive Medicine and Andrology, University Hospital, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Sarah R Catford
- Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | | | - Geraldine Delbes
- Institut National de la Recherche Scientifique, Centre Armand-Frappier Sante Biotechnologie, Laval, Quebec, Canada
| | - Michael L Eisenberg
- Department of Urology and Obstetrics and Gynecology, Stanford University, Stanford, CA, USA
| | - Nicolas Garrido
- IVI Foundation, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Brendan J Houston
- School of BioSciences and Bio21 Institute, The University of Melbourne, Parkville, Melbourne, Australia
| | - Niels Jørgensen
- Department of Growth and Reproduction, International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Csilla Krausz
- Department of Experimental and Clinical Biomedical Sciences, 'Mario Serio', University of Florence, University Hospital of Careggi Florence, Florence, Italy
| | - Ariane Lismer
- Department of Pharmacology and Therapeutics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Robert I McLachlan
- Hudson Institute of Medical Research and the Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
- Monash IVF Group, Richmond, Victoria, Australia
| | - Suks Minhas
- Department of Surgery and Cancer Imperial, London, UK
| | - Tim Moss
- Healthy Male and the Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Allan Pacey
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Lærke Priskorn
- Department of Growth and Reproduction, International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Stefan Schlatt
- Centre for Reproductive Medicine and Andrology, University of Münster, Münster, Germany
| | - Jacquetta Trasler
- Departments of Paediatrics, Human Genetics and Pharmacology & Therapeutics, McGill University and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Leonardo Trasande
- Center for the Investigation of Environmental Hazards, Department of Paediatrics, NYU Grossman School of Medicine, New York, NY, USA
| | - Frank Tüttelmann
- Institute of Reproductive Genetics, University of Münster, Münster, Germany
| | - Mónica Hebe Vazquez-Levin
- Instituto de Biología y Medicina Experimental, Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina, Fundación IBYME, Buenos Aires, Argentina
| | - Joris A Veltman
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Feng Zhang
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
| | - Moira K O'Bryan
- School of BioSciences and Bio21 Institute, The University of Melbourne, Parkville, Melbourne, Australia.
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Ter Welle-Butalid ME, van Osch L, van Bree BE, Vriens IJH, Derhaag JG, de Die-Smulders CEM, Tjan-Heijnen VCG, van Golde RJT. Considerations of breast cancer survivors to return for embryo transfer after fertility preservation: A qualitative study. Eur J Obstet Gynecol Reprod Biol 2024; 293:27-31. [PMID: 38100938 DOI: 10.1016/j.ejogrb.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/20/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE To gain insight into the considerations of breast cancer survivors to return or not for embryo transfer after the use of fertility preservation. STUDY DESIGN This is a qualitative study with semi-structured interviews. The interviews were planned until saturation of themes had been achieved. Content analysis was used to analyze the data. Sixteen out of 35 approached women took part in this study. Interviews were conducted with women who had oocytes or embryos cryopreserved prior to breast cancer treatment at the Maastricht University Medical Center between 2008 and 2016. All women who had cryopreservation more than two years ago were invited for the interviews. Women who had recurrence of disease were excluded. In the interviews we hypothesized the situation 'suppose the menses would have been recovered completely' for women who still had chemotherapy-induced menopause or used an GnRH (Gonadotropin-releasing hormone) analogue. RESULTS Most women had a strong intrinsic motivation to pursue natural conception over the use of earlier cryopreserved oocytes or embryos. Time pressure was the most mentioned consideration to use cryopreserved oocytes or embryos. The wish to use pre-implantation genetic testing (PGT) in the presence of a germline BRCA1/2 mutation was another consideration to opt for embryo transfer. Furthermore, the physician's advice was an important motivation to choose for either natural conception or the use of cryopreserved oocytes or embryos. CONCLUSION Multiple considerations influence women's decision making on the mode of conception after breast cancer. Although it concerned a single-center study in a highly-selected population, insight into these considerations can help physicians to address these important topics in counseling these women.
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Affiliation(s)
- Maria Elena Ter Welle-Butalid
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Liesbeth van Osch
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Clinical Genetics, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Bo E van Bree
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Ingeborg J H Vriens
- GROW - School for Oncology and Reproduction, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Internal Medicine, Division of Medical Oncology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Josien G Derhaag
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Christine E M de Die-Smulders
- GROW - School for Oncology and Reproduction, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Clinical Genetics, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- GROW - School for Oncology and Reproduction, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Internal Medicine, Division of Medical Oncology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Ron J T van Golde
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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Lambertini M, Blondeaux E, Agostinetto E, Hamy AS, Kim HJ, Di Meglio A, Bernstein Molho R, Hilbers F, Pogoda K, Carrasco E, Punie K, Bajpai J, Ignatiadis M, Moore HCF, Phillips KA, Toss A, Rousset-Jablonski C, Peccatori FA, Renaud T, Ferrari A, Paluch-Shimon S, Fruscio R, Cui W, Wong SM, Vernieri C, Ruddy KJ, Dieci MV, Matikas A, Rozenblit M, Villarreal-Garza C, De Marchis L, Del Mastro L, Puglisi F, Del Pilar Estevez-Diz M, Rodriguez-Wallberg KA, Mrinakova B, Meister S, Livraghi L, Clatot F, Yerushalmi R, De Angelis C, Sánchez-Bayona R, Meattini I, Cichowska-Cwalińska N, Berlière M, Salama M, De Giorgi U, Sonnenblick A, Chiodi C, Lee YJ, Maria C, Azim HA, Boni L, Partridge AH. Pregnancy After Breast Cancer in Young BRCA Carriers: An International Hospital-Based Cohort Study. JAMA 2024; 331:49-59. [PMID: 38059899 PMCID: PMC10704340 DOI: 10.1001/jama.2023.25463] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/17/2023] [Indexed: 12/08/2023]
Abstract
Importance Young women with breast cancer who have germline pathogenic variants in BRCA1 or BRCA2 face unique challenges regarding fertility. Previous studies demonstrating the feasibility and safety of pregnancy in breast cancer survivors included limited data regarding BRCA carriers. Objective To investigate cumulative incidence of pregnancy and disease-free survival in young women who are BRCA carriers. Design, Setting, and Participants International, multicenter, hospital-based, retrospective cohort study conducted at 78 participating centers worldwide. The study included female participants diagnosed with invasive breast cancer at age 40 years or younger between January 2000 and December 2020 carrying germline pathogenic variants in BRCA1 and/or BRCA2. Last delivery was October 7, 2022; last follow-up was February 20, 2023. Exposure Pregnancy after breast cancer. Main Outcomes and Measures Primary end points were cumulative incidence of pregnancy after breast cancer and disease-free survival. Secondary end points were breast cancer-specific survival, overall survival, pregnancy, and fetal and obstetric outcomes. Results Of 4732 BRCA carriers included, 659 had at least 1 pregnancy after breast cancer and 4073 did not. Median age at diagnosis in the overall cohort was 35 years (IQR, 31-38 years). Cumulative incidence of pregnancy at 10 years was 22% (95% CI, 21%-24%), with a median time from breast cancer diagnosis to conception of 3.5 years (IQR, 2.2-5.3 years). Among the 659 patients who had a pregnancy, 45 (6.9%) and 63 (9.7%) had an induced abortion or a miscarriage, respectively. Of the 517 patients (79.7%) with a completed pregnancy, 406 (91.0%) delivered at term (≥37 weeks) and 54 (10.4%) had twins. Among the 470 infants born with known information on pregnancy complications, 4 (0.9%) had documented congenital anomalies. Median follow-up was 7.8 years (IQR, 4.5-12.6 years). No significant difference in disease-free survival was observed between patients with or without a pregnancy after breast cancer (adjusted hazard ratio, 0.99; 95% CI, 0.81-1.20). Patients who had a pregnancy had significantly better breast cancer-specific survival and overall survival. Conclusions and Relevance In this global study, 1 in 5 young BRCA carriers conceived within 10 years after breast cancer diagnosis. Pregnancy following breast cancer in BRCA carriers was not associated with decreased disease-free survival. Trial Registration ClinicalTrials.gov Identifier: NCT03673306.
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Affiliation(s)
- Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U. O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Eva Blondeaux
- U. O. Epidemiologia Clinica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Elisa Agostinetto
- Breast Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
| | - Anne-Sophie Hamy
- Department of Medical Oncology, Universite Paris Cité, Institut Curie, Paris, France
| | - Hee Jeong Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Antonio Di Meglio
- Cancer Survivorship Program–Molecular Predicitors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Rinat Bernstein Molho
- Susanne Levy Gertner Oncogenetics Unit, Danek Gertner Institute of Human Genetics, Chaim Sheba Medical Center Affiliated to Tel Aviv University, Tel Hashomer, Israel
| | - Florentine Hilbers
- Department of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Katarzyna Pogoda
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Estela Carrasco
- Hereditary Cancer Genetics Unit, Medical Oncology Department, Vall d´Hebron University Hospital, Vall d´Hebron Institute of Oncology, Barcelona, Spain
| | - Kevin Punie
- Department of General Medical Oncology and Multidisciplinary Breast Center, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Michail Ignatiadis
- Breast Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
| | - Halle C. F. Moore
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Kelly-Anne Phillips
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Angela Toss
- Department of Oncology and Haematology, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Fedro A. Peccatori
- Gynecologic Oncology Department, European Institute of Oncology (IRCCS), Milan, Italy
| | | | - Alberta Ferrari
- Hereditary Breast and Ovarian Cancer Unit and General Surgery 3–Senology, Surgical Department, Fondazione IRCCS Policlinico San Matteo, and University of Pavia, Pavia, Italy
| | - Shani Paluch-Shimon
- Breast Oncology Unit, Sharett Institute of Oncology, Hadassah University Hospital, and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Robert Fruscio
- UO Gynecology, Department of Medicine and Surgery, University of Milan–Bicocca, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Wanda Cui
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stephanie M. Wong
- Stroll Cancer Prevention Centre, Jewish General Hospital, and McGill University Medical School, Montreal, Quebec, Canada
| | - Claudio Vernieri
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- IFOM ETS, AIRC Institute of Molecular Oncology, Milan, Italy
| | - Kathryn J. Ruddy
- Department of Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Maria Vittoria Dieci
- Dipartimento di Scienze Chirurgiche, Oncologiche, e Gastroenterologiche, Università di Padova, Padova, Italy
- Oncologia 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Alexios Matikas
- Department of Oncology/Pathology, Karolinska Institute, and Breast Center, Karolinska University Hospital, Stockholm, Sweden
| | - Mariya Rozenblit
- Department of Medical Oncology, Smilow Cancer Hospital at Yale New Haven, New Haven, Connecticut
| | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion–TecSalud, Tecnologico de Monterrey, Monterrey, Mexico
| | - Laura De Marchis
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Rome, Italy
- Division of Oncology, Department of Hematology, Oncology, and Dermatology, Umberto 1 University Hospital, Rome, Italy
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U. O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Fabio Puglisi
- Department of Medical Oncology, Centro di Riferimento Oncologico di Avano (CRO) IRCCS, Aviano, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Maria Del Pilar Estevez-Diz
- Department of Radiology and Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Kenny A. Rodriguez-Wallberg
- Department of Oncology-Pathology, Laboratory of Translational Fertility Preservation, Karolinska Institute, Stockholm, Sweden
- Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Bela Mrinakova
- First Department of Oncology, Comenius University and St Elisabeth Cancer Institute, Bratislava, Slovakia
| | - Sarah Meister
- Department of Obstetrics and Gynecology, Ludwig Maximilian University (LMU) Hospital, LMU Munich, Germany
| | - Luca Livraghi
- Department of Medical Oncology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
- Department of Medical Oncology, Hospital of Prato, Azienda USL Toscana Centro, Italy
| | - Florian Clatot
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Rinat Yerushalmi
- Department of Medical Oncology, Davidoff Center, Rabin Medical Center, Petah Tikva, Tel Aviv University, Tel Aviv, Israel
| | - Carmine De Angelis
- Department of Medical Oncology, University of Naples Federico II, Napoli, Italy
| | | | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences M. Serio, University of Florence, and Radiation Oncology Unit, Oncology Department, Florence University Hospital, Florence, Italy
| | - Natalia Cichowska-Cwalińska
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
- Early Phase Clinical Trials Centre, Medical University of Gdańsk, Gdańsk, Poland
| | - Martine Berlière
- Department of Medical Oncology and Breast Surgery, Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Mahmoud Salama
- Oncofertility Consortium and Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Amir Sonnenblick
- Oncology Division, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Camila Chiodi
- Cancer Survivorship Program–Molecular Predicitors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Young-Jin Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Camille Maria
- Department of Medical Oncology, Universite Paris Cité, Institut Curie, Paris, France
| | - Hatem A. Azim
- Breast Cancer Center, Hospital Zambrano Hellion–TecSalud, Tecnologico de Monterrey, Monterrey, Mexico
- Cairo Oncology Center, Cairo, Egypt
| | - Luca Boni
- U. O. Epidemiologia Clinica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Ann H. Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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Mailankody S, Bajpai J, Arora PR, Sreedharan R, Chitalkar P, Kurkure P, Malhotra H, Parikh FR, Gupta S, Banavali SD. Oncofertility and Pregnancy in Adolescent and Young Adult Cancers: Physicians' Knowledge and Preferences in India. JCO Glob Oncol 2024; 10:e2300205. [PMID: 38207248 DOI: 10.1200/go.23.00205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/11/2023] [Accepted: 11/03/2023] [Indexed: 01/13/2024] Open
Abstract
PURPOSE The treatment outcomes of adolescent and young adult (AYA) cancers have improved with advanced oncology care. Hence, fertility preservation (FP) and post-therapy pregnancies (PTPs) become vital issues. MATERIALS AND METHODS An online survey link with 17 questions regarding oncofertility and PTPs was circulated among oncologists to assess the knowledge, understand the oncofertility care patterns, and seek suggestions to improve oncofertility services. RESULTS The median age of 179 respondents, predominantly medical oncologists (68.7%), was 37 years (IQR, 10; range, 29-74), working in academic centers (39%) having a median experience of 4 years (IQR, 4; range, 1-42); 23 (12.8%) had dedicated AYA cancer units. Although a quarter (19%-24%) of respondents discussed fertility issues in >90% of AYA patients with cancer, only a tenth (8%-11%) refer >90% for FP, with significantly higher (P < .05) discussions and referrals in males and by more experienced oncologists (P < .05). Forty-six (25.6%) were not well versed with international guidelines for FP. Most (122, 68.1%) oncologists knew about the referral path for semen cryopreservation; however, only 46% were knowledgeable about additional complex procedures. One hundred and ten (61.5%) oncologists never or rarely altered the systemic treatment for FP. Prominent barriers to FP were ignorance, lack of collaboration, and fear of delaying cancer treatment. Lead thrust areas identified to improve FP practices are education, and enhanced and affordable access to FP facilities. Seventy-four (41.3%) respondents knew about international guidelines for PTPs; however, only half (20%) of them often monitored fertility outcomes in survivors. Oncologists have conflicting opinions and uncertainties regarding pregnancy safety, assisted reproductive techniques, breastfeeding, and pregnancy outcomes among survivors. CONCLUSION Oncologists are uncertain about the guidelines, FP practices, referral pathways, and PTPs. Multipronged approaches to improve awareness and provision for affordable oncofertility facilities are needed to enhance AYA cancer outcomes in India, which will be applicable to other low- and middle-income countries too.
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Affiliation(s)
- Sharada Mailankody
- Department of Medical Oncology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Puneet R Arora
- Center for Infertility and Assisted Reproduction (CIFAR), Gurugram, India
| | | | - Prakash Chitalkar
- Department of Medical Oncology, Sri Aurobindo Institute of Medical Sciences, Indore, India
| | - Purna Kurkure
- Oncology Collegium, Narayana Health, SRCC Children Hospital, Mumbai, India
| | - Hemant Malhotra
- Department of Medical Oncology, Sri Ram Cancer Center, Mahatma Gandhi Medical College Hospital, Jaipur, India
| | - Firuza R Parikh
- IVF and Reproductive Medicine, Jaslok Hospital, Mumbai, India
- Well Women Centre, HN Reliance Hospital, Mumbai, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Shripad D Banavali
- Department of Medical Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
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Shvygin A, Manning-Geist BL, Sonoda Y. Fertility-sparing and minimally invasive surgery for early-stage cervical cancer. J Surg Oncol 2024; 129:112-116. [PMID: 38032090 DOI: 10.1002/jso.27540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Anna Shvygin
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, USA
| | - Beryl L Manning-Geist
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yukio Sonoda
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Dias Nunes J, Demeestere I, Devos M. BRCA Mutations and Fertility Preservation. Int J Mol Sci 2023; 25:204. [PMID: 38203374 PMCID: PMC10778779 DOI: 10.3390/ijms25010204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Hereditary cancers mostly affect the adolescent and young adult population (AYA) at reproductive age. Mutations in BReast CAncer (BRCA) genes are responsible for the majority of cases of hereditary breast and ovarian cancer. BRCA1 and BRCA2 act as tumor suppressor genes as they are key regulators of DNA repair through homologous recombination. Evidence of the accumulation of DNA double-strand break has been reported in aging oocytes, while BRCA expression decreases, leading to the hypothesis that BRCA mutation may impact fertility. Moreover, patients exposed to anticancer treatments are at higher risk of fertility-related issues, and BRCA mutations could exacerbate the treatment-induced depletion of the ovarian reserve. In this review, we summarized the functions of both genes and reported the current knowledge on the impact of BRCA mutations on ovarian ageing, premature ovarian insufficiency, female fertility preservation strategies and insights about male infertility. Altogether, this review provides relevant up-to-date information on the impact of BRCA1/2 mutations on fertility. Notably, BRCA-mutated patients should be adequately counselled for fertility preservation strategies, considering their higher sensitivity to chemotherapy gonadotoxic effects.
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Affiliation(s)
- Joana Dias Nunes
- Research Laboratory on Human Reproduction, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium; (J.D.N.); (M.D.)
| | - Isabelle Demeestere
- Research Laboratory on Human Reproduction, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium; (J.D.N.); (M.D.)
- Fertility Clinic, HUB-Erasme Hospital, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium
| | - Melody Devos
- Research Laboratory on Human Reproduction, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium; (J.D.N.); (M.D.)
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Chen L, Shen J, Jiang H, Lin H, He J, Fan S, Yang L, Yu D, Qiu R, Lin E. Incidence and influencing factors of fertility concerns in breast cancer in young women: a systematic review and meta-analysis. Front Oncol 2023; 13:1273529. [PMID: 38173831 PMCID: PMC10763242 DOI: 10.3389/fonc.2023.1273529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
Objective This systematic review and meta-analysis aimed to evaluate the prevalence and influencing factors of fertility concerns in breast cancer in young women. Methods A literature search on PubMed, Embase, Web of Science, and Cochrane Library databases was conducted up to February 2023 and was analyzed (Revman 5.4 software) in this study. The papers were chosen based on inclusion standards, and two researchers independently extracted the data. The included studies' quality was evaluated using criteria set out by the Agency for Healthcare Research and Quality. To identify significant variations among the risk factors, odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) were utilized. Results A total of 7 studies that included 1579 breast cancer in young women were enrolled in the study. The results showed that for breast cancer in young women, the incidence of fertility concerns 53%(95%CI [0.45,0.58]). The results showed that education (2.65, 95% CI 1.65-5.63), full-time work (0.12, 95% CI 1.03-1.93), fertility intentions (7.84, 95% CI 1.50-37.4), depression level (1.25, 95% CI 1.03-1.5), and endocrine therapy (1.32, 95% CI 1.08-1.62) were risk factors for fertility concerns in young women with BC. Having a partner (0.41, 95% CI 0.33-0.5), ≥1 child (0.3, 95% CI 0.22-0.4) were identified as protective factors against fertility concerns in young women with BC. Conclusions The incidence of fertility concerns in breast cancer in young women is at a moderately high level. We should pay more attention to the risk factors of fertility concerns to help breast cancer in young women cope with their fertility concerns and promote their psychological well-being.
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Affiliation(s)
- Lijuan Chen
- Department of General Surgery, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen, China
| | - Jiali Shen
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Hongzhan Jiang
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Huihui Lin
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jiaxi He
- School of Medicine, Xiamen University, Xiamen, China
| | - Siyue Fan
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Liping Yang
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Doudou Yu
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Rongliang Qiu
- The Third Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Ende Lin
- Department of General Surgery, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen, China
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Ruan X. Chinese Expert Consensus on ovarian function and fertility preservation of cervical cancer in pregnancy (2023). Front Endocrinol (Lausanne) 2023; 14:1280631. [PMID: 38152134 PMCID: PMC10751331 DOI: 10.3389/fendo.2023.1280631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/08/2023] [Indexed: 12/29/2023] Open
Abstract
Cervical cancer in pregnancy (CCIP) refers to cervical cancer diagnosed during pregnancy, the most common gynecological malignant tumor. Because of the special physiological changes of CCIP, although preserving ovarian function and fertility is very important, the methods are very limited. There is no guideline or consensus on the preservation methods of ovarian function and fertility in this special period. Therefore, the Committee of Fertility Protection and Preservation of China Association for the Promotion of Health Science and Technology, combined with the Chinese Society of Gynecological Endocrinology affiliated to the International Society of Gynecological Endocrinology, Society Endocrinology Branch of Beijing Institute of Obstetrics & Gynecology, combined with Society on Fertility Preservation affiliated with the Chinese Preventive Medicine Association, organized relevant experts from different disciplines to formulate this consensus, in order to guide ovarian function and fertility preservation of CCIP patients.
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Affiliation(s)
- Xiangyan Ruan
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
- Department of Women’s Health, University of Tuebingen, University Women’s Hospital and Research Centre for Women’s Health, Tuebingen, Germany
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Rodriguez-Wallberg KA, Nilsson HP, Bergh J, Malmros J, Ljungman P, Foukakis T, Stragliotto CL, Friman EI, Linderholm B, Valachis A, Andersson A, Harrysson S, Vennström L, Frisk P, Mörse H, Eloranta S. ProFertil study protocol for the investigation of gonadotropin-releasing hormone agonists (GnRHa) during chemotherapy aiming at fertility protection of young women and teenagers with cancer in Sweden-a phase III randomised double-blinded placebo-controlled study. BMJ Open 2023; 13:e078023. [PMID: 38070906 PMCID: PMC10728964 DOI: 10.1136/bmjopen-2023-078023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/31/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Gonadotropin-releasing hormone agonists (GnRHa) cotreatment used to transiently suppress ovarian function during chemotherapy to prevent ovarian damage and preserve female fertility is used globally but efficacy is debated. Most clinical studies investigating a beneficial effect of GnRHa cotreatment on ovarian function have been small, retrospective and uncontrolled. Unblinded randomised studies on women with breast cancer have suggested a beneficial effect, but results are mixed with lack of evidence of improvement in markers of ovarian reserve. Unblinded randomised studies of women with lymphoma have not shown any benefit regarding fertility markers after long-term follow-up and no placebo-controlled study has been conducted so far. The aim of this study is to investigate if administration of GnRHa during cancer treatment can preserve fertility in young female cancer patients in a double-blind, placebo-controlled clinical trial. METHODS AND ANALYSIS A prospective, randomised, double-blinded, placebo-controlled, phase III study including 300 subjects with breast cancer. In addition, 200 subjects with lymphoma, acute leukemias and sarcomas will be recruited. Women aged 14-42 will be randomised 1:1 to treatment with GnRHa (triptorelin) or placebo for the duration of their gonadotoxic chemotherapy. Follow-up until 5 years from end of treatment (EoT). The primary endpoint will be change in anti-Müllerian hormone (AMH) recovery at follow-up 12 months after EoT, relative to AMH levels at EoT, comparing the GnRHa group and the placebo group in women with breast cancer. ETHICS AND DISSEMINATION This study is designed in accordance with the principles of Good Clinical Practice (ICH-GCP E6 (R2)), local regulations (ie, European Directive 2001/20/EC) and the ethical principles of the Declaration of Helsinki. Within 6 months of study completion, the results will be analysed and the study results shall be reported in the EudraCT database. STUDY REGISTRATION The National Institutional review board in Sweden dnr:2021-03379, approval date 12 October 2021 (approved amendments 12 June 2022, dnr:2022-02924-02 and 13 December 2022, dnr:2022-05565-02). The Swedish Medical Product Agency 19 January 2022, Dnr:5.1-2021-98927 (approved amendment 4 February 2022). Manufacturing authorisation for authorised medicinal products approved 6 December 2021, Dnr:6.2.1-2020-079580. Stockholm Medical Biobank approved 22 June 2022, RBC dnr:202 253. TRIAL REGISTRATION NUMBER NCT05328258; EudraCT number:2020-004780-71.
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Affiliation(s)
- Kenny A Rodriguez-Wallberg
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
- Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | - Jonas Bergh
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
- Theme cancer, Karolinska Comprehensive Cancer Center and University Hospital, Stockholm, Sweden
| | - Johan Malmros
- Pediatric Theme Astrid Lindgren's Pediatric Hospital, Stockholm, Sweden
| | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden
- Division of Hematology, Department of Medicine Huddinge, Karolinska Institute, Huddinge, Sweden
| | - Theodoros Foukakis
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
- Theme cancer, Karolinska Comprehensive Cancer Center and University Hospital, Stockholm, Sweden
| | | | | | - Barbro Linderholm
- Department of Oncology, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Antonis Valachis
- Oncology, Örebro universitet Fakulteten för medicin och hälsa, Orebro, Sweden
| | - Anne Andersson
- Department of Oncology, Norrlands University Hospital, Umeå, Sweden
| | - Sara Harrysson
- Department of Hematology, Cancer Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Lovisa Vennström
- Department of Hematology and Coagulation, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Per Frisk
- Akademiska Hospital, Uppsala, Sweden
| | - Helena Mörse
- Center for Pediatric Oncology, Skåne University Hospital, Lund, Sweden
| | - Sandra Eloranta
- Department of Medicine, Karolinska Institute, Solna, Sweden
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
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Im C, Lu Z, Mostoufi-Moab S, Delaney A, Yu L, Baedke JL, Han Y, Sapkota Y, Yasui Y, Chow EJ, Howell RM, Bhatia S, Hudson MM, Ness KK, Armstrong GT, Nathan PC, Yuan Y. Development and validation of age-specific risk prediction models for primary ovarian insufficiency in long-term survivors of childhood cancer: a report from the Childhood Cancer Survivor Study and St Jude Lifetime Cohort. Lancet Oncol 2023; 24:1434-1442. [PMID: 37972608 PMCID: PMC10842148 DOI: 10.1016/s1470-2045(23)00510-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Female survivors of childhood cancer are at risk for primary ovarian insufficiency (POI), defined as the cessation of gonadal function before the age of 40 years. We aimed to develop and validate models to predict age-specific POI risk among long-term survivors of childhood cancer. METHODS To develop models to predict age-specific POI risk for the ages of 21-40 years, we used data from the Childhood Cancer Survivor Study (CCSS). Female survivors aged 18 years or older at their latest follow-up, with self-reported menstrual history information and free of subsequent malignant neoplasms within 5 years of diagnosis, were included. We evaluated models that used algorithms based on statistical or machine learning to consider all predictors, including cancer treatments. Cross-validated prediction performance metrics (eg, area under the receiver operating characteristic curve [AUROC]) were compared to select the best-performing models. For external validation of the models, we used data from 5-year survivors in the St Jude Lifetime Cohort (SJLIFE) with ovarian status clinically ascertained using hormone measurements (menopause defined by follicle stimulating hormone >30 mIU/mL and oestradiol <17 pg/mL) and medical chart or questionnaire review. We also evaluated an SJLIFE-based polygenic risk score for POI among 1985 CCSS survivors with genotype data available. FINDINGS 7891 female CCSS survivors (922 with POI) were included in the development of the POI risk prediction model, and 1349 female SJLIFE survivors (101 with POI) were included in the validation study. Median follow-up from cancer diagnosis was 23·7 years (IQR 18·3-30·0) in CCSS and 15·1 years (10·4-22·9) in SJLIFE. Between the ages of 21 and 40 years, POI prevalence increased from 7·9% (95% CI 7·3-8·5) to 18·6% (17·3-20·0) in CCSS and 7·3% (5·8-8·9) to 14·9% (11·6-19·1) in SJLIFE. Age-specific logistic regression models considering ovarian radiation dosimetry or prescribed pelvic and abdominal radiation dose, along with individual chemotherapy predictors, performed well in CCSS. In the SJLIFE validation, the prescribed radiation dose model performed well (AUROC 0·88-0·95), as did a simpler model that considered any exposures to pelvic or abdominal radiotherapy or alkylators (0·82-0·90). Addition of the polygenic risk predictor significantly improved the average positive predictive value (from 0·76 [95% CI 0·63-0·89] to 0·87 [0·80-0·94]; p=0·029) among CCSS survivors treated with ovarian radiation and chemotherapy. INTERPRETATION POI risk prediction models using treatment information showed robust prediction performance in adult survivors of childhood cancer. FUNDING Canadian Institutes of Health Research, US National Cancer Institute.
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Affiliation(s)
- Cindy Im
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Zhe Lu
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Sogol Mostoufi-Moab
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Angela Delaney
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA; Division of Endocrinology, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Lin Yu
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Jessica L Baedke
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Yutong Han
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Yadav Sapkota
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Eric J Chow
- Public Health Sciences and Clinical Research Divisions, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Rebecca M Howell
- Department of Radiation Physics, University of Texas at MD Anderson Cancer Center, Houston, TX, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Paul C Nathan
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Yan Yuan
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
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