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van der Perk MEM, Broer L, Yasui Y, Laven JSE, Robison LL, Tissing WJE, Versluys B, Bresters D, Kaspers GJL, Lambalk CB, Overbeek A, Loonen JJ, Beerendonk CCM, Byrne J, Berger C, Clemens E, van Dulmen-den Broeder E, Dirksen U, van der Pal HJ, de Vries ACH, Winther JF, Ranft A, Fosså SD, Grabow D, Muraca M, Kaiser M, Kepák T, Kruseova J, Modan-Moses D, Spix C, Zolk O, Kaatsch P, Kremer LCM, Brooke RJ, Wang F, Baedke JL, Uitterlinden AG, Bos AME, van Leeuwen FE, Ness KK, Hudson MM, van der Kooi ALLF, van den Heuvel-Eibrink MM. Inter-individual variation in ovarian reserve after gonadotoxic treatment in female childhood cancer survivors - a genome-wide association study: results from PanCareLIFE. Fertil Steril 2024:S0015-0282(24)00312-1. [PMID: 38729340 DOI: 10.1016/j.fertnstert.2024.05.002] [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: 08/15/2023] [Revised: 05/02/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE We aimed to discover new variants associated with low ovarian reserve after gonadotoxic treatment among adult female childhood cancer survivors using a genome-wide association study approach. DESIGN Genome-wide association study. SUBJECTS A discovery cohort of adult female childhood cancer survivors, from the pan-European PanCareLIFE cohort (n=743; median age: 25.8 years), excluding those who received bilateral ovarian irradiation, bilateral oophorectomy, central nerve system or total body irradiation, or stem cell transplantation. Replication was attempted in the USA-based St. Jude Lifetime Cohort (n=391; median age: 31.3 years). EXPOSURE Female childhood cancer survivors are at risk of therapy-related gonadal impairment. Alkylating agents are well-established risk factors, and the inter-individual variability in gonadotoxicity may be explained by genetic polymorphisms. Data were collected in real-life conditions and cyclophosphamide equivalent dose was used to quantify alkylation agent exposure. INTERVENTION No intervention was performed. MAIN OUTCOME MEASURE Anti-Müllerian hormone (AMH) levels served as a proxy for ovarian function and findings were combined in a meta-analysis. RESULTS Three genome-wide significant (<5.0x10-8) and 16 genome-wide suggestive (<5.0x10-6) loci were associated with log-transformed AMH levels, adjusted for cyclophosphamide equivalent dose of alkylating agents, age at diagnosis, and age at study in the PanCareLIFE cohort. Based on effect allele frequency (EAF) (>0.01 if not genome-wide significant), p-value (<5.0×10-6), and biological relevance, 15 SNPs were selected for replication. None of the SNPs were statistically significantly associated with AMH levels. A meta-analysis indicated that rs78861946 was associated at borderline genome-wide statistical significance (Reference/effect allele: C/T; EAF: 0.04, Beta (SE): -0.484 (0.091), p-value= 9.39×10-8). CONCLUSION This study found no genetic variants associated with a lower ovarian reserve after gonadotoxic treatment, as the findings of this GWAS were not statistically significant replicated in the replication cohort. Suggestive evidence for potential importance of one variant is briefly discussed, but the lack of statistical significance calls for larger cohort sizes. As the population of childhood cancer survivors is increasing, large-scale and systematic research is needed to identify genetic variants that could aid predictive risk models of gonadotoxicity and as well as fertility preservation options for childhood cancer survivors.
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Affiliation(s)
| | - Linda Broer
- Department of Internal Medicine, Rotterdam, Erasmus MC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Joop S E Laven
- Department of Obstetrics and Gynecology, Erasmus MC-University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; Department of pediatric oncology, University of Groningen, University Medical Center Groningen, Groningen ,The Netherlands
| | - Birgitta Versluys
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | - Gertjan J L Kaspers
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Cornelis B Lambalk
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Annelies Overbeek
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Jacqueline J Loonen
- Department of Haematology, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands
| | - Catharina C M Beerendonk
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands
| | - Julianne Byrne
- Boyne Research Institute, 1 The Maples, Bettystown, Co. Meath A92C635, Ireland
| | - Claire Berger
- Department of Paediatric Oncology, University Hospital, 42 055 St-Etienne, France; Lyon University, Jean Monnet University, INSERM, U 1059, Sainbiose, Saint-Etienne, France
| | - Eva Clemens
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | - Eline van Dulmen-den Broeder
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Uta Dirksen
- University Hospital Essen, Pediatrics III, West German Cancer Centre, 45147 Essen, Germany; German Cancer Research Centre, DKTK, Sites Duesseldorf-Essen, 45147 Essen, Germany
| | | | | | - Jeanette Falck Winther
- Danish Cancer Society Research Center, Childhood Cancer Research Group, DK-2100 Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, 8200 Aarhus, Denmark
| | - Andreas Ranft
- University Hospital Essen, Pediatrics III, West German Cancer Centre, 45147 Essen, Germany; German Cancer Research Centre, DKTK, Sites Duesseldorf-Essen, 45147 Essen, Germany
| | - Sophie D Fosså
- Department of Oncology, Oslo University Hospital, 0372 Oslo, Norway
| | - Desiree Grabow
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Monica Muraca
- DOPO Clinic, Division of Pediatric Hematology and Oncology, IRCCS Istituto Giannina Gaslini, Via G. Gaslini, 5, 16147 Genoa, Italy
| | - Melanie Kaiser
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Tomáš Kepák
- University Hospital Brno, International Clinical Research Center (FNUSA-ICRC), Masaryk University, 656 91 Brno, Czech Republic
| | | | - Dalit Modan-Moses
- The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Claudia Spix
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Oliver Zolk
- Institute of Clinical Pharmacology, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, 16816 Neuruppin, Germany
| | - Peter Kaatsch
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | - Russell J Brooke
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Fan Wang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Jessica L Baedke
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - André G Uitterlinden
- Department of Internal Medicine, Rotterdam, Erasmus MC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Annelies M E Bos
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; Department of Reproductive Medicine, University Medical Center Utrecht, The Netherland
| | - Flora E van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, USA; Department of Oncology, Division of Survivorship, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Anne-Lotte L F van der Kooi
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; Department of Obstetrics and Gynecology, Erasmus MC-University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; Division of Child Health, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
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Nadesapillai S, Mol F, Broer SL, Stevens Brentjens LBPM, Verhoeven MO, Heida KY, Goddijn M, van Golde RJT, Bos AME, van der Coelen S, Peek R, Braat DDM, van der Velden JAEM, Fleischer K. Reproductive Outcomes of Women with Turner Syndrome Undergoing Oocyte Vitrification: A Retrospective Multicenter Cohort Study. J Clin Med 2023; 12:6502. [PMID: 37892640 PMCID: PMC10607490 DOI: 10.3390/jcm12206502] [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: 09/03/2023] [Revised: 10/04/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Turner syndrome (TS) is accompanied with premature ovarian insufficiency. Oocyte vitrification is an established method to preserve fertility. However, data on the oocyte yield in women with TS who vitrify their oocytes and the return rate to utilize the oocytes are scarce. METHODS Retrospective multicenter cohort study. Data was collected from medical records of women with TS who started oocyte vitrification between 2010 and 2021. RESULTS Thirty-three women were included. The median cumulative number of vitrified oocytes was 20 per woman. Complications occurred in 4% of the cycles. Significant correlations were found between the cumulative number of vitrified oocytes and AMH (r = 0.54 and p < 0.01), AFC (r = 0.49 and p < 0.01), percentage of 46,XX cells (r = 0.49 and p < 0.01), and FSH (r = -0.65 and p < 0.01). Spontaneous (n = 8) and IVF (n = 2) pregnancies occurred in 10 women ± three years after vitrification. So far, none of the women have returned to utilize their vitrified oocytes. CONCLUSIONS Oocyte vitrification is a feasible fertility preservation option for women with TS, particularly in those with 46,XX cell lines or sufficient ovarian reserve. Multiple stimulation cycles are recommended to reach an adequate number of vitrified oocytes for pregnancy. It is too early to draw conclusions about the utilization of vitrified oocytes in women with TS.
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Affiliation(s)
- Sapthami Nadesapillai
- Department of Obstetrics and Gynecology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Femke Mol
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Center for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, University of Amsterdam, 1100 DD Amsterdam, The Netherlands
| | - Simone L. Broer
- Department of Reproductive Medicine, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Linda B. P. M. Stevens Brentjens
- Department of Obstetrics and Gynecology, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands
- GROW School for Oncology and Reproduction, 6229 ER Maastricht, The Netherlands
| | - Marieke O. Verhoeven
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Center for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, University of Amsterdam, 1100 DD Amsterdam, The Netherlands
| | - Karst Y. Heida
- Dijklander Hospital, Centrum Voor Kinderwens, 1441 RN Purmerend, The Netherlands
| | - Mariëtte Goddijn
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Center for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, University of Amsterdam, 1100 DD Amsterdam, The Netherlands
| | - Ron J. T. van Golde
- Department of Obstetrics and Gynecology, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands
- GROW School for Oncology and Reproduction, 6229 ER Maastricht, The Netherlands
| | - Annelies M. E. Bos
- Department of Reproductive Medicine, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Sanne van der Coelen
- Department of Obstetrics and Gynecology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Ronald Peek
- Department of Obstetrics and Gynecology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Didi D. M. Braat
- Department of Obstetrics and Gynecology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | | | - Kathrin Fleischer
- Department of Reproductive Medicine, Nij Geertgen Center for Fertility, 5424 SM Elsendorp, The Netherlands
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Grubliauskaite M, van der Perk MEM, Bos AME, Meijer AJM, Gudleviciene Z, van den Heuvel-Eibrink MM, Rascon J. Minimal Infiltrative Disease Identification in Cryopreserved Ovarian Tissue of Girls with Cancer for Future Use: A Systematic Review. Cancers (Basel) 2023; 15:4199. [PMID: 37686475 PMCID: PMC10486797 DOI: 10.3390/cancers15174199] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Ovarian tissue cryopreservation and transplantation are the only available fertility techniques for prepubertal girls with cancer. Though autotransplantation carries a risk of reintroducing malignant cells, it can be avoided by identifying minimal infiltrative disease (MID) within ovarian tissue. METHODS A broad search for peer-reviewed articles in the PubMed database was conducted in accordance with PRISMA guidelines up to March 2023. Search terms included 'minimal residual disease', 'cryopreservation', 'ovarian', 'cancer' and synonyms. RESULTS Out of 542 identified records, 17 were included. Ovarian tissues of at least 115 girls were evaluated and categorized as: hematological malignancies (n = 56; 48.7%), solid tumors (n = 42; 36.5%) and tumors of the central nervous system (n = 17; 14.8%). In ovarian tissue of 25 patients (21.7%), MID was detected using RT-qPCR, FISH or multicolor flow cytometry: 16 of them (64%) being ALL (IgH rearrangements with/without TRG, BCL-ABL1, EA2-PBX1, TEL-AML1 fusion transcripts), 3 (12%) Ewing sarcoma (EWS-FLI1 fusion transcript, EWSR1 rearrangements), 3 (12%) CML (BCR-ABL1 fusion transcript, FLT3) and 3 (12%) AML (leukemia-associated immunophenotypes, BCR-ABL1 fusion transcript) patients. CONCLUSION While the majority of malignancies were found to have a low risk of containing malignant cells in ovarian tissue, further studies are needed to ensure safe implementation of future fertility restoration in clinical practice.
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Affiliation(s)
- Monika Grubliauskaite
- Center for Pediatric Oncology and Hematology, Vilnius University Hospital Santaros Klinikos, Santariskiu Str. 4, LT-08406 Vilnius, Lithuania
- Life Sciences Center, Vilnius University, Sauletekio Ave. 7, LT-10257 Vilnius, Lithuania
- Department of Biobank, National Cancer Institute, Santariskiu Str. 1, LT-08406 Vilnius, Lithuania
| | | | - Annelies M. E. Bos
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
- Department of Reproductive Medicine, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | | | - Zivile Gudleviciene
- Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str. 21/27, LT-03101 Vilnius, Lithuania
| | - Marry M. van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
- Division of Child Health, UMCU-Wilhelmina Children’s Hospital, 3584 EA Utrecht, The Netherlands
| | - Jelena Rascon
- Center for Pediatric Oncology and Hematology, Vilnius University Hospital Santaros Klinikos, Santariskiu Str. 4, LT-08406 Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str. 21/27, LT-03101 Vilnius, Lithuania
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Stukaite-Ruibiene E, van der Perk MEM, Vaitkeviciene GE, Bos AME, Bumbuliene Z, van den Heuvel-Eibrink MM, Rascon J. Evaluation of oncofertility care in childhood cancer patients: the EU-Horizon 2020 twinning project TREL initiative. Front Pediatr 2023; 11:1212711. [PMID: 37565239 PMCID: PMC10411952 DOI: 10.3389/fped.2023.1212711] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/14/2023] [Indexed: 08/12/2023] Open
Abstract
Background The 5-year survival rate of childhood cancer exceeds 80%, however, many survivors develop late effects including infertility. The aim of this study was to evaluate the current status of oncofertility care at Vilnius University Hospital Santaros Klinikos (VULSK) within the framework of the EU-Horizon 2020 TREL project. Methods All parents or patients aged 12-17.9 years treated from July 1, 2021 until July 1, 2022 were invited to complete an oncofertility-care-evaluation questionnaire. After completing the questionnaire, patients were triaged to low-risk (LR) or high-risk (HR) of gonadal damage using a risk stratification tool (triage). Data was assessed using descriptive statistics. Results Questionnaires were completed by 48 parents and 13 children triaged as 36 (59%) LR and 25 (41%) HR patients. Most HR respondents (21/25, 84%) were not counseled by a fertility specialist. Six boys (4 HR, 2 LR) were counseled, none of the girls was counseled. Three HR boys underwent sperm cryopreservation. Only 17 (27.9%, 9 HR, 8 LR) respondents correctly estimated their risk. All counseled boys (n = 6) agreed the risk for fertility impairment had been mentioned as compared to 49.1% (n = 27) of uncounseled. All counseled respondents agreed they knew enough about fertility (vs. 42%). Conclusions Respondents counseled by a fertility specialist were provided more information on fertility than uncounseled. HR patients were not sufficiently counseled by a fertility specialist. Based on the current experience oncofertility care at VULSK will be improved.
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Affiliation(s)
| | | | - Goda Elizabeta Vaitkeviciene
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Center for Pediatric Oncology and Hematology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | - Zana Bumbuliene
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Center of Obstetrics and Gynecology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | - Jelena Rascon
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Center for Pediatric Oncology and Hematology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
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Clasen NHZ, van der Perk MEM, Neggers SJCMM, Bos AME, van den Heuvel-Eibrink MM. Experiences of Female Childhood Cancer Patients and Survivors Regarding Information and Counselling on Gonadotoxicity Risk and Fertility Preservation at Diagnosis: A Systematic Review. Cancers (Basel) 2023; 15:cancers15071946. [PMID: 37046607 PMCID: PMC10093478 DOI: 10.3390/cancers15071946] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/12/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
Background: Childhood cancer patients and their families are increasingly offered oncofertility care including information regarding their risk of gonadal damage by paediatric oncologists, fertility counselling by fertility specialists and fertility preservation options. However, experiences regarding oncofertility care are underreported. We aimed to summarize the available evidence of experiences of female childhood cancer patients and survivors regarding oncofertility care. Methods: Manuscripts were systematically identified using the PubMed and Embase database. From, respectively, 1256 and 3857 manuscripts, 7 articles were included and assessed, including risk of bias assessment. Outcome measures included data describing experiences of female childhood cancer patients and survivors, regarding fertility information, counselling and/or preservation. Results: Female patients and survivors are variably satisfied with fertility information, report challenges in communication with healthcare professionals and prefer to receive general information at diagnosis and detailed fertility information later. Regrets after fertility counselling are underreported, but are associated with refusing fertility preservation. Lastly, regardless of counselling, female patients and survivors report fertility concerns about their future children’s health and effect on relationships. Conclusion: Currently, the satisfaction with oncofertility care varies and female patients or survivors report regrets and concerns regardless of receiving fertility information or counselling. These results may help to improve the content of fertility information, communication skills of healthcare professionals and timing of counselling.
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Affiliation(s)
- Nikita H Z Clasen
- Princess Máxima Center for Pediatric Oncology, 3584CS Utrecht, The Netherlands
- Faculty of Medicine, Vrije Universiteit Amsterdam, 1081CX Amsterdam, The Netherlands
| | | | - Sebastian J C M M Neggers
- Department of Internal Medicine, Section Endocrinology, Erasmus Medical Center, 3015GD Rotterdam, The Netherlands
| | - Annelies M E Bos
- Princess Máxima Center for Pediatric Oncology, 3584CS Utrecht, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, 3584CS Utrecht, The Netherlands
- Division of Child Health, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3584EA Utrecht, The Netherlands
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van der Perk MEM, van der Kooi ALLF, Bos AME, Broer SL, Veening MA, van Leeuwen J, van Santen HM, van Dorp W, van den Heuvel-Eibrink MM. Oncofertility Perspectives for Girls with Cancer. J Pediatr Adolesc Gynecol 2022; 35:523-526. [PMID: 35358705 DOI: 10.1016/j.jpag.2022.03.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/03/2022] [Accepted: 03/18/2022] [Indexed: 11/17/2022]
Abstract
Infertility is a serious early, as well as late, effect of childhood cancer treatment. If addressed in a timely manner at diagnosis, fertility preservation measures can be taken, preferably before the start of cancer treatment. However, pediatric oncologists might remain reluctant to offer counseling on fertility-preservation methods, although infrastructure to freeze ovarian tissue has become available and is currently considered standard care for pre- and postpubertal girls at high risk of gonadal damage. More importantly, risk factors have been identified for cancer treatment-related impairment of gonadal function, and the first successful pregnancies have been reported after autotransplanted ovarian tissue, which has been harvested from children. Additionally, great progress has been made in the field of ex vivo maturation of oocytes in frozen ovarian tissue, which provides opportunities for those at risk of ovarian micrometastasis. Hence, it is time to counsel girls at risk and make every effort to cryopreserve their ovarian tissue, now more than ever before.
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Affiliation(s)
| | | | - Annelies M E Bos
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Simone L Broer
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Jeanette van Leeuwen
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hanneke M van Santen
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wendy van Dorp
- Department of Obstetrics and Gynecology, IJsselland Ziekenhuis, Rotterdam, the Netherlands
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Balkenende EME, Dahhan T, Beerendonk CCM, Fleischer K, Stoop D, Bos AME, Lambalk CB, Schats R, Smeenk JMJ, Louwé LA, Cantineau AEP, Bruin JPD, Linn SC, van der Veen F, van Wely M, Goddijn M. Fertility preservation for women with breast cancer: a multicentre randomized controlled trial on various ovarian stimulation protocols. Hum Reprod 2022; 37:1786-1794. [PMID: 35776109 PMCID: PMC9340107 DOI: 10.1093/humrep/deac145] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 11/29/2021] [Revised: 04/01/2022] [Indexed: 12/24/2022] Open
Abstract
STUDY QUESTION Does ovarian stimulation with the addition of tamoxifen or letrozole affect the number of cumulus-oocyte complexes (COCs) retrieved compared to standard ovarian stimulation in women with breast cancer who undergo fertility preservation? SUMMARY ANSWER Alternative ovarian stimulation protocols with tamoxifen or letrozole did not affect the number of COCs retrieved at follicle aspiration in women with breast cancer. WHAT IS KNOWN ALREADY Alternative ovarian stimulation protocols have been introduced for women with breast cancer who opt for fertility preservation by means of banking of oocytes or embryos. How these ovarian stimulation protocols compare to standard ovarian stimulation in terms of COC yield is unknown. STUDY DESIGN, SIZE, DURATION This multicentre, open-label randomized controlled superiority trial was carried out in 10 hospitals in the Netherlands and 1 hospital in Belgium between January 2014 and December 2018. We randomly assigned women with breast cancer, aged 18–43 years, who opted for banking of oocytes or embryos to one of three study arms; ovarian stimulation plus tamoxifen, ovarian stimulation plus letrozole or standard ovarian stimulation. Standard ovarian stimulation included GnRH antagonist, recombinant FSH and GnRH agonist trigger. Randomization was performed with a web-based system in a 1:1:1 ratio, stratified for oral contraception usage at start of ovarian stimulation, positive estrogen receptor (ER) status and positive lymph nodes. Patients and caregivers were not blinded to the assigned treatment. The primary outcome was number of COCs retrieved at follicle aspiration. PARTICIPANTS/MATERIALS, SETTING, METHODS During the study period, 162 women were randomly assigned to one of three interventions. Fifty-four underwent ovarian stimulation plus tamoxifen, 53 ovarian stimulation plus letrozole and 55 standard ovarian stimulation. Analysis was according to intention-to-treat principle. MAIN RESULTS AND THE ROLE OF CHANCE No differences among groups were observed in the mean (±SD) number of COCs retrieved: 12.5 (10.4) after ovarian stimulation plus tamoxifen, 14.2 (9.4) after ovarian stimulation plus letrozole and 13.6 (11.6) after standard ovarian stimulation (mean difference −1.13, 95% CI −5.70 to 3.43 for tamoxifen versus standard ovarian stimulation and 0.58, 95% CI −4.03 to 5.20 for letrozole versus standard ovarian stimulation). After adjusting for oral contraception usage at the start of ovarian stimulation, positive ER status and positive lymph nodes, the mean difference was −1.11 (95% CI −5.58 to 3.35) after ovarian stimulation plus tamoxifen versus standard ovarian stimulation and 0.30 (95% CI −4.19 to 4.78) after ovarian stimulation plus letrozole versus standard ovarian stimulation. There were also no differences in the number of oocytes or embryos banked. There was one serious adverse event after standard ovarian stimulation: one woman was admitted to the hospital because of ovarian hyperstimulation syndrome. LIMITATIONS, REASONS FOR CAUTION The available literature on which we based our hypothesis, power analysis and sample size calculation was scarce and studies were of low quality. Our study did not have sufficient power to perform subgroup analysis on follicular, luteal or random start of ovarian stimulation. WIDER IMPLICATIONS OF THE FINDINGS Our study showed that adding tamoxifen or letrozole to a standard ovarian stimulation protocol in women with breast cancer does not impact the effectiveness of fertility preservation and paves the way for high-quality long-term follow-up on breast cancer treatment outcomes and women’s future pregnancy outcomes. Our study also highlights the need for high-quality studies for all women opting for fertility preservation, as alternative ovarian stimulation protocols have been introduced to clinical practice without proper evidence. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by a grant (2011.WO23.C129) of ‘Stichting Pink Ribbon’, a breast cancer fundraising charity organization in the Netherlands. M.G., C.B.L. and R.S. declared that the Center for Reproductive Medicine, Amsterdam UMC (location VUMC) has received unconditional research and educational grants from Guerbet, Merck and Ferring, not related to the presented work. C.B.L. declared a speakers fee for Inmed and Yingming. S.C.L. reports grants and non-financial support from Agendia, grants, non-financial support and other from AstraZeneca, grants from Eurocept-pharmaceuticals, grants and non-financial support from Genentech/Roche and Novartis, grants from Pfizer, grants and non-financial support from Tesaro and Immunomedics, other from Cergentis, IBM, Bayer, and Daiichi-Sankyo, outside the submitted work; In addition, S.C.L. has a patent UN23A01/P-EP pending that is unrelated to the present work. J.M.J.S. reported payments and travel grants from Merck and Ferring. C.C.M.B. reports her role as unpaid president of the National guideline committee on Fertility Preservation in women with cancer. K.F. received unrestricted grants from Merck Serono, Good Life and Ferring not related to present work. K.F. declared paid lectures for Ferring. D.S. declared former employment from Merck Sharp & Dohme (MSD). K.F. declared paid lectures for Ferring. D.S. reports grants from MSD, Gedeon Richter and Ferring paid to his institution; consulting fee payments from MSD and Merck Serono paid to his institution; speaker honoraria from MSD, Gedeon Richter, Ferring Pharmaceuticals and Merck Serono paid to his institution. D.S. has also received travel and meeting support from MSD, Gedeon Richter, Ferring Pharmaceuticals and Merck Serono. No payments are related to present work. TRIAL REGISTRATION NUMBER NTR4108. TRIAL REGISTRATION DATE 6 August 2013. DATE OF FIRST PATIENT’S ENROLMENT 30 January 2014.
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Affiliation(s)
- Eva M E Balkenende
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Taghride Dahhan
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Catharina C M Beerendonk
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kathrin Fleischer
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dominic Stoop
- Center for Reproductive Medicine, UZ Brussel, Free University of Brussels, Brussels, Belgium.,Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Annelies M E Bos
- Department of Reproductive Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cornelis B Lambalk
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Roel Schats
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jesper M J Smeenk
- Department of Obstetrics and Gynaecology, St Elisabeth Hospital, Tilburg, The Netherlands
| | - Leonie A Louwé
- Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Astrid E P Cantineau
- Center for Reproductive Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan Peter de Bruin
- Department of Obstetrics and Gynecology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Sabine C Linn
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Fulco van der Veen
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Madelon van Wely
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Mariëtte Goddijn
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
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8
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van der Perk MEM, Stukaitė-Ruibienė E, Bumbulienė Ž, Vaitkevičienė GE, Bos AME, van den Heuvel-Eibrink MM, Rascon J. Development of a questionnaire to evaluate female fertility care in pediatric oncology, a TREL initiative. BMC Cancer 2022; 22:450. [PMID: 35468746 PMCID: PMC9036799 DOI: 10.1186/s12885-022-09450-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/11/2022] [Indexed: 11/28/2022] Open
Abstract
Background Currently the five-year survival of childhood cancer is up to 80% due to improved treatment modalities. However, the majority of childhood cancer survivors develop late effects including infertility. Survivors describe infertility as an important and life-altering late effect. Fertility preservation options are becoming available to pre- and postpubertal patients diagnosed with childhood cancer and fertility care is now an important aspect in cancer treatment. The use of fertility preservation options depends on the quality of counseling on this important and delicate issue. The aim of this manuscript is to present a questionnaire to determine the impact of fertility counseling in patients suffering from childhood cancer, to improve fertility care and evaluate what patients and their parents or guardians consider good fertility care. Methods Within the framework of the EU-Horizon 2020 TREL project, a fertility care evaluation questionnaire used in the Netherlands was made applicable for international multi-center use. The questionnaire to be used at least also in Lithuania, incorporates patients’ views on fertility care to further improve the quality of fertility care and counseling. Results evaluate fertility care and will be used to improve current fertility care in a national specialized pediatric oncology center in the Netherlands and a pediatric oncology center in Lithuania. Conclusion An oncofertility-care-evaluation questionnaire has been developed for pediatric oncology patients and their families specifically. Results of this questionnaire may contribute to enhancement of fertility care in pediatric oncology in wider settings and thus improve quality of life of childhood cancer patients and survivors. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09450-2.
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Affiliation(s)
| | | | - Žana Bumbulienė
- Vilnius University, Faculty of Medicine, Vilnius, Lithuania.,Center of Obstetrics and Gynaecology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Goda Elizabeta Vaitkevičienė
- Vilnius University, Faculty of Medicine, Vilnius, Lithuania.,Center for Pediatric Oncology and Hematology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Annelies M E Bos
- University Medical Center Utrecht, Reproductive Medicine and Gynaecology, Utrecht, The Netherlands
| | | | - Jelena Rascon
- Vilnius University, Faculty of Medicine, Vilnius, Lithuania.,Center for Pediatric Oncology and Hematology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
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9
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van der Perk MEM, Cost NG, Bos AME, Brannigan R, Chowdhury T, Davidoff AM, Daw NC, Dome JS, Ehrlich P, Graf N, Geller J, Kalapurakal J, Kieran K, Malek M, McAleer MF, Mullen E, Pater L, Polanco A, Romao R, Saltzman AF, Walz AL, Woods AD, van den Heuvel-Eibrink MM, Fernandez CV. White paper: Onco-fertility in pediatric patients with Wilms tumor. Int J Cancer 2022; 151:843-858. [PMID: 35342935 PMCID: PMC9541948 DOI: 10.1002/ijc.34006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 11/18/2022]
Abstract
The survival of childhood Wilms tumor is currently around 90%, with many survivors reaching reproductive age. Chemotherapy and radiotherapy are established risk factors for gonadal damage and are used in both COG and SIOP Wilms tumor treatment protocols. The risk of infertility in Wilms tumor patients is low but increases with intensification of treatment including the use of alkylating agents, whole abdominal radiation or radiotherapy to the pelvis. Both COG and SIOP protocols aim to limit the use of gonadotoxic treatment, but unfortunately this cannot be avoided in all patients. Infertility is considered one of the most important late effects of childhood cancer treatment by patients and their families. Thus, timely discussion of gonadal damage risk and fertility preservation options is important. Additionally, irrespective of the choice for preservation, consultation with a fertility preservation (FP) team is associated with decreased patient and family regret and better quality of life. Current guidelines recommend early discussion of the impact of therapy on potential fertility. Since most patients with Wilms tumors are prepubertal, potential FP methods for this group are still considered experimental. There are no proven methods for FP for prepubertal males (testicular biopsy for cryopreservation is experimental), and there is just a single option for prepubertal females (ovarian tissue cryopreservation), posing both technical and ethical challenges. Identification of genetic markers of susceptibility to gonadotoxic therapy may help to stratify patient risk of gonadal damage and identify patients most likely to benefit from FP methods.
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Affiliation(s)
| | - Nicholas G Cost
- Department of Surgery, Division of Urology, University of Colorado School of Medicine and the Surgical Oncology Program of the Children's Hospital Colorado, Aurora, CO, USA
| | - Annelies M E Bos
- University Medical Center Utrecht, Reproductive Medicine and Gynaecology, Utrecht, Netherlands
| | - Robert Brannigan
- Department of Urology, Northwestern University, Chicago, Illinois, USA
| | - Tanzina Chowdhury
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, USA
| | - Najat C Daw
- Department of Pediatrics - Patient Care, MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey S Dome
- Division of Oncology at Children's National Hospital, Washington, DC, USA
| | - Peter Ehrlich
- University of Michigan, C.S. Mott Children's Hospital Section of Pediatric Surgery, Ann Arbor, MI, USA
| | - Norbert Graf
- Department for Pediatric Oncology and Hematology, Saarland University Medical Center, Homburg, Germany
| | - James Geller
- Division of Pediatric Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - John Kalapurakal
- Department of Radiation Oncology, Northwestern University, Chicago, Illinois, USA
| | - Kathleen Kieran
- Department of Urology, University of Washington, and Division of Urology, Seattle Children's Hospital, Seattle, USA
| | - Marcus Malek
- Division of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, USA
| | - Mary F McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elizabeth Mullen
- Department of Pediatric Oncology, Children's Hospital Boston/Dana-Farber Cancer Institute, Boston, MA, USA
| | - Luke Pater
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Angela Polanco
- National Cancer Research Institute Children's Group Consumer Representative, London, UK
| | - Rodrigo Romao
- Departments of Surgery and Urology, IWK Health Centre, Dalhousie University, Halifax, Canada
| | | | - Amy L Walz
- Division of Hematology, Oncology, Neuro-Oncology, and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
| | - Andrew D Woods
- Children's Cancer Therapy Development Institute, Beaverton, Oregon, USA
| | | | - Conrad V Fernandez
- Department of Pediatric Hematology/Oncology, IWK Health Centre and Dalhousie University, Halifax, Canada
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10
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van der Plas RCJ, Bos AME, Jürgenliemk-Schulz IM, Gerestein CG, Zweemer RP. Fertility-sparing surgery and fertility preservation in cervical cancer: The desire for parenthood, reproductive and obstetric outcomes. Gynecol Oncol 2021; 163:538-544. [PMID: 34583837 DOI: 10.1016/j.ygyno.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/30/2021] [Revised: 08/30/2021] [Accepted: 09/03/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the desire for parenthood and reproductive outcomes of young cervical cancer survivors who underwent fertility-sparing surgery or fertility preservation procedures for invasive cervical cancer. METHODS All women <45 years who underwent fertility-sparing treatment for invasive cervical cancer in a tertiary referral center in the Netherlands between January 2009 and January 2020 were identified. Fertility-sparing treatment options included Vaginal Radical Trachelectomy (VRT) for patients with early-stage disease and fertility preservation techniques (FP) when requiring Radical Hysterectomy (RH) or chemoradiotherapy. Data on reproductive intentions - and outcomes were retrieved from medical files and questionnaires. RESULTS 75 patients were identified of whom 34 underwent VRT, 9 RH and 32 had (chemo)radiotherapy. 26 patients started FP of whom 23 (88.5%) successfully preserved fertility through cryopreservation of embryos, oocytes and ovarian tissue. After a median follow-up of 49 months, 5 patients developed recurrent disease and died. Reproductive outcomes were retrieved in 58 patients. 89.6% maintained their desire for parenthood after cancer treatment. Following VRT, we report a pregnancy rate of 61.9% among the patients attempting conception (n = 24). 15 patients conceived 21 pregnancies which resulted in 15 live-births, yielding a live-birth rate of 75.0%. Following RH or (chemo)radiotherapy, 3 surrogate pregnancies were established (21.4%) using frozen-thawed material with good neonatal outcomes. CONCLUSION Many cervical cancer survivors maintain the desire to become parents eventually. In early-stage disease, VRT shows good reproductive outcomes without compromising oncological safety. For those requiring gonadotoxic treatment fertility preservation and gestational surrogacy provides a promising alternative for achieving a biological offspring.
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Affiliation(s)
- R C J van der Plas
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, the Netherlands; Department of Gynecological Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, the Netherlands.
| | - A M E Bos
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, the Netherlands
| | - I M Jürgenliemk-Schulz
- Department of Radiology and Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, the Netherlands
| | - C G Gerestein
- Department of Gynecological Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, the Netherlands
| | - R P Zweemer
- Department of Gynecological Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, the Netherlands
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11
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van der Perk MEM, Broer L, Yasui Y, Robison LL, Hudson MM, Laven JSE, van der Pal HJ, Tissing WJE, Versluys B, Bresters D, Kaspers GJL, de Vries ACH, Lambalk CB, Overbeek A, Loonen JJ, Beerendonk CCM, Byrne J, Berger C, Clemens E, Dirksen U, Falck Winther J, Fosså SD, Grabow D, Muraca M, Kaiser M, Kepák T, Kruseova J, Modan-Moses D, Spix C, Zolk O, Kaatsch P, Krijthe JH, Kremer LCM, Brooke RJ, Baedke JL, van Schaik RHN, van den Anker JN, Uitterlinden AG, Bos AME, van Leeuwen FE, van Dulmen-den Broeder E, van der Kooi ALLF, van den Heuvel-Eibrink MM. Effect of Genetic Variation in CYP450 on Gonadal Impairment in a European Cohort of Female Childhood Cancer Survivors, Based on a Candidate Gene Approach: Results from the PanCareLIFE Study. Cancers (Basel) 2021; 13:4598. [PMID: 34572825 PMCID: PMC8470074 DOI: 10.3390/cancers13184598] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/01/2021] [Accepted: 09/04/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Female childhood cancer survivors (CCSs) carry a risk of therapy-related gonadal dysfunction. Alkylating agents (AA) are well-established risk factors, yet inter-individual variability in ovarian function is observed. Polymorphisms in CYP450 enzymes may explain this variability in AA-induced ovarian damage. We aimed to evaluate associations between previously identified genetic polymorphisms in CYP450 enzymes and AA-related ovarian function among adult CCSs. METHODS Anti-Müllerian hormone (AMH) levels served as a proxy for ovarian function in a discovery cohort of adult female CCSs, from the pan-European PanCareLIFE cohort (n = 743; age (years): median 25.8, interquartile range (IQR) 22.1-30.6). Using two additive genetic models in linear and logistic regression, nine genetic variants in three CYP450 enzymes were analyzed in relation to cyclophosphamide equivalent dose (CED) score and their impact on AMH levels. The main model evaluated the effect of the variant on AMH and the interaction model evaluated the modifying effect of the variant on the impact of CED score on log-transformed AMH levels. Results were validated, and meta-analysis performed, using the USA-based St. Jude Lifetime Cohort (n = 391; age (years): median 31.3, IQR 26.6-37.4). RESULTS CYP3A4*3 was significantly associated with AMH levels in the discovery and replication cohort. Meta-analysis revealed a significant main deleterious effect (Beta (95% CI): -0.706 (-1.11--0.298), p-value = 7 × 10-4) of CYP3A4*3 (rs4986910) on log-transformed AMH levels. CYP2B6*2 (rs8192709) showed a significant protective interaction effect (Beta (95% CI): 0.527 (0.126-0.928), p-value = 0.01) on log-transformed AMH levels in CCSs receiving more than 8000 mg/m2 CED. CONCLUSIONS Female CCSs CYP3A4*3 carriers had significantly lower AMH levels, and CYP2B6*2 may have a protective effect on AMH levels. Identification of risk-contributing variants may improve individualized counselling regarding the treatment-related risk of infertility and fertility preservation options.
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Affiliation(s)
- M. E. Madeleine van der Perk
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
| | - Linda Broer
- Department of Internal Medicine, Rotterdam, ErasmusMC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (L.B.); (A.G.U.)
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (Y.Y.); (L.L.R.); (M.M.H.); (R.J.B.); (J.L.B.)
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (Y.Y.); (L.L.R.); (M.M.H.); (R.J.B.); (J.L.B.)
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (Y.Y.); (L.L.R.); (M.M.H.); (R.J.B.); (J.L.B.)
- Department of Oncology, Division of Survivorship, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Joop S. E. Laven
- Department of Obstetrics and Gynecology, Erasmus MC–University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Helena J. van der Pal
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
| | - Wim J. E. Tissing
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
| | - Birgitta Versluys
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
| | - Gertjan J. L. Kaspers
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
- Department of Pediatric Oncology-Haematology, Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Andrica C. H. de Vries
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
| | - Cornelis B. Lambalk
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands; (C.B.L.); (A.O.)
| | - Annelies Overbeek
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands; (C.B.L.); (A.O.)
| | - Jacqueline J. Loonen
- Department of Haematology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
| | - Catharina C. M. Beerendonk
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
| | - Julianne Byrne
- Boyne Research Institute, 5 Bolton Square, East, Drogheda, A92 RY6K Co. Louth, Ireland;
| | - Claire Berger
- Department of Paediatric Oncology, University Hospital, 42 055 Saint-Etienne, France;
- Lyon University, Jean Monnet University, INSERM, U 1059, Sainbiose, 42023 Saint-Etienne, France
| | - Eva Clemens
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
| | - Uta Dirksen
- University Hospital Essen, Pediatrics III, West German Cancer Centre, 45147 Essen, Germany;
- German Cancer Research Centre, DKTK, Site Essen, 45147 Essen, Germany
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, 2100 Copenhagen, Denmark;
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, 8200 Aarhus, Denmark
| | - Sophie D. Fosså
- Department of Oncology, Oslo University Hospital, 0372 Oslo, Norway;
| | - Desiree Grabow
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (D.G.); (M.K.); (C.S.); (P.K.)
| | - Monica Muraca
- Epidemiology and Biostatistics Unit and DOPO Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
| | - Melanie Kaiser
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (D.G.); (M.K.); (C.S.); (P.K.)
| | - Tomáš Kepák
- University Hospital Brno, International Clinical Research Center (FNUSA-ICRC), Masaryk University, 656 91 Brno, Czech Republic;
| | | | - Dalit Modan-Moses
- The Edmond and Lily Safra Children’s Hospital, Chaim Sheba Medical Center, Tel Hashomer, and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel;
| | - Claudia Spix
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (D.G.); (M.K.); (C.S.); (P.K.)
| | - Oliver Zolk
- Institute of Clinical Pharmacology, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, 16816 Neuruppin, Germany;
| | - Peter Kaatsch
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (D.G.); (M.K.); (C.S.); (P.K.)
| | - Jesse H. Krijthe
- Department of Intelligent Systems, Delft University of Technology, 2628 BL Delft, The Netherlands;
| | - Leontien C. M. Kremer
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
| | - Russell J. Brooke
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (Y.Y.); (L.L.R.); (M.M.H.); (R.J.B.); (J.L.B.)
| | - Jessica L. Baedke
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (Y.Y.); (L.L.R.); (M.M.H.); (R.J.B.); (J.L.B.)
| | - Ron H. N. van Schaik
- Department of clinical chemistry, Erasmus MC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands;
| | - John N. van den Anker
- Division of Clinical Pharmacology, Children’s National Hospital, Washington, DC 20010, USA;
| | - André G. Uitterlinden
- Department of Internal Medicine, Rotterdam, ErasmusMC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (L.B.); (A.G.U.)
| | - Annelies M. E. Bos
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, 3584 CS Utrecht, The Netherlands;
| | - Flora E. van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands;
| | - Eline van Dulmen-den Broeder
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
| | - Anne-Lotte L. F. van der Kooi
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
- Department of Obstetrics and Gynecology, Erasmus MC–University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Marry M. van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.v.d.P.); (W.J.E.T.); (B.V.); (D.B.); (G.J.L.K.); (A.C.H.d.V.); (E.C.); (L.C.M.K.); (E.v.D.-d.B.); (A.-L.L.F.v.d.K.); (M.M.v.d.H.-E.)
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Kool EM, van der Graaf R, Bos AME, Fauser BCJM, Bredenoord AL. Fair allocation of cryopreserved donor oocytes: towards an accountable process. Hum Reprod 2021; 36:840-846. [PMID: 33394023 DOI: 10.1093/humrep/deaa356] [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: 11/14/2019] [Revised: 11/17/2020] [Indexed: 11/14/2022] Open
Abstract
A growing number of people desire ART with cryopreserved donor oocytes. The allocation of these oocytes to couples and mothers to be is a 2-fold process. The first step is to select a pool of recipients. The second step is to decide who should be treated first. Prioritizing recipients is critical in settings where demand outstrips supply. So far, the issue of how to fairly allocate cryopreserved donor oocytes has been poorly addressed. Our ethical analysis aims to support clinics involved in allocation decisions by formulating criteria for recipient selection irrespective of supply (Part I) and recipient prioritization in case supply is limited (Part II). Relevant criteria for recipient selection are: a need for treatment to experience parenthood; a reasonable chance for successful treatment; the ability to safely undergo an oocyte donation pregnancy; and the ability to establish a stable and loving relationship with the child. Recipients eligible for priority include those who: have limited time left for treatment; have not yet experienced parenthood; did not undergo previous treatment with cryopreserved donor oocytes; and contributed to the supply of donor oocytes by bringing a donor to the bank. While selection criteria function as a threshold principle, we argue that the different prioritization criteria should be carefully balanced. Since specifying and balancing the allocation criteria undoubtedly raises a moral dispute, a fair and legitimate allocation process is warranted (Part III). We argue that allocation decisions should be made by a multidisciplinary committee, staffed by relevant experts with a variety of perspectives. Furthermore, the committees' reasoning behind decisions should be transparent and accessible to those affected: clinicians, donors, recipients and children born from treatment. Insight into the reasons that underpin allocation decisions allows these stakeholders to understand, review and challenge decisions, which is also known as accountability for reasonableness.
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Affiliation(s)
- E M Kool
- Department of Medical Humanities, University Medical Center, Julius Centre, Utrecht, The Netherlands
| | - R van der Graaf
- Department of Medical Humanities, University Medical Center, Julius Centre, Utrecht, The Netherlands
| | - A M E Bos
- Department of Reproductive Medicine and Gynecology, University Medical Centre, Utrecht, The Netherlands
| | - B C J M Fauser
- Department of Reproductive Medicine and Gynecology, University Medical Centre, Utrecht, The Netherlands
| | - A L Bredenoord
- Department of Medical Humanities, University Medical Center, Julius Centre, Utrecht, The Netherlands
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Dahhan T, van der Veen F, Bos AME, Goddijn M, Dancet EAF. The experiences of women with breast cancer who undergo fertility preservation. Hum Reprod Open 2021; 2021:hoab018. [PMID: 33959685 PMCID: PMC8082579 DOI: 10.1093/hropen/hoab018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 06/22/2020] [Revised: 03/18/2021] [Indexed: 11/21/2022] Open
Abstract
STUDY QUESTION How do women, who have just been diagnosed with breast cancer, experience oocyte or embryo banking? SUMMARY ANSWER Fertility preservation was a challenging yet welcome way to take action when confronted with breast cancer. WHAT IS KNOWN ALREADY Fertility preservation for women with breast cancer is a way to safeguard future chances of having children. Women who have just been diagnosed with breast cancer report stress, as do women who have to undergo IVF treatment. How women experience the collision of these two stressfull events, has not yet been studied. STUDY DESIGN, SIZE, DURATION We performed a multicenter qualitative study with a phenomenological approach including 21 women between March and July 2014. Women were recruited from two university-based fertility clinics. PARTICIPANTS/MATERIALS, SETTING, METHODS Women with breast cancer who banked oocytes or embryos 1–15 months before study participation were eligible. We conducted in-depth, face-to-face interviews with 21 women, which was sufficient to reach data saturation. MAIN RESULTS AND THE ROLE OF CHANCE The 21 women interviewed had a mean age of 32 years. Analysis of the 21 interviews revealed three main experiences: the burden of fertility preservation, the new identity of a fertility patient and coping with breast cancer through fertility preservation. LIMITATIONS, REASONS FOR CAUTION Interviewing women after, rather than during, fertility preservation might have induced recall bias. Translation of quotes was not carried out by a certified translator. WIDER IMPLICATIONS OF THE FINDINGS The insights gained from this study of the experiences of women undergoing fertility preservation while being newly diagnosed with breast cancer could be used as a starting point for adapting the routine psychosocial care provided by fertility clinic staff. Future studies are necessary to investigate whether adapting routine psychosocial care improves women’s wellbeing. STUDY FUNDING/COMPETING INTEREST(S) None of the authors in this study declare potential conflicts of interest. The study was funded by the Center of Reproductive Medicine of the Academic Medical Center.
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Affiliation(s)
- T Dahhan
- Center of Reproductive Medicine, Amsterdam UMC (location AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - F van der Veen
- Center of Reproductive Medicine, Amsterdam UMC (location AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - A M E Bos
- Center of Reproductive Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Goddijn
- Center of Reproductive Medicine, Amsterdam UMC (location AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - E A F Dancet
- Department of Development and Regeneration, Research Foundation-Flanders, University of Leuven, Leuven, Belgium
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Piek MW, Postma EL, van Leeuwaarde R, de Boer JP, Bos AME, Lok C, Stokkel M, Filipe MD, van der Ploeg IMC. The Effect of Radioactive Iodine Therapy on Ovarian Function and Fertility in Female Thyroid Cancer Patients: A Systematic Review and Meta-Analysis. Thyroid 2021; 31:658-668. [PMID: 33012254 DOI: 10.1089/thy.2020.0356] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Thyroid cancer is one of the most common carcinomas diagnosed in adolescents and young adults, with a rapidly rising incidence for the past three decades. Surgery is the standard treatment for patients with differentiated thyroid carcinoma (DTC), and when indicated, followed by radioactive iodine (RAI) treatment. The aim of this study was to evaluate the possible effects of RAI therapy on ovarian function and fertility in women. Methods: The PubMed, Embase, and Web of Science databases were systematically searched up to January 2020. In addition, a meta-analyses were performed for anti-Mullerian hormone (AMH) levels after RAI, comparison of AMH levels prior and 1 year after RAI, and pregnancy rates in patient with thyroid cancer receiving RAI compared with patients with thyroid cancer who did not receive RAI. Results: A total of 36 studies were eligible for full-text screening and 22 studies were included. The majority of the studies had a retrospective design. Menstrual irregularities were present in the first year after RAI in 12% and up to 31% of the patients. Approximately 8-16% of the patients experienced amenorrhea in the first year after RAI. Women who received RAI treatment (median dose 3700 MBq [range 1110-40,700 MBq]); had menopause at a slightly younger age compared with women who did not receive RAI treatment, 49.5 and 51 years, respectively (p < 0.001). Pooled AMH of the seven studies reporting AMH concentrations after RAI was 1.79 ng/mL. Of these, four studies reported AMH concentrations prior and 1 year after RAI. The mean difference was 1.50 ng/mL, which was significant. Finally, meta-analysis showed that patients undergoing RAI were not at a decreased risk of becoming pregnant. Conclusions: Most of the studies indicate that RAI therapy for DTC is not associated with a long-term decrease in pregnancy rates although meta-analyses show a significant decrease in AMH levels after RAI therapy. Prospective studies are needed to confirm these results. We recommend counseling patients about the possible effects of 131I and incorporate today's knowledge in multidisciplinary counseling.
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Affiliation(s)
- Marceline W Piek
- Department of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Emily L Postma
- Department of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Rachel van Leeuwaarde
- Department of Endocrine Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Reproductive Medicine and The University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jan Paul de Boer
- Department of Endocrine Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Annelies M E Bos
- Department of Reproductive Medicine and The University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Department of Endocrine Oncology, The University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Christianne Lok
- Department of Gynecologic Oncology, and The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Marcel Stokkel
- Department of Nuclear Medicine, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Mando D Filipe
- Department of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Iris M C van der Ploeg
- Department of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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van der Perk MEM, van der Kooi ALLF, van de Wetering MD, IJgosse IM, van Dulmen-den Broeder E, Broer SL, Klijn AJ, Versluys AB, Arends B, Oude Ophuis RJA, van Santen HM, van der Steeg AFW, Veening MA, van den Heuvel-Eibrink MM, Bos AME. Oncofertility care for newly diagnosed girls with cancer in a national pediatric oncology setting, the first full year experience from the Princess Máxima Center, the PEARL study. PLoS One 2021; 16:e0246344. [PMID: 33667234 PMCID: PMC7935241 DOI: 10.1371/journal.pone.0246344] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/18/2021] [Indexed: 11/20/2022] Open
Abstract
Background Childhood cancer patients often remain uninformed regarding their potential risk of gonadal damage. In our hospital we introduced a five step standard oncofertility care plan for all newly diagnosed female patients aiming to identify, inform and triage 100% of patients and counsel 100% of patients at high risk (HR) of gonadal damage. This observational retrospective study (PEARL study) evaluated the use of this standard oncofertility care plan in the first full year in a national cohort. Methods The steps consist of 1)timely (preferably before start of gonadotoxic treatment) identification of all new patients, 2)triage of gonadal damage risk using a standardized gonadal damage risk stratification tool, 3)informing all patients and families, 4)counseling of a selected subset of girls, and 5) fertility preservation including ovarian tissue cryopreservation (OTC) in HR patients using amended Edinburgh criteria. A survey of the medical records of all girls newly diagnosed with cancer the first year (1-1-2019 until 31-12-2019) was conducted. Results Of 261 girls, 228 (87.4%) were timely identified and triaged. Triage resulted in 151 (66%) low(LR), 32 (14%) intermediate(IR) and 45 (20%) high risk(HR) patients. Ninety-nine families were documented to be timely informed regarding gonadal damage risk. In total, 35 girls (5 LR, 5 IR, 25 HR) were counseled by an oncofertility expert. 16/25 HR patients underwent fertility preservation (1 ovariopexy + OTC, oocyte cryopreservation (1 with and 1 without OTC) and 13 OTC). Fertility preservation did not lead to complications or delay of cancer treatment in any patient. Conclusion We timely identified and triaged most girls (88%) with cancer with a high risk of gonadal damage to be counseled for fertility preservation. We aim to optimize the oncofertility care plan and the standardized gonadal damage risk stratification tool based on this experience and these may be of value to other pediatric oncology centers.
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Affiliation(s)
| | | | | | - Irene M. IJgosse
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | | | - Simone L. Broer
- Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Aart J. Klijn
- Pediatric Urology, University Medical Center Utrecht—Wilhelmina Children’s Hospital, Utrecht, Netherlands
| | | | - Brigitte Arends
- Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Ralph J. A. Oude Ophuis
- Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Hanneke M. van Santen
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Pediatric Endocrinology, University Medical Center Utrecht—Wilhelmina Children’s Hospital, Utrecht, Netherlands
| | | | | | | | - Annelies M. E. Bos
- Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, Netherlands
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van den Berg M, van der Meij E, Bos AME, Boshuizen MCS, Determann D, van Eekeren RRJP, Lok CAR, Schaake EE, Witteveen PO, Wondergem MJ, Braat DDM, Beerendonk CCM, Hermens RPMG. Development and testing of a tailored online fertility preservation decision aid for female cancer patients. Cancer Med 2021; 10:1576-1588. [PMID: 33580749 PMCID: PMC7940215 DOI: 10.1002/cam4.3711] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 08/23/2020] [Revised: 12/20/2020] [Accepted: 12/22/2020] [Indexed: 12/28/2022] Open
Abstract
Background Decision making regarding future fertility can be very difficult for female cancer patients. To support patients in decision making, fertility preservation decision aids (DAs) are being developed. However, to make a well‐informed decision, patients need personalized information tailored to their cancer type and treatment. Tailored cancer‐specific DAs are not available yet. Methods Our DA was systematically developed by a multidisciplinary steering group (n = 21) in an iterative process of draft development, three rounds of alpha testing, and revisions. The drafts were based on current guidelines, literature, and patients' and professionals' needs. Results In total, 24 cancer‐specific DAs were developed. In alpha testing, cancer survivors and professionals considered the DA very helpful in decision making, and scored an 8.5 (scale 1–10). In particular, the cancer‐specific information and the tool for recognizing personal values were of great value. Revisions were made to increase readability, personalization, usability, and be more careful in giving any false hope. Conclusions A fertility preservation DA containing cancer‐specific information is important in the daily care of female cancer patients and should be broadly available. Our final Dutch version is highly appraised, valid, and usable in decision making. After evaluating its effectiveness with newly diagnosed patients, the DA can be translated and adjusted according to (inter)national guidelines.
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Affiliation(s)
- Michelle van den Berg
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Elleke van der Meij
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Annelies M E Bos
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | - Christianne A R Lok
- Centre for Gynecological Oncology Amsterdam, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Eva E Schaake
- Department of Radiotherapy, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Petronella O Witteveen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marielle J Wondergem
- Department of Hematology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Didi D M Braat
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Catharina C M Beerendonk
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rosella P M G Hermens
- Department of IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
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Mulder RL, Font-Gonzalez A, Hudson MM, van Santen HM, Loeffen EAH, Burns KC, Quinn GP, van Dulmen-den Broeder E, Byrne J, Haupt R, Wallace WH, van den Heuvel-Eibrink MM, Anazodo A, Anderson RA, Barnbrock A, Beck JD, Bos AME, Demeestere I, Denzer C, Di Iorgi N, Hoefgen HR, Kebudi R, Lambalk C, Langer T, Meacham LR, Rodriguez-Wallberg K, Stern C, Stutz-Grunder E, van Dorp W, Veening M, Veldkamp S, van der Meulen E, Constine LS, Kenney LB, van de Wetering MD, Kremer LCM, Levine J, Tissing WJE. Fertility preservation for female patients with childhood, adolescent, and young adult cancer: recommendations from the PanCareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol 2021; 22:e45-e56. [PMID: 33539753 DOI: 10.1016/s1470-2045(20)30594-5] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 09/10/2020] [Accepted: 09/16/2020] [Indexed: 01/05/2023]
Abstract
Female patients with childhood, adolescent, and young adult cancer are at increased risk for fertility impairment when treatment adversely affects the function of reproductive organs. Patients and their families desire biological children but substantial variations in clinical practice guidelines reduce consistent and timely implementation of effective interventions for fertility preservation across institutions. As part of the PanCareLIFE Consortium, and in collaboration with the International Late Effects of Childhood Cancer Guideline Harmonization Group, we reviewed the current literature and developed a clinical practice guideline for fertility preservation in female patients who were diagnosed with childhood, adolescent, and young adult cancer at age 25 years or younger, including guidance on risk assessment and available methods for fertility preservation. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to grade the available evidence and to form the recommendations. This clinical practice guideline leverages existing evidence and international expertise to develop transparent recommendations that are easy to use to facilitate the care of female patients with childhood, adolescent, and young adult cancer who are at high risk for fertility impairment. A complete review of the existing evidence, including a quality assessment, transparent reporting of the guideline panel's decisions, and achievement of global interdisciplinary consensus, is an important result of this intensive collaboration.
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Affiliation(s)
- Renée L Mulder
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.
| | - Anna Font-Gonzalez
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control and Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Hanneke M van Santen
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, Netherlands
| | - Erik A H Loeffen
- Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, UMC Groningen, University of Groningen, Groningen, Netherlands
| | - Karen C Burns
- Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Gwendolyn P Quinn
- Department of Obstetrics and Gynecology, Department of Population Health, and Division of Medical Ethics, New York University School of Medicine, New York University, New York, NY, USA
| | - Eline van Dulmen-den Broeder
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Riccardo Haupt
- Epidemiology and Biostatistics Unit and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - W Hamish Wallace
- Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Hematology and Oncology, Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia; Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Richard A Anderson
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Anke Barnbrock
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt, Germany
| | - Joern D Beck
- Hospital for Children and Adolescents, University of Erlangen-Nürnberg, Erlangen, Germany; LESS Group, Hospital for Children and Adolescents, University of Lübeck, Lübeck, Germany
| | - Annelies M E Bos
- Department of Reproductive Medicine and Gynaecology, UMC Utrecht, Utrecht, Netherlands
| | - Isabelle Demeestere
- Research Laboratory on Human Reproduction and Fertility Clinic, Department of Obstetrics and Gynecology, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Christian Denzer
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm, Germany
| | - Natascia Di Iorgi
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Holly R Hoefgen
- Division of Pediatric and Adolescent Gynecology, Washington University School of Medicine, Washington University, St Louis, MO, USA
| | - Rejin Kebudi
- Division of Pediatric Hematology-Oncology, Cerrahpasa Medical Faculty, Istanbul University Cerrahpasa, Istanbul, Turkey; Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Cornelis Lambalk
- Department of Obstetrics and Gynecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Thorsten Langer
- Division Pediatric Hematology and Oncology, University Hospital of Schleswig-Holstein, Lübeck, Germany
| | - Lillian R Meacham
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA; Division of Hematology/Oncology and Division of Endocrinology, Department of Pediatrics, Emory University School of Medicine, Emory University, Atlanta, GA, USA
| | - Kenny Rodriguez-Wallberg
- Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Catharyn Stern
- Melbourne IVF, East Melbourne, VIC, Australia; Reproductive Services, Royal Women's Hospital, Melbourne, VIC, Australia
| | - Eveline Stutz-Grunder
- Department of Pediatric Oncology, Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Wendy van Dorp
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, Netherlands
| | - Margreet Veening
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Saskia Veldkamp
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Louis S Constine
- Department of Radiation Oncology and Department of Pediatrics, University of Rochester Medical Center, University of Rochester, Rochester, NY, USA
| | - Lisa B Kenney
- Boston Children's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Harvard University, Boston, MA, USA
| | | | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Jennifer Levine
- Division of Pediatric Hematology and Oncology, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, UMC Groningen, University of Groningen, Groningen, Netherlands
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van Santen HM, van de Wetering MD, Bos AME, Vd Heuvel-Eibrink MM, van der Pal HJ, Wallace WH. Reproductive Complications in Childhood Cancer Survivors. Pediatr Clin North Am 2020; 67:1187-1202. [PMID: 33131541 DOI: 10.1016/j.pcl.2020.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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] [Indexed: 12/17/2022]
Abstract
Gonadal dysfunction and infertility after cancer treatment are major concerns for childhood cancer survivors and their parents. Uncertainty about fertility or being diagnosed with infertility has a negative impact on quality of survival. In this article, determinants of gonadal damage are reviewed and consequences for fertility and pregnancies are discussed. Recommendations for screening and treatment of gonadal function are provided. These should enable timely treatment of gonadal insufficiency aiming to improve linear growth, pubertal development, and sexual functioning. Options for fertility preservation are discussed.
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Affiliation(s)
- Hanneke M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, UMCU, PO Box 85090, Utrecht 3505 AB, The Netherlands; Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, Utrecht 3584 CS, The Netherlands.
| | | | - Annelies M E Bos
- Department of Reproductive Medicine and Gynecology, University Medical Centre, Utrecht, Postbus 85500, Utrecht 3508 GA, the Netherlands
| | | | - Helena J van der Pal
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, Utrecht 3584 CS, The Netherlands
| | - William Hamish Wallace
- Department of Pediatric Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, Scotland
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Huele EH, Kool EM, Bos AME, Fauser BCJM, Bredenoord AL. The ethics of embryo donation: what are the moral similarities and differences of surplus embryo donation and double gamete donation? Hum Reprod 2020; 35:2171-2178. [DOI: 10.1093/humrep/deaa166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 04/03/2020] [Indexed: 11/13/2022] Open
Abstract
ABSTRACT
Over the years, the demand for ART with donated embryos has increased. Treatment can be performed using donated ‘surplus embryos’ from IVF treatment or with embryos intentionally created through so-called ‘double gamete donation’. Embryo donation is particularly sensitive because treatment results in the absence of a genetic link between the parent(s) and the child, creating complex family structures, including full genetic siblings living in another family in the case of surplus embryo donation. In this paper, we explore the ethical acceptability of embryo donation in light of the similarities and differences between surplus embryo donation and double gamete donation. We will argue that no overriding objections to either form of embryo donation exist. First of all, ART with donated embryos respects patients’ reproductive autonomy by allowing them to experience gestational parenthood. It also respects IVF patients’ reproductive autonomy by providing an additional option to discarding or donating surplus embryos to research. Second, an extensive body of empirical research has shown that a genetic link between parent and child is not a condition for a loving caring relationship between parent(s) and child. Third, the low moral status of a pre-implantation embryo signifies no moral duty for clinics to first use available surplus embryos or to prevent the development of (more) surplus embryos through double gamete donation. Fourth, there is no reason to assume that knowledge of having (full or half) genetically related persons living elsewhere provides an unacceptable impact on the welfare of donor-conceived offspring, existing children of the donors, and their respective families. Thus, patients and clinicians should discuss which form of ART would be suitable in their specific situation. To guarantee ethically sound ART with donated embryos certain conditions have to be met. Counselling of IVF patients should involve a discussion on the destination of potential surplus embryos. When counselling donors and recipient(s) a discussion of the significance of early disclosure of the child’s mode of conception, the implications of having children raised in families with whom they share no genetic ties, expectations around information-exchange and contact between donor and recipient families or genetically related siblings is warranted. Importantly, conclusions are mainly drawn from results of empirical studies on single gamete donation families. To evaluate the welfare of families created through surplus embryo donation or double gamete donation additional empirical research on these particular families is warranted.
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Affiliation(s)
- E H Huele
- Department of Reproductive Medicine and Gynecology, University Medical Centre, 3508 GA Utrecht, The Netherlands
| | - E M Kool
- Department of Medical Humanities, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands
| | - A M E Bos
- Department of Reproductive Medicine and Gynecology, University Medical Centre, 3508 GA Utrecht, The Netherlands
| | - B C J M Fauser
- Department of Reproductive Medicine and Gynecology, University Medical Centre, 3508 GA Utrecht, The Netherlands
| | - A L Bredenoord
- Department of Medical Humanities, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands
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Kool EM, van der Graaf R, Bos AME, Pieters JJPM, Custers IM, Fauser BCJM, Bredenoord AL. Stakeholders views on the ethical aspects of oocyte banking for third-party assisted reproduction: a qualitative interview study with donors, recipients and professionals. Hum Reprod 2019; 34:842-850. [PMID: 30927419 PMCID: PMC9185857 DOI: 10.1093/humrep/dez032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 02/01/2019] [Accepted: 02/19/2019] [Indexed: 01/28/2023] Open
Abstract
STUDY QUESTION What are the moral considerations held by donors, recipients and professionals towards the ethical aspects of the intake and distribution of donor bank oocytes for third-party assisted reproduction? SUMMARY ANSWER Interviews with oocyte donors, oocyte recipients and professionals demonstrate a protective attitude towards the welfare of the donor and the future child. WHAT IS KNOWN ALREADY The scarcity of donor oocytes challenges the approach towards the many ethical aspects that arise in establishing and operating an oocyte bank for third-party assisted reproduction. Including experiences and moral considerations originating from practice provides useful insight on how to overcome these challenges. STUDY DESIGN, SIZE, DURATION The project was set-up as a qualitative interview study and took place between October 2016 and August 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS We conducted 25 semi-structured interviews with professionals engaged in the practice of oocyte banking (n = 10), recipients of donor oocytes (n = 7) and oocyte donors (n = 8). Key themes were formulated by means of a thematic analysis. MAIN RESULTS AND THE ROLE OF CHANCE Based on the interviews, we formulated four main themes describing stakeholders’ views regarding the ethical aspects of the intake and distribution of donor bank oocytes. First, respondents articulated that when selecting donors and recipients, healthcare workers should prevent donors from making a wrong decision and safeguard the future child’s well-being by minimizing health risks and selecting recipients based on their parental capabilities. Second, they proposed to provide a reasonable compensation and to increase societal awareness on the scarcity of donor oocytes to diminish barriers for donors. Third, respondents considered the prioritization of recipients in case of scarcity a difficult choice, because they are all dependent on donor oocytes to fulfil their wish for a child. They emphasized that treatment attempts should be limited, but at least include one embryo transfer. Fourth and finally, the importance of good governance of oocyte banks was mentioned, including a homogenous policy and the facilitation of exchange of experiences between oocyte banks. LIMITATIONS, REASONS FOR CAUTION The possibility of selection bias exists, because we interviewed donors and recipients who were selected according to the criteria currently employed in the clinics. WIDER IMPLICATIONS OF THE FINDINGS Respondents’ moral considerations regarding the ethical aspects of the intake and distribution of donor oocytes demonstrate a protective attitude towards the welfare of the donor and the future child. At the same time, respondents also questioned whether such a (highly) protective attitude was justified. This finding may indicate there is room for reconsidering strategies for the collection and distribution of donor bank oocytes. STUDY FUNDING/COMPETING INTEREST(s) This study was funded by ZonMw: The Dutch Organization for Health Research and Development (Grant number 70-73000-98-200). A.M.E.B. and B.C.J.M.F. are the initiators of the UMC Utrecht oocyte bank. J.J.P.M.P. is the director of the MCK Fertility Centre. IMC is working as a gynaecologist at the AMC Amsterdam oocyte bank. During the most recent 5-year period, BCJM Fauser has received fees or grant support from the following organizations (in alphabetic order): Actavis/Watson/Uteron, Controversies in Obstetrics & Gynaecologist (COGI), Dutch Heart Foundation, Dutch Medical Research Counsel (ZonMW), Euroscreen/Ogeda, Ferring, London Womens Clinic (LWC), Merck Serono (GFI), Myovant, Netherland Genomic Initiative (NGI), OvaScience, Pantharei Bioscience, PregLem/Gedeon Richter/Finox, Reproductive Biomedicine Online (RBMO), Roche, Teva and World Health Organization (WHO). The authors have no further competing interests to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- E M Kool
- Department of Medical Humanities, University Medical Center Utrecht, Julius Centre, PO Box 85500, Universiteitsweg 100, Utrecht, The Netherlands
| | - R van der Graaf
- Department of Medical Humanities, University Medical Center Utrecht, Julius Centre, PO Box 85500, Universiteitsweg 100, Utrecht, The Netherlands
| | - A M E Bos
- Department of Reproductive Medicine and Gynecology, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
| | - J J P M Pieters
- MCK Fertility Centre, Center of Reproductive Medicine, Simon Smithweg 16, Leiderdorp, The Netherlands
| | - I M Custers
- Centre for Reproductive Medicine, Amsterdam University Medical Centre, Meibergdreef 9, Amsterdam, The Netherlands
| | - B C J M Fauser
- Department of Reproductive Medicine and Gynecology, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
| | - A L Bredenoord
- Department of Medical Humanities, University Medical Center Utrecht, Julius Centre, PO Box 85500, Universiteitsweg 100, Utrecht, The Netherlands
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Kool EM, Bos AME, van der Graaf R, Fauser BCJM, Bredenoord AL. Ethics of oocyte banking for third-party assisted reproduction: a systematic review. Hum Reprod Update 2018; 24:615-635. [DOI: 10.1093/humupd/dmy016] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/20/2018] [Indexed: 12/29/2022] Open
Affiliation(s)
- E M Kool
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Universiteitsweg 100, GA Utrecht, The Netherlands
- Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - A M E Bos
- Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - R van der Graaf
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Universiteitsweg 100, GA Utrecht, The Netherlands
| | - B C J M Fauser
- Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - A L Bredenoord
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Universiteitsweg 100, GA Utrecht, The Netherlands
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Dahhan T, Balkenende EME, Beerendonk CCM, Fleischer K, Stoop D, Bos AME, Lambalk CB, Schats R, van Golde RJT, Schipper I, Louwé LA, Cantineau AEP, Smeenk JMJ, de Bruin JP, Reddy N, Kopeika Y, van der Veen F, van Wely M, Linn SC, Goddijn M. Stimulation of the ovaries in women with breast cancer undergoing fertility preservation: Alternative versus standard stimulation protocols; the study protocol of the STIM-trial. Contemp Clin Trials 2017; 61:96-100. [PMID: 28710053 DOI: 10.1016/j.cct.2017.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 04/29/2016] [Revised: 03/04/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Chemotherapy for breast cancer may have a negative impact on reproductive function due to gonadotoxicity. Fertility preservation via banking of oocytes or embryos after ovarian stimulation with FSH can increase the likelihood of a future live birth. It has been hypothesized that elevated serum estrogen levels during ovarian stimulation may induce breast tumour growth. This has led to the use of alternative stimulation protocols with addition of tamoxifen or letrozole. The effectiveness of these stimulation protocols in terms of oocyte yield is unknown. METHODS/DESIGN Randomized open-label trial comparing ovarian stimulation plus tamoxifen and ovarian stimulation plus letrozole with standard ovarian stimulation in the course of fertility preservation. The study population consists of women with breast cancer who opt for banking of oocytes or embryos, aged 18-43years at randomisation. Primary outcome is the number of oocytes retrieved at follicle aspiration. Secondary outcomes are number of mature oocytes retrieved, number of oocytes or embryos banked and peak E2 levels during ovarian stimulation. DISCUSSION Concerning the lack of evidence on which stimulation protocol should be used in women with breast cancer and the growing demand for fertility preservation, there is an urgent need to undertake this study. By performing this study, we will be able to closely monitor the effects of various stimulation protocols in women with breast cancer and pave the way for long term follow up on the safety of this procedure in terms of breast cancer prognosis. TRIAL REGISTRATION NTR4108.
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Affiliation(s)
- T Dahhan
- Center for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - E M E Balkenende
- Center for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands.
| | - C C M Beerendonk
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - K Fleischer
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - D Stoop
- Center for Reproductive Medicine, UZ Brussel, Free University of Brussels, Belgium
| | - A M E Bos
- Department of Reproductive Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C B Lambalk
- Department of Reproductive Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - R Schats
- Department of Reproductive Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - R J T van Golde
- Department of Reproductive Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - I Schipper
- Department of Obstetrics and Gynaecology, St Elisabeth Hospital, Tilburg, The Netherlands
| | - L A Louwé
- Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - A E P Cantineau
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, Groningen, The Netherlands
| | - J M J Smeenk
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J P de Bruin
- Department of Obstetrics and Gynecology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - N Reddy
- Assisted Conception Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Y Kopeika
- Assisted Conception Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - F van der Veen
- Center for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - M van Wely
- Center for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - S C Linn
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M Goddijn
- Center for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands
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23
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Bos AME, Klapwijk P, Fauser BCJM. [Wide support for oocyte donation and banking in the Netherlands]. Ned Tijdschr Geneeskd 2012; 156:A4145. [PMID: 22296901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To assess the general consensus on the cryopreservation of oocytes and the introduction of oocyte banking facilities in the Netherlands. DESIGN Poll investigation METHOD A poll with the use of an online questionnaire was conducted among nearly 19,000 participants of the Dutch EenVandaag opinion panel in May 2011. The poll results were adjusted to the Dutch population based on data from the Dutch Central Office for Statistics for age, gender, education, marital status, geographical area and political preference (measured according to the lower house elections of 2010). The primary endpoints were the percentages of supporters of oocyte freezing for own future use and of the concept of introducing oocyte banking facilities in The Netherlands. The secondary endpoints were the demographic differences between supporters and opponents. RESULTS Approximately half of 18.911 participants supported oocyte freezing (47%). Fifty-percent of all participants supported oocyte banking in the Netherlands. Supporters of oocyte freezing were mainly women ≤ 45 years of age, who are highly educated and have no children. Four percent of the participating women aged ≤ 45 years would seriously consider obtaining donor oocytes from an available oocyte banking facility. Twelve percent of the participating women ≤ 45 years of age said they would definitely donate their oocytes or would seriously consider donating. Thirty-seven percent of all participants were against the introduction of oocyte banking facilities. The most important arguments against oocyte freezing were that women should reproduce during normal reproductive years and that it was not medically necessary. CONCLUSION Poll results showed much support for oocyte freezing and for the introduction of oocyte banking facilities in the Netherlands. In addition, the poll shows that oocyte banking facilities would fulfil a need in the population.
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Affiliation(s)
- Annelies M E Bos
- Universitair Medisch Centrum Utrecht, afd. Voortplantingsgeneeskunde en Gynaecologie, Utrecht, the Netherlands.
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van Ijsselmuiden MN, Bos AME, Hoek A, van Beek AP, Kerstens MN. [Lichen sclerosus and Turner syndrome]. Ned Tijdschr Geneeskd 2010; 154:A773. [PMID: 20178664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Lichen sclerosus was diagnosed at a young age (19, 22 and 37 years) in three women with Turner syndrome. The oldest of these patients had probably suffered from this disorder for over 20 years. The relatively young age of these three patients is remarkable. This observation also suggests an increased frequency of lichen sclerosus among women with Turner syndrome. Immunological and hormonal factors might explain this association. Early detection of lichen sclerosus is important, as malignant transformation into carcinoma of the vulva may occur. It is advisable to perform regular gynaecological examination as part of the recommended periodic screening of adult women with Turner syndrome.
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25
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Bos AME, Pelinck MJ, Dumoulin JCM, Arts EGJM, van Echten-Arends J, Simons AHM. [IVF in a modified natural cycle]. Ned Tijdschr Geneeskd 2010; 154:A2519. [PMID: 21118595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In vitro fertilisation (IVF) usually involves controlled ovarian stimulation (COS). There is now increasing emphasis on methods that make IVF safer and more patient-friendly. Modified natural cycle (MNC)-IVF is an example of this. In MNC-IVF spontaneous ovulation is prevented with a minimal amount of hormones and spontaneous monofollicular growth is supported. As a result, there is no risk of ovarian hyperstimulation syndrome, and the risk of a multiple pregnancy is low. There is a 9.1% chance of a pregnancy after one MNC-cycle and the cumulative pregnancy rate after a maximum of 6 MNC-IVF cycles is 33.4%. The cumulative results of a maximum of 6 MNC-IVF cycles are comparable to those of the first COS-IVF treatment cycle including transfer of cryopreserved embryos produced as a result of the treatment (33.4% versus 37.7%). The risk of a twin pregnancy following MNC-IVF is 0.1%, and 18.3% following COS-IVF. This means that MNC-IVF is a good alternative for COS-IVF.
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Affiliation(s)
- Annelies M E Bos
- Universitair Medisch Centrum Groningen, Afd. Obstetrie & Gynaecologie, the Netherlands
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De Vos FYFL, Bos AME, Schaapveld M, de Swart CAM, de Graaf H, van der Zee AGJ, Boezen HM, de Vries EGE, Willemse PHB. A randomized phase II study of paclitaxel with carboplatin +/- amifostine as first line treatment in advanced ovarian carcinoma. Gynecol Oncol 2005; 97:60-7. [PMID: 15790438 DOI: 10.1016/j.ygyno.2004.11.052] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Will amifostine (A) protect against chemotherapy-induced neuro- and myelotoxicity. PATIENTS AND METHODS Ninety ovarian cancer patients were randomized to receive standard paclitaxel + carboplatin without (PC) or preceded by amifostine 740 mg/m(2) (PC + A). RESULTS The mean baseline values of hemoglobin, leukocyte, and platelets were slightly lower in the amifostine group, but the mean percentual decrease of these parameters after each treatment cycle showed no difference between both arms. Symptoms of neurotoxicity remained absent in 40% PC vs. 49% PC + A cycles; sensory neurotoxicity grade I occurred in 45% vs. 48% and grade II in 12% PC vs. 2% of PC + A cycles (overall P < 0.001). Nausea grade II was reported in 2% vs. 6% (P = 0.007) and vomiting grade II in 1% of PC vs. 8% PC + A cycles (P < 0.001). Amifostine was temporarily interrupted in five patients due to hypotension, but no dose reductions were indicated. Quality of life questionnaires showed no difference in neurotoxicity scores between both study arms at treatment completion. The median progression-free survival was 16 vs. 22 months (n.s.) for PC and PC + A patients. In a pooled analysis of four randomized studies, amifostine diminished the risk of developing neurotoxicity grade II-III (Odds Ratio 0.3, 95% confidence interval 0.15-0.63, P < 0.05), but had no effect on the risk for bone marrow toxicity. CONCLUSION Amifostine shows only minor but significant activity in diminishing neurotoxicity without preventing paclitaxel + carboplatin-induced bone marrow toxicity.
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Affiliation(s)
- F Y F L De Vos
- Department of Medical Oncology, University Hospital of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
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Bos AME, De Vos FYFL, de Vries EGE, Beijnen JH, Rosing H, Mourits MJE, van der Zee AGJ, Gietema JA, Willemse PHB. A phase I study of intraperitoneal topotecan in combination with intravenous carboplatin and paclitaxel in advanced ovarian cancer. Eur J Cancer 2005; 41:539-48. [PMID: 15737558 DOI: 10.1016/j.ejca.2004.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2004] [Revised: 10/25/2004] [Accepted: 12/03/2004] [Indexed: 11/16/2022]
Abstract
The aim of this study was to determine the maximum tolerated dose (MTD) of intraperitoneal (i.p.) topotecan combined with standard doses of intravenous (i.v.) carboplatin and paclitaxel and to investigate its pharmacokinetics. Women with primary ovarian cancer stage IIb - IV received six cycles of i.v. carboplatin and paclitaxel with escalating topotecan doses i.p. of 10, 15, 20 and 25 mg/m(2). Twenty-one patients entered this trial. Febrile neutropenia, thrombocytopenia requiring platelet transfusion and fatigue grade 3 were dose-limiting toxicities (DLT) at 25 mg/m(2) i.p. and 20 mg/m(2) i.p. of topotecan was considered to be the MTD. The mean plasma t(1/2) was 3.8 +/- 2.3 h for total topotecan and 4.4 +/- 3.9 h for active lactone. The area under the curve (AUC) was proportional with dose, R = 0.54, p < 0.05 for total topotecan and the peritoneal / plasma AUC ratio was 46 +/- 30. Fifteen patients who completed treatment had a median progression-free survival (PFS) of 27 months. In this setting the MTD of topotecan is 20 mg/m(2) i.p. The efficacy of this regimen should be explored further in a formal phase III study.
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Affiliation(s)
- A M E Bos
- Department of Medical Oncology, University Hospital Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
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Bos AME, Boom K, Vinks AA, Boezen HM, Wanders J, Dombernovsky P, Aamdal S, de Vries EGE, Uges DRA. Development of an optimal sampling strategy for clinical pharmacokinetic studies of the novel anthracycline disaccharide analogue MEN-10755. Cancer Chemother Pharmacol 2004; 54:64-70. [PMID: 15069581 DOI: 10.1007/s00280-004-0772-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2003] [Accepted: 01/19/2004] [Indexed: 10/26/2022]
Abstract
AIM MEN-10755 is a novel anthracycline analogue that has shown an improved therapeutic efficacy over doxorubicin in animal models, especially in gynaecological and lung cancers and is currently under clinical development for the treatment of solid tumours. The aim of the project was to develop an optimal sampling strategy for MEN-10755 to provide an efficient basis for future pharmacokinetic/pharmacodynamic investigations. METHODS Data from 24 patients who participated in a phase I clinical pharmacokinetic study of MEN-10755 administered as a short i.v. infusion were included. Individual pharmacokinetic values were calculated by fitting the plasma concentration data to a two-compartment model using nonlinear least-squared regression (KINFIT, Ed 3.5). Population pharmacokinetic analysis was carried out using (a) the traditional standard two-stage method (STS) based on all data (KINFIT-ALL), (b) the iterative two-stage Bayesian (IT(2)B) population modelling algorithm (KINPOP), and (c) the STS method using KINFIT and using four optimally timed plasma concentrations (KINFIT-OSS4). Determinant (D) optimal sampling strategy (OSS) was used to evaluate the four most information-rich sampling times. The pharmacokinetic parameters V(c) (l), k(el) (h(-1)), k(12) (h(-1)) and k(21) (h(-1)) calculated using KINPOP served as a model for calculation of four D-optimal sampling times. D-optimal sampling data sets were analysed using KINFIT-OSS4 and compared with the population model obtained by the traditional standard two-stage approach for all data sets (KINFIT-ALL). RESULTS The optimal sampling times were: the end of the infusion, and 1.5 h, 3.8 h and 24 h after the start of the infusion. The four-point D-optimal sampling design determined in this study gave individual parameter estimates close to the basic standard estimates using the full data set. CONCLUSION Because accurate estimates of pharmacokinetic parameters were achieved, the four-point D-optimal sampling design may be very useful in future studies with MEN-10755.
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Affiliation(s)
- A M E Bos
- Department of Medical Oncology, University Hospital Groningen, P.O. box 30.001, 9700 RB, Groningen, The Netherlands
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de Vos FYFL, Bos AME, Gietema JA, Pras E, Van der Zee AGJ, de Vries EGE, Willemse PHB. Paclitaxel and carboplatin concurrent with radiotherapy for primary cervical cancer. Anticancer Res 2004; 24:345-8. [PMID: 15015619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND Concurrent radiochemotherapy is currently considered the new standard treatment in locally advanced cervical cancer. PATIENTS AND METHODS Eight women with cervical cancer stage IB2-IVA were treated with standard radiation therapy in combination with standard carboplatin (AUC=2, once weekly, x 6) and escalating doses of paclitaxel (60 mg/m2, once weekly, x 4, then x 5 and x 6). RESULTS At the lowest dose level, four weekly paclitaxel cycles in six patients, three developed grade III diarrhoea and one severe radiation enteritis several weeks after radiotherapy. Two patients did not achieve complete remission and underwent additive salvage hysterectomy. All patients remained free of local recurrence, but one patient had distant metastases after 13 months. The median disease-free survival was 25 months with a median follow-up of 26 months. CONCLUSION Standard pelvic radiotherapy in combination with weekly carboplatin and paclitaxel is poorly tolerated due to dose-limiting diarrhoea.
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Affiliation(s)
- F Y F L de Vos
- Department of Medical Oncology, Groningen University Hospital, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
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30
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Hofstra LS, Bos AME, de Vries EGE, van der Zee AGJ, Willemsen ATM, Rosing H, Beijnen JH, Mulder NH, Aalders JG, Willemse PHB. Kinetic modeling and efficacy of intraperitoneal paclitaxel combined with intravenous cyclophosphamide and carboplatin as first-line treatment in ovarian cancer. Gynecol Oncol 2002; 85:517-23. [PMID: 12051884 DOI: 10.1006/gyno.2002.6665] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the efficacy, tolerability, and pharmacokinetics of intraperitoneal (ip) paclitaxel combined with intravenous (iv) carboplatin and cyclophosphamide. PATIENTS AND METHODS Twenty-five newly diagnosed patients with Stage IC-IV epithelial ovarian cancer received ip paclitaxel with iv carboplatin and cyclophosphamide as a first-line treatment. Paclitaxel pharmacokinetics was determined during the first cycle on day 1 or 8. RESULTS This regimen was well tolerated, as abdominal pain and hematological toxicities were minor, while neurotoxicity grade I/II was reported in only 20% and myalgia in 24% of patients and were fully reversible. After treatment 13 of 18 (72%) of the patients had no evidence of disease. At a median follow-up of 30 months patients with residual disease after surgery (n = 10) had a median progression-free survival (PSF) of 13 months; for the optimally debulked group (n = 15) the actuarial PFS was 60% at 48 months. The elimination of paclitaxel from the peritoneal cavity and plasma followed first-order kinetics and was not influenced by adding carboplatin with cyclophosphamide. CONCLUSION This regimen was well tolerated, with minimal hematologic or neurotoxicity, and allowed the application of a triple-drug schedule without compromising dose intensity. To judge its efficacy, comparison with a standard iv paclitaxel-based schedule should be performed in a formal phase III study.
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Affiliation(s)
- L S Hofstra
- Department of Medical Oncology, University Hospital Groningen, Groningen, The Netherlands
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31
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Schrijvers D, Bos AME, Dyck J, de Vries EGE, Wanders J, Roelvink M, Fumoleau P, Bortini S, Vermorken JB. Phase I study of MEN-10755, a new anthracycline in patients with solid tumours: a report from the European Organization for Research and Treatment of Cancer, Early Clinical Studies Group. Ann Oncol 2002; 13:385-91. [PMID: 11996468 DOI: 10.1093/annonc/mdf061] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A phase I study was performed with MEN-10755, a novel anthracycline with promising preclinical antitumour activity, in patients with solid tumours to determine the maximum tolerated dose (MTD); the dose-limiting toxicities (DLTs); to document antitumour activity; and to propose a safe dose for phase II evaluation. MEN-10755 at a starting dose of 15 mg/m2/week was given by short intravenous infusion weekly for 3 weeks and cycles were repeated every 28 days. Twenty-four patients received 55 cycles. Doses of MEN-10755 were 15, 30, 40 and 45 mg/m2. At a dose of MEN-10755 45 mg/m2, treatment could not be given as planned due to neutropenia and one patient developed a decrease in cardiac function. This dose level was considered to be the MTD. Chemotherapy-naive patients could be treated with 40 mg/m2/week, and only one DLT (grade 4 neutropenia) was observed. At that dose, three of six chemotherapy pretreated patients developed a DLT during their first treatment cycle: one patient developed a grade 4 thrombocytopenia, one patient a grade 4 neutropenia and one patient developed a grade 3 acute hypersensitivity reaction resulting in discontinuation of treatment. At this dose level, one other patient did not receive treatment on day 15 as planned due to grade 3 neutropenia. No responses were observed. MEN-107555 at a dose of 30 mg/m2/week in pretreated patients and 40 mg/m2/week in chemotherapy-naive patients for three consecutive weeks followed by 1 week rest is recommended for phase II testing.
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Affiliation(s)
- D Schrijvers
- Department of Medical Oncology, University Hospital Antwerp, Edegem, Belgium
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