Clinical trial NCT00504699: Safety of Ovarian Stimulation With Letrozole and Gonadotropins in Breast Cancer Patients
Official title: Safety of Ovarian Stimulation With Letrozole and Gonadotropins in Breast Cancer Patients Undergoing Embryo or Oocyte Cryopreservation: A Prospective Controlled Follow up Study
Study type: INTERVENTIONAL
Overall status: TERMINATED
Phase: NA
Conditions: Breast Cancer
Keywords: breast cancer
ovarian stimulation
aromatase inhibitors
letrozole
fertility preservation
recurrence
Lead sponsor: New York Medical College
Sponsor class: OTHER
First posted: 2007-07-20
Enrollment: 120
Sex: FEMALE
Minimum age (years): 18
Maximum age (years): 45
Standard ages: ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: SINGLE_GROUP
Primary purpose: OTHER

Brief summary: Breast cancer patients are commonly treated with drugs that eggs present in the ovary and may reduce their chance for getting pregnant. Their fertility can be preserved by stimulating their ovaries, collecting multiple eggs, fertilize them in the lab and freeze them. Ovarian stimulation increase their estrogen levels in blood.this may stimulate their cancer and increase chance for recurrence. If a medicine that prevent estrogen rise is used (letrozole), this may increase the safety of stimulation. In this study we compared ovarian stimulation in breast cancer patients using letrozole with those who did not undergo stimulation and showed that there is no increase risk for recurrence after a median follow up of 2 years

Detailed description: 215 women with breast cancer were evaluated for fertility preservation before chemotherapy. Of those, 79 elected to undergo controlled ovarian stimulation (COH) with letrozole and gonadotropins for embryo or oocyte cryopreservation. The 136 patients who declined served as controls.There were no significant differences between the study and control groups regarding age at diagnosis, breast cancer prognostic parameters (tumor size, grade, number of positive lymph nodes, estrogen receptor status, her2-neu overexpression and vascular space invasion), and chemotherapy regimens. There was no difference between the two groups in the projected 10 year relapse, breast cancer specific mortality or overall mortality. There were 3 recurrences or contralateral breast cancers (2 distant, 1 locoregional) in the letrozole group, and 11 in the control group (9 distant, 1 locoregional, 1 contralateral breast).

Comparison; breast cancer patients that underwent ovarian stimulation with letrozole+gonadotropins and those who declined ovarian stimulation.

Eligibility criteria: Inclusion Criteria:

* Age 18-45 years
* Biopsy proven breast cancer
* No prior chemotherapy or oophorectomy
* Regular menstrual cycles
* Normal basal FSH and estradiol

Exclusion Criteria:

* Stage 4 breast cancer

Primary outcomes:
measure: Breast cancer relapse free survival after ovarian stimulation
timeFrame: after chemotherapy to end of follow up
Secondary outcomes:
measure: Estradiol level, number of embryos cryopreserved, clinical pregnancy rate, ovarian reserve after chemotherapy
timeFrame: during stimulation, after stimulation and 1-2 years after chemotherapy
Other outcomes:
Locations:
city: Valhalla
country: United States
facility: IFPn
state: New York
Study officials:
affiliation: IFP
name: Kutluk H Oktay, MD, FACOG
role: PRINCIPAL_INVESTIGATOR
References:
citation: Oktay K, Turan V, Bedoschi G, Pacheco FS, Moy F. Fertility Preservation Success Subsequent to Concurrent Aromatase Inhibitor Treatment and Ovarian Stimulation in Women With Breast Cancer. J Clin Oncol. 2015 Aug 1;33(22):2424-9. doi: 10.1200/JCO.2014.59.3723. Epub 2015 Jun 22.
citation: Reddy J, Turan V, Bedoschi G, Moy F, Oktay K. Triggering final oocyte maturation with gonadotropin-releasing hormone agonist (GnRHa) versus human chorionic gonadotropin (hCG) in breast cancer patients undergoing fertility preservation: an extended experience. J Assist Reprod Genet. 2014 Jul;31(7):927-32. doi: 10.1007/s10815-014-0248-6. Epub 2014 May 23.
citation: Azim AA, Costantini-Ferrando M, Oktay K. Safety of fertility preservation by ovarian stimulation with letrozole and gonadotropins in patients with breast cancer: a prospective controlled study. J Clin Oncol. 2008 Jun 1;26(16):2630-5. doi: 10.1200/JCO.2007.14.8700.