Abstract P3-09-19: A prospective study of fertility preservation by controlled ovarian hyperstimulation (COH) without letrozole in young breast cancer patients before adjuvant chemotherapy: Preliminary results

Background: 6300 new cases of breast cancer arise in young women under 40 each year in France. The majority receives chemotherapy and a lot of them have not completed their family. The incidence of persistent chemotherapy-induced amenorrhea in these patients is approximately 20%. The incidence of infertility, although poorly studied, is probably higher. Besides, there has been a development of techniques of fertility preservation and henceforth physicians have to systematically offer these techniques to these young patients before the onset of chemotherapy. Few studies have addressed the issue of COH for fertility preservation in breast cancer pts. In most of these, letrozole is required during COH in order to limit the estrogen levels increase. In France, the use of letrozole in this specific area is not allowed. The aim of this prospective observational study is to evaluate the benefit/risk of the ovarian stimulation without letrozole for oocyte/embryo freezing in young breast cancer pts undergoing adjuvant chemotherapy.

Methods: 28 young breast cancer patients were referred for fertility preservation before chemotherapy. Inclusion criteria were age 18 to 38, histologically confirmed invasive breast carcinoma, absence of metastases. 12 patients (6 due to a neoadjuvant setting and 6 because of the wishes of the patient) had only a follow up of their ovarian reserve. The 16 others patients were in an adjuvant setting and were asking for a fertility preservation. These 16 patients underwent COH during the interval between complete surgery and start of adjuvant chemotherapy. To reduce the risk of ovarian hyperstimulation, ovarian stimulation protocol will use gonadotropins and a GnRH antagonist and a GnRH agonist will do the ovulation trigger. All the patients were then enrolled in a systematic oncologic and reproductive follow-up for 2 consecutive years after the end of chemotherapy. All patients gave their informed consent for COH, egg/embryo freezing and follow-up.

Results: Mean age of the study population was 31 years (25-37). Histologic type was invasive ductular carcinoma in all cases, except 1 medullary carcinoma. 14 tumours were hormonal receptors positive, 4 were Her 2 positive. 14 patients had not yet children. Mean initial AMH levels and AFC were respectively 17 (7,7-120) and 21(6-68). Length of stimulation was 12.5 (11-16). Time between surgery and chemotherapy was 46 days (19-95). Time between first consultation in the fertility preservation center and chemotherapy was 25 days (2-73). The mean number of vitrified oocytes was 6,2 (0-14). The mean number of frozen embryo was 2,8 (0-8). Mean duration of follow-up after the end of chemotherapy was 265 days (27-585). To date, no oncologic adverse effects were observed during the study period.

Conclusion: These preliminary results confirmed the feasibility of a collaboration between oncologists, reproductive medicine doctor and biologist to allow all the women concerned to have access to a preservation of their fertility. Safety and results of COH had to be confirmed in a larger population.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-09-19.

Abstract P2-13-10: Prospective randomized and multicentric evaluation of cognition in menopausal breast cancer patients receiving adjuvant hormonotherapy: a phase III study (Preliminary results)

Background: Cognitive impairment has been considered to be a possible adverse effect of aromatase inhibitors (AI). The aim of the study was to compare the impact of tamoxifen or AI on verbal memory (Rey auditory-verbal learning test) and other cognitive functions (memory, executive and attentional functions) after 6 months of treatment.

Methods: In this randomized, open-label phase III study, menopausal patients treated with adjuvant hormonotherapy for early breast cancer were enrolled at the end of the radiotherapy. Patients over 70 years, with a history of cognitive disorder or with prior chemotherapy were excluded. Detailed neuropsychological assessments and quality of life evaluations were performed before the 1st administration of hormonotherapy and then 6 months later. Considering the usual norms of the auditivo-verbal Rey test, an alpha risk of 5% and a 95% power, 27 patients per arm had to be included. Statistical analyses included Chi2 test and Student tests when appropriate.

Results: 62 consecutive evaluable patients were randomized in 2 arms between March 2009 and April 2011. Patients received tamoxifen in arm A (n = 31) and AI in arm B (letrozole n=17; anastrozole n=12; exemestane n= 2). Median age at inclusion was 61.4 years. The median time since menopause was 10 years. Characteristics of the breast tumor and initial neuropsychological evaluations did not differ significantly between the 2 arms. After 6 months, we observed a significant decline of the performance at the episodic memory test (immediate recall of the Rey auditory verbal learning test) (p = 0.0015) in arm A only and a significant improvement on executive measures (Trail Making Test and Stroop test) (respectively p = 0.03/p = 0.002) in arm B. Quality of life didn't differ after 6 months of treatment.

Conclusions: These preliminary results do not support that AI have a worse adverse effect on cognitive functions than tamoxifen after 6 months of treatment. A confirmation is planned after one year of treatment.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-13-10.

Prognostic factors for cancer patients with good performance status considered for inclusion in phase I clinical trials

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Background: For investigators, the selection of patients to be considered for phase I clinical trials is difficult, because of the lack of objective criteria for a rational decision-making process. From October 1997 to October 2002, we retrospectively assessed prognostic factors for cancer patients considered for Phase 1 trials. Methods: 148 consecutive patients who had been screened for inclusion in 6 different phase I trials were included in the present study. 70 out of them actually received the phase I treatment. Univariate (Log-Rank test) and multivariate analysis (Cox proportional hazard ratio model) were performed to determine the prognostic factors related to overall survival (OS) after screening. Results: The study comprised 63 men and 85 women, with a median age of 54 (range 23–79). The most frequent primary cancer sites were: breast (38 cases), head and neck (28 cases), lung (18 cases) and colorectal (17 cases). 91 out of them had a performance status PS = 0. The median OS of the 148 patients was 5.7 months (173 days, range 1–2,421). Univariate analysis identified PS = 1, Body Mass Index < 20, liver and visceral metastasis, serum albumin < 38 g/L, lymphocytes count < 0.7 x 109/L and granulocytes count > 7.5 x 109/L as poor prognostic factors. The Cox model identified serum albumin < 38 g/L (HR 2.51 [1.51–4.18], p=0.0001) and lymphocyte count < 0.7 x 109/L (HR 2.27 [1.13–4.62], p=0.024) as independent prognostic variables for OS. All patients presenting with both prognostic factors died within 90 days. Conclusion: We propose a simple model, easily obtained at the patient bedside, which can discriminate patients who have a life expectancy of over 3 months and thus could be enrolled in phase-I anti-cancer trials.

No significant financial relationships to disclose.