Current practices in oncofertility counseling: updated evidence on fertility preservation and post-treatment pregnancies in young women affected by early breast cancer

ABSTRACT

Introduction

Anticancer treatments have significantly contributed to increasing cure rates of breast cancer in the last years; however, they can also lead to short- and long-term side effects, including gonadotoxicity, and compromised fertility in young women. Oncofertility is a crucial issue for young patients who have not yet completed their family planning at the time of cancer diagnosis.

Areas covered

This review aims to cover all the latest available evidence in the field of oncofertility, including the gonadotoxicity of currently adopted anticancer therapies in the curative breast cancer setting, the available strategies for fertility preservation and the feasibility of achieving a pregnancy following anticancer treatment completion.

Expert opinion

Over the past years, a significant progress has been made in oncofertility care for young women with breast cancer. In the context of the currently available evidence, every young woman with newly diagnosed breast cancer should receive a proper and complete oncofertility counseling before starting any anticancer treatment to increase her chances of future pregnancies.

KEYWORDS:

• Anticancer treatments
• fertility preservation
• gonadotoxicity
• young patients
• oocytes/embryo cryopreservation
• ovarian tissue cryopreservation
• survivorship
• oncofertility
• breast cancer

Article highlights

• Most anticancer regimens administered in the treatment of early breast cancer can impair ovarian reserve and fertility in young women through different mechanisms.

• Still too many patients do not receive proper oncofertility counseling before starting anticancer treatments, with a subsequent risk of permanently compromise their chances of having a future pregnancy.

• Fertility preservation techniques, such as cryopreservation of oocytes/embryos or ovarian tissue, are feasible and safe in almost all young women with early breast cancer patients before treatment initiation.

• Pregnancy following diagnosis and proper treatment can be considered safe for most patients with both hormone receptor-negative and positive breast cancer.

• Optimizing oncofertility care is a crucial component of survivorship with direct positive effect on patients’ quality of life, by enabling young women to regain a normal life after breast cancer diagnosis and treatment.

Declaration of interest

M. Lambertini reports being in an advisory role for Roche, Lilly, Novartis, AstraZeneca, Pfizer, Seagen, Gilead, MSD, Menarini and Exact Sciences and receiving speaker honoraria from Roche, Lilly, Novartis, Pfizer, Sandoz, Libbs, Daiichi Sankyo, Knight, AstraZeneca, Menarini and Takeda, Travel Grants from Gilead, Roche and Daiichi Sankyo, and research support (to the Institution) from Gilead outside the submitted work. C. Genova declares honoraria from Astra Zeneca, Bristol-Myers-Squibb, Boehringer-Ingelheim, Merck-Sharp-Dohme, Roche, Takeda. CD declares honoraria from Astra Zeneca, Bristol-Myers-Squibb, Merck-Sharp-Dohme, Roche. E. de Azambuja declares honoraria from or participation in advisory boards for Roche, Genentech, Novartis, SeaGen, Zodiac, Libbs, Pierre Fabre, Eli Lilly, and AstraZeneca. JC declares consulting or advisor roles supported by Roche, Celgene, Cellestia, AstraZeneca, SeaGen, Daiichi Sankyo, Erytech, Athenex, Polyphor, Eli Lilly, Merck Sharp and Dohme, GSK, Leuko, Bioasis, Clovis Oncology, Boehringer Ingelheim, Ellipses, Hibercell, BioInvent, Gemoab, Gilead, Menarini, Zymeworks, Reveal Genomics, and Expres2ion Biotechnologies. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was partially funded by the Italian Association for Cancer Research (“Associazione Italiana per la Ricerca sul Cancro”, AIRC; MFAG 2020 ID 24698).