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
Authors: Mailliez A , Vendel Y , Govaere A , Jebert S , Bonneterre J , Decanter C 
Published: August 2014

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.