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Arecco L, Blondeaux E, Bruzzone M, Latocca MM, Mariamidze E, Begijanashvili S, Sokolovic E, Gentile G, Scavone G, Ottonello S, Boutros A, Vaz-Luis I, Saura C, Anderson RA, Demeestere I, Azim HA, de Azambuja E, Peccatori FA, Del Mastro L, Partridge AH, Lambertini M. Safety of pregnancy after breast cancer in young women with hormone receptor-positive disease: a systematic review and meta-analysis. ESMO Open 2023; 8:102031. [PMID: 37879234 PMCID: PMC10774870 DOI: 10.1016/j.esmoop.2023.102031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 09/13/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Despite increasing evidence on the safety of pregnancy after anticancer treatments in breast cancer survivors, many physicians and patients remain concerned about a potential risk of pregnancy specifically in the case of hormone receptor-positive breast cancer. MATERIALS AND METHODS A systematic literature search of Medline, Embase and Cochrane library with no language or date restriction up to 31 March 2023 was carried out. To be included, articles had to be retrospective and prospective case-control and cohort studies as well as clinical trials comparing survival outcomes of premenopausal women with or without a pregnancy after prior diagnosis of hormone receptor-positive breast cancer. Disease-free survival (DFS) and overall survival (OS) were the outcomes of interest. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. Study protocol is registered in PROSPERO (n. CRD42023394232). RESULTS Out of 7796 screened studies, 8 were eligible to be included in the final analysis. A total of 3805 patients with hormone receptor-positive invasive early breast cancer were included in these studies, of whom 1285 had a pregnancy after breast cancer diagnosis. Median follow-up time ranged from 3.8 to 15.8 years and was similar in the pregnancy and non-pregnancy cohorts. In three studies (n = 987 patients) reporting on DFS, no difference was observed between patients with and those without a subsequent pregnancy (HR 0.96, 95% CI 0.75-1.24, P = 0.781). In the six studies (n = 3504 patients) reporting on OS, patients with a pregnancy after breast cancer had a statistically significant better OS than those without a pregnancy (HR 0.46, 95% CI 0.27-0.77, P < 0.05). CONCLUSIONS This systematic review and meta-analysis of retrospective cohort studies provides updated evidence that having a pregnancy in patients with prior history of hormone receptor-positive invasive early breast cancer appears safe without detrimental effect on prognosis.
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Affiliation(s)
- L Arecco
- 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. https://twitter.com/Lucarecco
| | - E Blondeaux
- U.O. Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - M Bruzzone
- U.O. Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - M M Latocca
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova
| | - E Mariamidze
- Department of Oncology and Hematology, Todua Clinic, Tbilisi
| | - S Begijanashvili
- Department of Clinical Oncology, American Hospital, Tbilisi, Georgia
| | - E Sokolovic
- Clinic of Oncology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - G Gentile
- Medical Oncology Unit B, Department of Radiology, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome
| | - G Scavone
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova
| | - S Ottonello
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova
| | - A Boutros
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova; Department of Medical Oncology, Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - I Vaz-Luis
- Unit 981-Molecular Predictors and New Targets in Oncology, Interdisciplinary Department for the Organization of Patient Pathways (DIOPP), INSERM and Institut Gustave Roussy, Paris, France
| | - C Saura
- Breast Cancer Unit, Medical Oncology Service, Vall d'Hebron University Hospital, Barcelona, Spain
| | - R A Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - I Demeestere
- Research Laboratory on Human Reproduction, Fertility Clinic (HUB-Erasme), Brussels, Belgium
| | - H A Azim
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - E de Azambuja
- Academic Trials Promoting Team, Institut Jules Bordet and l'Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - F A Peccatori
- Fertility and Procreation Unit, Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - L Del Mastro
- 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
| | - A H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - 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.
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Favero D, Lapuchesky LS, Poggio F, Nardin S, Perachino M, Arecco L, Scavone G, Ottonello S, Latocca MM, Borea R, Puglisi S, Cosso M, Fozza A, Spinaci S, Lambertini M. Choosing the appropriate pharmacotherapy for breast cancer during pregnancy: what needs to be considered? Expert Opin Pharmacother 2023; 24:1975-1984. [PMID: 38179613 DOI: 10.1080/14656566.2023.2293167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 12/06/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Breast cancer is the most commonly diagnosed malignancy during pregnancy. Breast cancer during pregnancy is a challenging clinical condition requiring proper and timely multidisciplinary management. AREAS COVERED This review focuses on the management of breast cancer during pregnancy with a focus about the current state-of-the-art on the feasibility and safety of pharmacotherapy approaches in this setting. EXPERT OPINION Multidisciplinary care is key for a proper diagnostic-therapeutic management of breast cancer during pregnancy. Engaging patients and their caregivers in the decision-making process is essential and psychological support should be provided. The treatment of patients with breast cancer during pregnancy should follow the same recommendations as those for breast cancer in young women outside pregnancy but taking into account the gestational age at the time of treatment.Anthracycline-, cyclophosphamide-, and taxane-based regimens can be safely administered during the second and third trimesters with standard protocols, preferring weekly regimens whenever possible. Endocrine therapy, immune checkpoint inhibitors, and targeted agents are contraindicated throughout pregnancy, also due to the very limited data available to guide their administration in this setting. During treatment, careful fetal growth monitoring is mandatory, and even after delivery proper health monitoring for the children exposed in utero to chemotherapy should be continued.
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Affiliation(s)
- Diletta Favero
- Department of Internal Medicine and Medical Specialties (Di.M.I.), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Laura Sabina Lapuchesky
- Department of Medical Oncology, Instituto Alexander Fleming, University of Buenos Aires, Buenos Aires, Argentina
| | - Francesca Poggio
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Simone Nardin
- Department of Internal Medicine and Medical Specialties (Di.M.I.), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marta Perachino
- Department of Internal Medicine and Medical Specialties (Di.M.I.), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Luca Arecco
- Department of Internal Medicine and Medical Specialties (Di.M.I.), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Graziana Scavone
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Silvia Ottonello
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Maddalena Latocca
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Roberto Borea
- Department of Internal Medicine and Medical Specialties (Di.M.I.), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Silvia Puglisi
- Department of Internal Medicine and Medical Specialties (Di.M.I.), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maurizio Cosso
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandra Fozza
- Department of Radiotherapy, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Stefano Spinaci
- Division of Breast Surgery, Ospedale Villa Scassi, Genoa, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (Di.M.I.), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Lambertini M, Ceppi M, Anderson RA, Cameron DA, Bruzzone M, Franzoi MA, Massarotti C, El-Abed S, Wang Y, Lecocq C, Nuciforo P, Rolyance R, Pusztai L, Sohn J, Latocca MM, Arecco L, Pistilli B, Ruddy KJ, Ballestrero A, Del Mastro L, Peccatori FA, Partridge AH, Saura C, Untch M, Piccart M, Di Cosimo S, de Azambuja E, Demeestere I. Impact of Anti-HER2 Therapy Alone and With Weekly Paclitaxel on the Ovarian Reserve of Young Women With HER2-Positive Breast Cancer. J Natl Compr Canc Netw 2023; 21:33-41.e16. [PMID: 36634607 DOI: 10.6004/jnccn.2022.7065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/09/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND The potential gonadotoxicity of anti-HER2 agents remains largely unknown, and limited, conflicting evidence exists for taxanes. Antimüllerian hormone (AMH) is an established biomarker of ovarian reserve that may aid in quantifying anticancer treatment-induced gonadotoxicity. PATIENTS AND METHODS The present biomarker analysis of the randomized phase III neoadjuvant NeoALTTO trial included premenopausal women aged ≤45 years at diagnosis of HER2-positive early breast cancer with available frozen serum samples at baseline (ie, before anticancer treatments), at week 2 (ie, the "biological window" of anti-HER2 therapy alone), and/or at the time of surgery (ie, after completing paclitaxel + anti-HER2 therapy, before starting adjuvant chemotherapy). RESULTS The present analysis included 130 patients with a median age of 38 years (interquartile ratio [IQR], age 33-42 years). AMH values at the 3 time points differed significantly (P<.001). At baseline, median AMH levels were 1.29 ng/mL (IQR, 0.56-2.62 ng/mL). At week 2, a small but significant reduction in AMH levels was observed (median, 1.10 ng/mL; IQR, 0.45-2.09 ng/mL; P<.001). At surgery, a larger significant decline in AMH levels was observed (median, 0.01 ng/mL; IQR, 0.01-0.03 ng/mL; P<.001). Although the type of anti-HER2 treatment (trastuzumab and/or lapatinib) did not seem to impact the results, age and pretreatment ovarian reserve had a major influence on treatment-induced gonadotoxicity risk. CONCLUSIONS This NeoALTTO biomarker analysis showed that anti-HER2 therapies alone had limited gonadotoxicity but that the addition of weekly paclitaxel resulted in marked AMH decline with possible negative implications for subsequent ovarian function and fertility.
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Affiliation(s)
- Matteo Lambertini
- School of Medicine, University of Genova, Genova, Italy.,UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Richard A Anderson
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - David A Cameron
- Institute of Genomics and Cancer, The University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Claudia Massarotti
- IRCCS Ospedale Policlinico San Martino, Genova, Italy.,University of Genova, Genova, Italy
| | | | | | | | - Paolo Nuciforo
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, SOLTI BC Cooperative Group, Barcelona, Spain
| | | | | | - Joohyuk Sohn
- Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Maria Maddalena Latocca
- School of Medicine, University of Genova, Genova, Italy.,UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Luca Arecco
- School of Medicine, University of Genova, Genova, Italy.,UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | | | - Alberto Ballestrero
- School of Medicine, University of Genova, Genova, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Lucia Del Mastro
- School of Medicine, University of Genova, Genova, Italy.,UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Ann H Partridge
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Cristina Saura
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, SOLTI BC Cooperative Group, Barcelona, Spain
| | | | - Martine Piccart
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Evandro de Azambuja
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Isabelle Demeestere
- Fertility Clinic, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Arecco L, Blondeaux E, Bruzzone M, Ceppi M, Latocca MM, Marrocco C, Boutros A, Spagnolo F, Razeti MG, Favero D, Spinaci S, Condorelli M, Massarotti C, Goldrat O, Del Mastro L, Demeestere I, Lambertini M. Safety of fertility preservation techniques before and after anticancer treatments in young women with breast cancer: a systematic review and meta-analysis. Hum Reprod 2022; 37:954-968. [PMID: 35220429 PMCID: PMC9071231 DOI: 10.1093/humrep/deac035] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/19/2022] [Indexed: 11/25/2022] Open
Abstract
STUDY QUESTION Is it safe to perform controlled ovarian stimulation (COS) for fertility preservation before starting anticancer therapies or ART after treatments in young breast cancer patients? SUMMARY ANSWER Performing COS before, or ART following anticancer treatment in young women with breast cancer does not seem to be associated with detrimental prognostic effect in terms of breast cancer recurrence, mortality or event-free survival (EFS). WHAT IS KNOWN ALREADY COS for oocyte/embryo cryopreservation before starting chemotherapy is standard of care for young women with breast cancer wishing to preserve fertility. However, some oncologists remain concerned on the safety of COS, particularly in patients with hormone-sensitive tumors, even when associated with aromatase inhibitors. Moreover, limited evidence exists on the safety of ART in breast cancer survivors for achieving pregnancy after the completion of anticancer treatments. STUDY DESIGN, SIZE, DURATION The present systematic review and meta-analysis was carried out by three blinded investigators using the keywords 'breast cancer' and 'fertility preservation'; keywords were combined with Boolean operators. Eligible studies were identified by a systematic literature search of Medline, Web of Science, Embase and Cochrane library with no language or date restriction up to 30 June 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS To be included in this meta-analysis, eligible studies had to be case-control or cohort studies comparing survival outcomes of women who underwent COS or ART before or after breast cancer treatments compared to breast cancer patients not exposed to these strategies. Survival outcomes of interest were cancer recurrence rate, relapse rate, overall survival and number of deaths. Adjusted relative risk (RR) and hazard ratio (HR) with 95% CI were extracted. When the number of events for each group were available but the above measures were not reported, HRs were estimated using the Watkins and Bennett method. We excluded case reports or case series with <10 patients and studies without a control group of breast cancer patients who did not pursue COS or ART. Quality of data and risk of bias were assessed using the Newcastle-Ottawa Assessment Scale. MAIN RESULTS AND THE ROLE OF CHANCE A total of 1835 records were retrieved. After excluding ineligible publications, 15 studies were finally included in the present meta-analysis (n = 4643). Among them, 11 reported the outcomes of breast cancer patients who underwent COS for fertility preservation before starting chemotherapy, and 4 the safety of ART following anticancer treatment completion. Compared to women who did not receive fertility preservation at diagnosis (n = 2386), those who underwent COS (n = 1594) had reduced risk of recurrence (RR 0.58, 95% CI 0.46-0.73) and mortality (RR 0.54, 95% CI 0.38-0.76). No detrimental effect of COS on EFS was observed (HR 0.76, 95% CI 0.55-1.06). A similar trend of better outcomes in terms of EFS was observed in women with hormone-receptor-positive disease who underwent COS (HR 0.36, 95% CI 0.20-0.65). A reduced risk of recurrence was also observed in patients undergoing COS before neoadjuvant chemotherapy (RR 0.22, 95% CI 0.06-0.80). Compared to women not exposed to ART following completion of anticancer treatments (n = 540), those exposed to ART (n = 123) showed a tendency for better outcomes in terms of recurrence ratio (RR 0.34, 95% CI 0.17-0.70) and EFS (HR 0.43, 95% CI 0.17-1.11). LIMITATIONS, REASONS FOR CAUTION This meta-analysis is based on abstracted data and most of the studies included are retrospective cohort studies. Not all studies had matching criteria between the study population and the controls, and these criteria often differed between the studies. Moreover, rate of recurrence is reported as a punctual event and it is not possible to establish when recurrences occurred and whether follow-up, which was shorter than 5 years in some of the included studies, is adequate to capture late recurrences. WIDER IMPLICATIONS OF THE FINDINGS Our results demonstrate that performing COS at diagnosis or ART following treatment completion does not seem to be associated with detrimental prognostic effect in young women with breast cancer, including among patients with hormone receptor-positive disease and those receiving neoadjuvant chemotherapy. STUDY FUNDING/COMPETING INTEREST(S) Partially supported by the Associazione Italiana per la Ricerca sul Cancro (AIRC; grant number MFAG 2020 ID 24698) and the Italian Ministry of Health-5 × 1000 funds 2017 (no grant number). M.L. acted as consultant for Roche, Pfizer, Novartis, Lilly, AstraZeneca, MSD, Exact Sciences, Gilead, Seagen and received speaker honoraria from Roche, Pfizer, Novartis, Lilly, Ipsen, Takeda, Libbs, Knight, Sandoz outside the submitted work. F.S. acted as consultant for Novartis, MSD, Sun Pharma, Philogen and Pierre Fabre and received speaker honoraria from Roche, Novartis, BMS, MSD, Merck, Sun Pharma, Sanofi and Pierre Fabre outside the submitted work. I.D. has acted as a consultant for Roche, has received research grants from Roche and Ferring, has received reagents for academic clinical trial from Roche diagnostics, speaker's fees from Novartis, and support for congresses from Theramex and Ferring outside the submitted work. L.D.M. reported honoraria from Roche, Novartis, Eli Lilly, MSD, Pfizer, Ipsen, Novartis and had an advisory role for Roche, Eli Lilly, Novartis, MSD, Genomic Health, Pierre Fabre, Daiichi Sankyo, Seagen, AstraZeneca, Eisai outside the submitted work. The other authors declare no conflict of interest. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript and decision to submit the manuscript for publication. REGISTRATION NUMBER N/A.
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Affiliation(s)
- L Arecco
- U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - E Blondeaux
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy
- U.O.S.D. Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - M Bruzzone
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - M Ceppi
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - M M Latocca
- U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - C Marrocco
- U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - A Boutros
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy
- U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - F Spagnolo
- U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - M G Razeti
- U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - D Favero
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy
- U.O.S.D. Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - S Spinaci
- Breast Unit, Ospedale Villa Scassi, Genova, Italy
| | - M Condorelli
- Department of Obstetrics and Gynecology, Hôpital Erasme, Université Libre de Bruxelles (U.L.B), Brussels, Belgium
- Research Laboratory on Human Reproduction, Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - C Massarotti
- Physiopathology of Human Reproduction Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), School of Medicine, University of Genova, Genova, Italy
| | - O Goldrat
- Department of Obstetrics and Gynecology, Hôpital Erasme, Université Libre de Bruxelles (U.L.B), Brussels, Belgium
- Research Laboratory on Human Reproduction, Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - L Del Mastro
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy
- U.O.S.D. Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - I Demeestere
- Department of Obstetrics and Gynecology, Hôpital Erasme, Université Libre de Bruxelles (U.L.B), Brussels, Belgium
- Research Laboratory on Human Reproduction, Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - M Lambertini
- U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy
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5
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Arecco L, Blondeaux E, Bruzzone M, Ceppi M, Latocca MM, Boutros A, Marrocco C, Razeti MG, Cosso M, Spinaci S, Condorelli M, Massarotti C, Mastro LD, Demeestere I, Lambertini M. Abstract PD5-07: Safety of assisted reproductive technologies before and after anticancer treatments in young women with breast cancer: A systematic review and meta-analysis. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-pd5-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Controlled ovarian stimulation (COS) for oocyte/embryo cryopreservation before starting chemotherapy is standard of care for young women with breast cancer wishing to preserve fertility. However, some oncologists remain concerned on the safety of COS, particularly in patients with hormone-sensitive tumors. Moreover, limited evidence exists on the safety of assisted reproductive technologies (ART) in breast cancer survivors after completion of anticancer treatments. Material and methods: A systematic literature review with no date restriction up to June 30, 2021 was conducted to identify studies reporting results of oncological outcomes in breast cancer patients and survivors who underwent COS or other ART compared to patients and survivors who did not access these techniques. From each included study, recurrence ratio, event-free survival (EFS) and mortality rate were extracted. Pooled relative risks (RRs) and hazard ratios (HRs) with 95% confidence intervals (CI) were calculated using the random effects models. Results: Out of 15 included studies (n=4,643), 11 reported outcomes of patients who underwent COS for fertility preservation before starting chemotherapy, and 4 of survivors who underwent ART following anticancer treatment completion. Compared to women who did not receive fertility preservation at diagnosis (n=2,386), those who underwent COS (n=1,594) had reduced risk of recurrence (RR 0.58, 95% CI 0.46-0.73) or mortality (RR 0.54, 95% CI 0.38-0.76). No detrimental effect of COS on EFS was observed (HR 0.76, 95% CI 0.55-1.06). A similar trend of better outcomes in terms of EFS was observed in women with hormone-receptor positive disease who underwent COS (HR 0.36, 95% CI 0.20-0.65).Compared to women not exposed to ART following completion of anticancer treatments (n=540), those exposed to ART (n=123) showed a tendency for better outcomes in terms of recurrence ratio (RR 0.34, 95% CI 0.17-0.70) and EFS (HR 0.43, 95% CI 0.17-1.11). Conclusions: Despite including mostly retrospective studies, this meta-analysis suggests that accessing COS at diagnosis, also in hormone receptor-positive disease, or ART following treatment completion is not associated with detrimental prognostic effect in young women with breast cancer. These results are important to reassure patients and oncologists on the safety of these procedures to increase the chances of future conception.
Citation Format: Luca Arecco, Eva Blondeaux, Marco Bruzzone, Marcello Ceppi, Maria Maddalena Latocca, Andrea Boutros, Camilla Marrocco, Maria Grazia Razeti, Maurizio Cosso, Stefano Spinaci, Margherita Condorelli, Claudia Massarotti, Lucia Del Mastro, Isabelle Demeestere, Matteo Lambertini. Safety of assisted reproductive technologies before and after anticancer treatments in young women with breast cancer: A systematic review and meta-analysis [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr PD5-07.
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Affiliation(s)
- Luca Arecco
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Eva Blondeaux
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Arecco L, Ruelle T, Martelli V, Boutros A, Latocca MM, Spinaci S, Marrocco C, Massarotti C, Lambertini M. How to Protect Ovarian Function before and during Chemotherapy? J Clin Med 2021; 10:jcm10184192. [PMID: 34575299 PMCID: PMC8467797 DOI: 10.3390/jcm10184192] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/29/2021] [Accepted: 09/03/2021] [Indexed: 12/22/2022] Open
Abstract
A significant number of women receive a cancer diagnosis before their age of natural menopause. Among these patients, the most frequent neoplasms are breast cancer, gynecological, and hematological malignancies. Premature ovarian insufficiency and infertility are among the most feared short- to long-term consequences of anticancer treatments in premenopausal patients. Both patient- and treatment-related characteristics are key factors in influencing the risk of gonadotoxicity with the use of chemotherapy. The cryopreservation of oocytes/embryos is a standard strategy for fertility preservations offered to young women interested in future family planning, but it does not allow gonadal function protection during chemotherapy. Ovarian suppression with gonadotropin-releasing hormone agonist (GnRHa) during chemotherapy is now recommended as an option to reduce the risk of gonadotoxicity in order to avoid the negative consequences of premature ovarian insufficiency in premenopausal women receiving cytotoxic therapy, including those not interested in fertility preservation. This review summarizes the risk of treatment-induced gonadotoxicity in premenopausal patients and the evidence available on the protective role of administering GnRHa during chemotherapy to preserve ovarian function.
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Affiliation(s)
- Luca Arecco
- U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (L.A.); (M.M.L.); (C.M.)
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, 16132 Genova, Italy; (T.R.); (V.M.); (A.B.)
| | - Tommaso Ruelle
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, 16132 Genova, Italy; (T.R.); (V.M.); (A.B.)
- U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Valentino Martelli
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, 16132 Genova, Italy; (T.R.); (V.M.); (A.B.)
- U.O. Oncologia Medica 1, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Andrea Boutros
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, 16132 Genova, Italy; (T.R.); (V.M.); (A.B.)
- U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Maria Maddalena Latocca
- U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (L.A.); (M.M.L.); (C.M.)
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, 16132 Genova, Italy; (T.R.); (V.M.); (A.B.)
| | - Stefano Spinaci
- Division of Breast Surgery, Ospedale Villa Scassi ASL3, 16149 Genova, Italy;
| | - Camilla Marrocco
- U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (L.A.); (M.M.L.); (C.M.)
| | - Claudia Massarotti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), School of Medicine, University of Genova, 16132 Genova, Italy;
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Matteo Lambertini
- U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (L.A.); (M.M.L.); (C.M.)
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, 16132 Genova, Italy; (T.R.); (V.M.); (A.B.)
- Correspondence: ; Tel.: +39-010-555-4254; Fax: +39-010-555-6536
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Martelli V, Latocca MM, Ruelle T, Perachino M, Arecco L, Beshiri K, Razeti MG, Tagliamento M, Cosso M, Fregatti P, Lambertini M. Comparing the Gonadotoxicity of Multiple Breast Cancer Regimens: Important Understanding for Managing Breast Cancer in Pre-Menopausal Women. Breast Cancer (Dove Med Press) 2021; 13:341-351. [PMID: 34079366 PMCID: PMC8164347 DOI: 10.2147/bctt.s274283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/14/2021] [Indexed: 11/23/2022]
Abstract
Over the last several decades, improvements in breast cancer treatment have contributed to increased cure rates for women diagnosed with this malignancy. Consequently, great importance should be paid to the long-term side effects of systemic therapies. For young women (defined as per guideline ≤40 years at diagnosis) who undergo chemotherapy, one of the most impactful side effects on their quality of life is premature ovarian insufficiency (POI) leading to fertility-related problems and the side effects of early menopause. Regimens, type, and doses of chemotherapy, as well as the age of patients and their ovarian reserve at the time of treatment are major risk factors for treatment-induced POI. For these reasons, childbearing desire and preservation of ovarian function and/or fertility should be discussed with all premenopausal patients before planning the treatments. This manuscript summarizes the available fertility preservation techniques in breast cancer patients, the risk of treatment-induced POI with different anticancer treatments, and the possible procedures to prevent it. A special focus is paid to the role of oncofertility counseling, as a central part of the visit in this setting, during which the patient should receive all the information about the potential consequences of the disease and of the proposed treatment on her future life.
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Affiliation(s)
- Valentino Martelli
- Department of Medical Oncology, U.O.C Clinica Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Maria Maddalena Latocca
- Department of Medical Oncology, U.O.C Clinica Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Tommaso Ruelle
- Department of Medical Oncology, U.O.C Clinica Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Marta Perachino
- Department of Medical Oncology, U.O.C Clinica Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Luca Arecco
- Department of Medical Oncology, U.O.C Clinica Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Kristi Beshiri
- Department of Medical Oncology, U.O.C Clinica Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Maria Grazia Razeti
- Department of Medical Oncology, U.O.C Clinica Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Marco Tagliamento
- Department of Medical Oncology, U.O.C Clinica Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Maurizio Cosso
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Piero Fregatti
- U.O.C. Clinica Di Chirurgia Senologica, Department of Surgery, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Integrated Diagnostic Surgical Sciences, School of Medicine, University of Genova, Genova, Italy
| | - Matteo Lambertini
- Department of Medical Oncology, U.O.C Clinica Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
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Cerbone L, Cattrini C, Vallome G, Latocca MM, Boccardo F, Zanardi E. Combination therapy in metastatic renal cell carcinoma: Back to the future? Semin Oncol 2020; 47:361-366. [PMID: 33168323 DOI: 10.1053/j.seminoncol.2020.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/16/2020] [Accepted: 10/16/2020] [Indexed: 01/12/2023]
Abstract
The treatment landscape of metastatic renal cell carcinoma (mRCC), a chemotherapy-resistant disease, has dramatically changed in the last decade after the introduction of small molecule inhibitors targeting the vascular endothelial growth factor receptor and mammalian target of rapamycin kinases. The CheckMate 025 phase III trial in second line mRCC also introduced immunotherapy with immune-checkpoint inhibitors as an option in the management of mRCC. Both small molecules and immunotherapy are used as single agents and they are associated with different toxicities. Recent data demonstrated that the combination of 2 immunotherapies, nivolumab and ipilimumab, is more effective than tyrosine kinase inhibitors (TKI) monotherapy as first line treatment in intermediate and poor risk mRCC. Furthermore, combination of immunotherapies and TKI has been tested in several trials to evaluate if the combo with agents presenting a different mechanism of action is more effective than monotherapy with TKI. During the past several years, combined therapy of cytokines doublets or cytokines and bevacizumab doublets demonstrated little improvement in clinical outcomes and a relevant toxicity profile. Conversely, the combination of new agents has been recently shown to improve survival in patients with metastatic disease, thus changing the treatment landscape of mRCC. This comprehensive review aims at summarizing the recent advances in the treatment of mRCC.
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Affiliation(s)
- Luigi Cerbone
- Dipartimento di Medicina Interna e Specialità Mediche, DIMI, Università degli Studi di Genova, Genoa, Italy; Academic Unit of Medical Oncology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Carlo Cattrini
- Dipartimento di Medicina Interna e Specialità Mediche, DIMI, Università degli Studi di Genova, Genoa, Italy; Academic Unit of Medical Oncology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Giacomo Vallome
- Dipartimento di Medicina Interna e Specialità Mediche, DIMI, Università degli Studi di Genova, Genoa, Italy; Academic Unit of Medical Oncology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Maddalena Latocca
- Dipartimento di Medicina Interna e Specialità Mediche, DIMI, Università degli Studi di Genova, Genoa, Italy; Academic Unit of Medical Oncology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Boccardo
- Dipartimento di Medicina Interna e Specialità Mediche, DIMI, Università degli Studi di Genova, Genoa, Italy; Academic Unit of Medical Oncology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisa Zanardi
- Dipartimento di Medicina Interna e Specialità Mediche, DIMI, Università degli Studi di Genova, Genoa, Italy; Academic Unit of Medical Oncology, Ospedale Policlinico San Martino, Genoa, Italy.
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Arecco L, Perachino M, Damassi A, Latocca MM, Soldato D, Vallome G, Parisi F, Razeti MG, Solinas C, Tagliamento M, Spinaci S, Massarotti C, Lambertini M. Burning Questions in the Oncofertility Counseling of Young Breast Cancer Patients. Breast Cancer (Auckl) 2020; 14:1178223420954179. [PMID: 32952399 PMCID: PMC7476336 DOI: 10.1177/1178223420954179] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/10/2020] [Indexed: 12/28/2022]
Abstract
The improved prognosis of breast cancer patients makes survivorship issues an area of crucial importance. In this regard, an increased attention is needed toward the development of potential anticancer treatment-related long-term side-effects, including gonadal failure and infertility in young women. Therefore, fertility preservation and family planning are crucial issues to be addressed in all young women of reproductive age with newly diagnosed cancer. Despite a growing availability of data on the efficacy and safety of fertility preservation options and the fact that conceiving after prior history of breast cancer has become more accepted over time, there are still several gray zones in this field so that many physicians remain uncomfortable to deal with these topics. The purpose of this review is to answer some of the most controversial questions frequently asked by patients during their oncofertility counseling, in order to provide a detailed and up-to-date overview on the evidence available in this field to physicians involved in the care of young women with breast cancer.
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Affiliation(s)
- Luca Arecco
- 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, University of Genova, Genova, Italy
| | - Marta Perachino
- 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, University of Genova, Genova, Italy
| | - Alessandra Damassi
- 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, University of Genova, Genova, Italy
| | - Maria Maddalena Latocca
- 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, University of Genova, Genova, Italy
| | - Davide Soldato
- 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, University of Genova, Genova, Italy
| | - Giacomo Vallome
- 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, University of Genova, Genova, Italy
| | - Francesca Parisi
- 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, University of Genova, Genova, Italy
| | - Maria Grazia Razeti
- 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, University of Genova, Genova, Italy
| | - Cinzia Solinas
- Department of Medical Oncology, Azienda Tutela della Salute Sardegna, Hospital A.Segni Ozieri, Sassari, Italy
| | - Marco Tagliamento
- 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, University of Genova, Genova, Italy
| | - Stefano Spinaci
- Division of Breast Surgery, Ospedale Villa Scassi e ASL3, Genova, Italy
| | - Claudia Massarotti
- Physiopathology of Human Reproduction Unit, 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, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
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Cattrini C, Bersanelli M, Latocca MM, Conte B, Vallome G, Boccardo F. Sex Hormones and Hormone Therapy during COVID-19 Pandemic: Implications for Patients with Cancer. Cancers (Basel) 2020; 12:E2325. [PMID: 32824674 PMCID: PMC7464909 DOI: 10.3390/cancers12082325] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/13/2020] [Indexed: 01/08/2023] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) shows a wide spectrum of clinical presentations, severity, and fatality rates. The reason older patients and males show increased risk of severe disease and death remains uncertain. Sex hormones, such as estradiol, progesterone, and testosterone, might be implicated in the age-dependent and sex-specific severity of COVID-19. High testosterone levels could upregulate transmembrane serine protease 2 (TMPRSS2), facilitating the entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) into host cells via angiotensin-converting enzyme 2 (ACE2). Data from patients with prostate cancer treated with androgen-deprivation therapy seem to confirm this hypothesis. Clinical studies on TMPRSS2 inhibitors, such as camostat, nafamostat, and bromhexine, are ongoing. Antiandrogens, such as bicalutamide and enzalutamide, are also under investigation. Conversely, other studies suggest that the immune modulating properties of androgens could protect from the unfavorable cytokine storm, and that low testosterone levels might be associated with a worse prognosis in patients with COVID-19. Some evidence also supports the notion that estrogens and progesterone might exert a protective effect on females, through direct antiviral activity or immune-mediated mechanisms, thus explaining the higher COVID-19 severity in post-menopausal women. In this perspective, we discuss the available evidence on sex hormones and hormone therapy in patients infected with SARS-CoV-2, and we highlight the possible implications for cancer patients, who can receive hormonal therapies during their treatment plans.
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Affiliation(s)
- Carlo Cattrini
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, 16132 Genoa, Italy; (C.C.); (M.M.L.); (B.C.); (G.V.)
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre (CNIO), 28029 Madrid, Spain
| | - Melissa Bersanelli
- Medical Oncology Unit, University Hospital of Parma, 43126 Parma, Italy;
| | - Maria Maddalena Latocca
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, 16132 Genoa, Italy; (C.C.); (M.M.L.); (B.C.); (G.V.)
- Academic Unit of Medical Oncology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Benedetta Conte
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, 16132 Genoa, Italy; (C.C.); (M.M.L.); (B.C.); (G.V.)
- Academic Unit of Medical Oncology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Giacomo Vallome
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, 16132 Genoa, Italy; (C.C.); (M.M.L.); (B.C.); (G.V.)
- Academic Unit of Medical Oncology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Francesco Boccardo
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, 16132 Genoa, Italy; (C.C.); (M.M.L.); (B.C.); (G.V.)
- Academic Unit of Medical Oncology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
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Zanardi E, Soldato D, Latocca MM, Cattrini C, Boccardo F. To switch or not to switch? A real-life experience using dexamethasone in combination with abiraterone. Ther Adv Urol 2019; 11:1756287219854908. [PMID: 31217821 PMCID: PMC6560791 DOI: 10.1177/1756287219854908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 04/29/2019] [Indexed: 01/21/2023] Open
Abstract
The recently published phase II prospective SWITCH trial evaluated whether patients with metastatic castration-resistant prostate cancer (mCRPC) treated with abiraterone acetate could benefit from a ‘steroid switch’ from prednisone to dexamethasone. A total of 26 patients, both chemonaïve (14 patients) or pretreated with docetaxel (12 patients), with biochemical and/or limited radiological progression, were enrolled in this trial. Primary endpoint was prostate specific antigen (PSA) 30 defined as the proportion of patients with a PSA level decline 30% or more after 6 weeks of treatment with abiraterone acetate + dexamethasone. Secondary endpoints were: a PSA50 rate (defined as the proportion of patients with PSA decline of 50% or more after 12 weeks on abiraterone acetate + dexamethasone), biochemical and radiological progression-free survival (bPFS and rPFS, respectively), benefit from subsequent treatment and identification of biomarkers of response. Primary endpoint was reached in 46.2% of patients (12 patients), and two patients had an objective partial response on computed tomography scan. Median bPFS and rPFS were 5.3 months and 11.8 months. We present a case series of 11 patients who were consecutively treated with a steroid switch at our institution from January 2016 to August 2018 to investigate if this strategy could be used in a ‘real-life’ setting. We observed a PSA30 response in two patients (18%), median bPFS was 4.77 months (95% confidence interval [CI] 2.5–14.6) and median rPFS was 7.2 months (95% CI 3.8–15.5). Seven patients had a radiological stable disease as best response to steroid switch. Three patients were being still treated with abiraterone acetate + dexamethasone at data cut-off time. Our case series confirms that switching from prednisone to dexamethasone during abiraterone acetate treatment produces biochemical and radiological responses in both a predocetaxel and a postdocetaxel setting, providing a clinical benefit in mCRPC patients. However, to date, there is no clear indication as to which patient could benefit most from this kind of strategy.
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Affiliation(s)
- Elisa Zanardi
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, Largo R. Benzi 10, Genoa, 16132, Italy
| | - Davide Soldato
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | | | - Carlo Cattrini
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Francesco Boccardo
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
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12
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Cattrini C, Rubagotti A, Nuzzo PV, Zinoli L, Salvi S, Boccardo S, Perachino M, Cerbone L, Vallome G, Latocca MM, Zanardi E, Boccardo F. Overexpression of Periostin in Tumor Biopsy Samples Is Associated With Prostate Cancer Phenotype and Clinical Outcome. Clin Genitourin Cancer 2018; 16:e1257-e1265. [PMID: 30170989 DOI: 10.1016/j.clgc.2018.07.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Overexpression of periostin (POSTN) is associated with prostate cancer (PCa) aggressiveness. We investigated the prognostic significance of POSTN expression in tumor biopsy samples of patients with PCa. METHODS We scored POSTN expression by immunohistochemistry analysis on 215 PCa biopsy samples using an anti-POSTN-specific antibody. A total immunoreactive score (T-IRS) was calculated by adding the POSTN staining scores of stromal and epithelial tumor cells. Prostate-specific antigen (PSA) progression/recurrence-free survival (PFS), radiographic progression/recurrence-free survival (rPFS), and overall survival (OS) were the study end points. RESULTS A total of 143 patients received therapy with radical attempt, whereas 72 had locally advanced or metastatic disease and received hormone therapy alone. Median T-IRS was 9 and 12 (range, 0-20), respectively (P = .001). Overall, we found a weak positive correlation of T-IRS with prebiopsy PSA levels (r = 0.166, P = .016) and Gleason score (r = 0.266, P < .000). T-IRS ≥ 8 independently predicted for shorter PSA-PFS and OS (hazard ratio [HR] [95% confidence interval (CI)] ≥ 8 versus < 8: 1.50 [1.06-2.14], P = .024 and 1.92 [1.20-3.07], P = .007, respectively). In the subgroup analysis, the association between T-IRS and patient outcome was retained in patients who received therapy with radical attempt (HR [95% CI] ≥ 8 vs. < 8: rPFS: 2.06 [1.18-3.58], P = .01; OS: 2.36 [1.24-4.50], P = .009) and in those with low to intermediate Gleason scores (HR [95% CI] ≥ 8 vs. < 8: PSA-PFS: 1.65 [1.06-2.59], P = .028; rPFS: 2.09 [1.14-3.87], P = .018; OS: 2.57 [1.31-5.04], P = .006). CONCLUSION POSTN T-IRS on PCa biopsy samples independently predicted the risk of recurrence, progression, and death in patients with localized disease and in those with low to intermediate Gleason scores.
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Affiliation(s)
- Carlo Cattrini
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy
| | - Alessandra Rubagotti
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Pier Vitale Nuzzo
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy
| | - Linda Zinoli
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Sandra Salvi
- Pathology Unit, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Simona Boccardo
- Pathology Unit, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Marta Perachino
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy
| | - Luigi Cerbone
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy
| | - Giacomo Vallome
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy
| | - Maria Maddalena Latocca
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy
| | - Elisa Zanardi
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy
| | - Francesco Boccardo
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy.
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Messina C, Messina M, Buzzatti G, Cattrini C, Cerbone L, Latocca MM, Vallome G, Zanardi E, Boccardo F. CDK inhibitors in advanced HR+ Her 2- breast cancer: A systematic review and meta-analysis of randomized trials. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e13047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Carlo Messina
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Marco Messina
- Unit of Medical Oncology, Istituto Fondazione G. Giglio, Palermo, Italy
| | - Giulia Buzzatti
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Carlo Cattrini
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Luigi Cerbone
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Maria Maddalena Latocca
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Giacomo Vallome
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Elisa Zanardi
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Francesco Boccardo
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
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14
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Cattrini C, Cerbone L, Rubagotti A, Zinoli L, Latocca MM, Buzzatti G, Vallome G, Rizzo F, Cavo A, Beshiri K, Soldato D, Messina C, Zanardi E, Boccardo F. Prognostic variables in localized small cell neuroendocrine carcinoma of the bladder: A population-based study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e16506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Carlo Cattrini
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Luigi Cerbone
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Alessandra Rubagotti
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Linda Zinoli
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Maria Maddalena Latocca
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Giulia Buzzatti
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Giacomo Vallome
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Fabio Rizzo
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Alessia Cavo
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Kristi Beshiri
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Davide Soldato
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Carlo Messina
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Elisa Zanardi
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Francesco Boccardo
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
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15
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Cattrini C, Zanardi E, Vallome G, Cavo A, Cerbone L, Di Meglio A, Fabbroni C, Latocca MM, Rizzo F, Messina C, Rubagotti A, Barboro P, Boccardo F. Targeting androgen-independent pathways: new chances for patients with prostate cancer? Crit Rev Oncol Hematol 2017; 118:42-53. [PMID: 28917268 DOI: 10.1016/j.critrevonc.2017.08.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/21/2017] [Accepted: 08/21/2017] [Indexed: 02/08/2023] Open
Abstract
Androgen deprivation therapy (ADT) is the mainstay treatment for advanced prostate cancer (PC). Most patients eventually progress to a condition known as castration-resistant prostate cancer (CRPC), characterized by lack of response to ADT. Although new androgen receptor signaling (ARS) inhibitors and chemotherapeutic agents have been introduced to overcome resistance to ADT, many patients progress because of primary or acquired resistance to these agents. This comprehensive review aims at exploring the mechanisms of resistance and progression of PC, with specific focus on alterations which lead to the activation of androgen receptor (AR)-independent pathways of survival. Our work integrates available clinical and preclinical data on agents which target these pathways, assessing their potential clinical implication in specific settings of patients. Given the rising interest of the scientific community in cancer immunotherapy strategies, further attention is dedicated to the role of immune evasion in PC.
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Affiliation(s)
- C Cattrini
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy.
| | - E Zanardi
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - G Vallome
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - A Cavo
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - L Cerbone
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - A Di Meglio
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - C Fabbroni
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - M M Latocca
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - F Rizzo
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - C Messina
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - A Rubagotti
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Via A. Pastore 1, 16132, Genoa, Italy
| | - P Barboro
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy
| | - F Boccardo
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
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