Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
TL;DR: The aim of this work is to provide a systematic review and meta-analysis of the literature on canine coronavirus infection and its role in infertility and procreation that has been reported on in previous studies and is concerned with the well-being of newborns.
About: This article is published in Annals of Oncology.The article was published on 2013-10-01 and is currently open access. It has received 598 citations till now.
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TL;DR: This work presents the results of a meta-analysis conducted at the 2016 European Oncology and Radiotherapy Guidelines Working Group (ESMO) workshop on breast cancer diagnosis and prognosis of women with atypical central giant cell granuloma (CGM) who have previously had surgery.
2,274 citations
Gdańsk Medical University1, Institut Gustave Roussy2, Pontifícia Universidade Católica do Rio Grande do Sul3, Karolinska University Hospital4, Fortis Healthcare5, European Institute of Oncology6, Curie Institute7, American University of Beirut8, Brighton and Sussex Medical School9, Peter MacCallum Cancer Centre10, BC Cancer Agency11, Ludwig Maximilian University of Munich12, Memorial Sloan Kettering Cancer Center13, Sheba Medical Center14, Harvard University15, Université libre de Bruxelles16, Paris Descartes University17, University of California, San Francisco18, Johns Hopkins University19, Indiana University20, University of Washington21, Martin Luther University of Halle-Wittenberg22, King's College London23, Peking Union Medical College24
TL;DR: This ESO-ESMO ABC 5 Clinical Practice Guideline provides key recommendations for managing advanced breast cancer patients, and provides updates on managing patients with all breast cancer subtypes, LABC, follow-up, palliative and supportive care.
1,514 citations
TL;DR: There is conflicting evidence to recommend gonadotrophin-releasing hormone agonists (GnRHa) and other means of ovarian suppression for fertility preservation and the panel notes that the field of ovarian tissue cryopreservation is advancing quickly and may evolve to become standard therapy in the future.
Abstract: PurposeTo provide current recommendations about fertility preservation for adults and children with cancer.MethodsA systematic review of the literature published from January 2013 to March 2017 was completed using PubMed and the Cochrane Library. An Update Panel reviewed the identified publications.ResultsThere were 61 publications identified and reviewed. None of these publications prompted a significant change in the 2013 recommendations.RecommendationsHealth care providers should initiate the discussion on the possibility of infertility with patients with cancer treated during their reproductive years or with parents/guardians of children as early as possible. Providers should be prepared to discuss fertility preservation options and/or to refer all potential patients to appropriate reproductive specialists. Although patients may be focused initially on their cancer diagnosis, providers should advise patients regarding potential threats to fertility as early as possible in the treatment process so as t...
865 citations
TL;DR: Although there is a great interest in this field, due to the lack of large prospective cohort studies and randomized trials on these topics, the level of evidence is not higher than 3 for most of the recommendations highlighting the need of further research efforts in many areas of this field.
Abstract: In the last years, thanks to the improvement in the prognosis of cancer patients, a growing attention has been given to the fertility issues. International guidelines on fertility preservation in cancer patients recommend that physicians discuss, as early as possible, with all patients of reproductive age their risk of infertility from the disease and/or treatment and their interest in having children after cancer, and help with informed fertility preservation decisions. As recommended by the American Society of Clinical Oncology and the European Society for Medical Oncology, sperm cryopreservation and embryo/oocyte cryopreservation are standard strategies for fertility preservations in male and female patients, respectively; other strategies (e.g. pharmacological protection of the gonads and gonadal tissue cryopreservation) are considered experimental techniques. However, since then, new data have become available, and several issues in this field are still controversial and should be addressed by both patients and their treating physicians. In April 2015, physicians with expertise in the field of fertility preservation in cancer patients from several European countries were invited in Genova (Italy) to participate in a workshop on the topic of “cancer and fertility preservation”. A total of ten controversial issues were discussed at the conference. Experts were asked to present an up-to-date review of the literature published on these topics and the presentation of own unpublished data was encouraged. On the basis of the data presented, as well as the expertise of the invited speakers, a total of ten recommendations were discussed and prepared with the aim to help physicians in counseling their young patients interested in fertility preservation. Although there is a great interest in this field, due to the lack of large prospective cohort studies and randomized trials on these topics, the level of evidence is not higher than 3 for most of the recommendations highlighting the need of further research efforts in many areas of this field. The participation to the ongoing registries and prospective studies is crucial to acquire more robust information in order to provide evidence-based recommendations.
632 citations
Cites background or methods from "Cancer, pregnancy and fertility: ES..."
...To date, pregnancy after cancer should be considered safe and not be discouraged in general [11]....
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...According to expert opinion, the timing should be “personalized” taking into account age and ovarian reserve of the patient, previous treatments and time of their completion, and individual risk of relapse [11]....
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...Embryo cryopreservation and oocyte cryopreservation are standard strategies for fertility preservation in female cancer patients [10, 11]....
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...Sperm cryopreservation before gonadotoxic therapies is the standard strategy for fertility preservation in adult men [10, 11]....
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...As recommended by major international guidelines on fertility preservation in cancer patients, clinicians should discuss with their patients the potential impact of anticancer treatment on fertility as early as possible and help with fertility preservation decisions among at-risk survivors interested in having children after cancer [10, 11, 38]....
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339 citations
References
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TL;DR: In this paper, the efficacy of two different taxanes, docetaxel and paclitaxel, given either weekly or every 3 weeks, in the adjuvant treatment of breast cancer was compared.
Abstract: Background We compared the efficacy of two different taxanes, docetaxel and paclitaxel, given either weekly or every 3 weeks, in the adjuvant treatment of breast cancer. Methods We enrolled 4950 women with axillary lymph node–positive or high-risk, lymph node–negative breast cancer. After randomization, all patients first received 4 cycles of intravenous doxorubicin and cyclophosphamide at 3-week intervals and were then assigned to intravenous paclitaxel or docetaxel given at 3-week intervals for 4 cycles or at 1-week intervals for 12 cycles. The primary end point was disease-free survival. Results As compared with patients receiving standard therapy (paclitaxel every 3 weeks), the odds ratio for disease-free survival was 1.27 among those receiving weekly paclitaxel (P=0.006), 1.23 among those receiving docetaxel every 3 weeks (P=0.02), and 1.09 among those receiving weekly docetaxel (P=0.29) (with an odds ratio >1 favoring the groups receiving experimental therapy). As compared with standard therapy, wee...
835 citations
TL;DR: The combination of low-dose FSH with tamoxifen (TamFSH-IVF) or letrozole (Letrozoles- IVF) results in higher embryo yield compared with Tam-IVf, and the letroZole protocol may be preferred because it results in lower peak E2 levels.
Abstract: Purpose To develop safe ovarian stimulation methods to perform in vitro fertilization (IVF) in breast cancer patients who wish to preserve their fertility via embryo cryopreservation before chemotherapy. Patients and Methods Sixty women (age range, 24 to 43 years) with breast cancer were prospectively studied. Twenty-nine patients underwent 33 ovarian stimulation cycles with either tamoxifen 60 mg/d alone (Tam-IVF) or in combination with low-dose follicle-stimulating hormone (TamFSH-IVF) or letrozole 5 mg in combination with FSH (Letrozole-IVF). After IVF, all resultant embryos were cryopreserved to preserve fertility. Recurrence rates were compared with controls (n 31) who elected not to undergo IVF. Results Compared with Tam-IVF, both TamFSH-IVF and Letrozole-IVF patients had greater numbers of follicles (2 0.3 v 6 1 and 7.8 0.9, respectively; P .0001), mature oocytes (1.5 0.3 v 5.1 1.1 and 8.5 1.6, respectively; P .001), and embryos (1.3 0.2 v 3.8 0.8 and 5.3 0.8, respectively; P .001). Peak estradiol (E2) levels were lower with Letrozole-IVF and Tam-IVF compared with TamFSH-IVF. After 554 31 days (range, 153 to 1,441 days) of follow-up, cancer recurrence rate was similar between IVF and control patients (three of 29 v three of 31 patients, respectively; hazard ratio, 1.5; 95% CI, 0.29 to 7.4), and this estimate was not affected by cancer stage. Conclusion The combination of low-dose FSH with tamoxifen (TamFSH-IVF) or letrozole (Letrozole-IVF) results in higher embryo yield compared with Tam-IVF. Recurrence rates do not seem to be increased, but the letrozole protocol may be preferred because it results in lower peak E2 levels.
485 citations
"Cancer, pregnancy and fertility: ES..." refers background in this paper
...The use of gonadotropins and letrozole or tamoxifen has been shown to be associated with adequate yield of oocytes with a lower increase in serum estradiol levels compared with standard stimulation regimens [70, 71] and is generally Figure 1....
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Journal Article•
TL;DR: The age of the mother plays a strong role in a wide range of birth outcomes (e.g., birthweight, multiple births, and birth defects), so it is critical to track the average age at which women have their first birth.
Abstract: Of particular interest to both researchers and the public is the "average" age of women when they have a child, especially their first. Age at first birth influences the total number of births that a woman might have in her life, which impacts the size, composition, and future growth of the population. The age of the mother, both younger and older, plays a strong role in a wide range of birth outcomes (e.g., birthweight, multiple births, and birth defects), so it is critical to track the average age at which women have their first birth.
483 citations
"Cancer, pregnancy and fertility: ES..." refers background in this paper
...Over the past four decades, there has been a rising trend of delaying childbearing [1]....
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TL;DR: The diagnosis of most cancer types during pregnancy or lactation does not increase the risk of cause-specific death, and the "healthy mother effect" for women with a postcancer pregnancy is confirmed.
Abstract: Purpose To assess if cancers diagnosed during pregnancy or lactation are associated with increased risk of cause-specific death. Patients and Methods In this population-based cohort study using data from the Cancer Registry and the Medical Birth Registry of Norway, 42,511 women, age 16 to 49 years and diagnosed with cancer from 1967 to 2002, were eligible. They were grouped as not pregnant (reference), pregnant, or lactating at diagnosis. Cause-specific survival for all sites combined, and for the most frequent malignancies, was investigated using a Cox proportional hazards model. An additional analysis with timedependent covariates was performed for comparison of women with and without a postcancer pregnancy. The multivariate analyses were adjusted for age at diagnosis, extent of disease, and diagnostic periods. Results For all sites combined, no intergroup differences in cause-specific death were seen, with hazard ratio (HR) of 1.03 (95% CI, 0.86 to 1.22) and HR 1.02 (95% CI, 0.86 to 1.22) for the pregnant and lactating groups, respectively. Patients with breast (HR, 1.95; 95% CI, 1.36 to 2.78) and ovarian cancer (HR, 2.23; 95% CI, 1.05 to 4.73) diagnosed during lactation had an increased risk of cause-specific death. Diagnosis of malignant melanoma during pregnancy slightly increased this risk. For all sites combined, the risk of cause-specific death was significantly decreased for women who had postcancer pregnancies. Conclusion In general, the diagnosis of most cancer types during pregnancy or lactation does not increase the risk of cause-specific death. Breast and ovarian cancer diagnosed during lactation represents an exception. We confirmed the “healthy mother effect” for women with a postcancer pregnancy. J Clin Oncol 27:45-51. © 2008 by American Society of Clinical Oncology
421 citations
"Cancer, pregnancy and fertility: ES..." refers result in this paper
...Pathological features and prognosis of patients diagnosed during pregnancy are usually comparable with age- and stage-matched non-pregnant patients [3] [IV, B]....
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TL;DR: Ovarian stimulation with gonadotropins and letrozole for the purpose of fertility preservation is unlikely to cause substantially increased recurrence risk, and longer-term follow-up is needed to confirm these findings.
Abstract: Purpose Because of the accompanying increase in estrogen levels, safety of performing in vitro fertilization (IVF) in women with breast cancer is unknown. Our goal was to determine the effect of controlled ovarian stimulation (COS) using a combination of letrozole with standard fertility medications on disease-free survival in women undergoing embryo or oocyte cryopreservation before adjuvant chemotherapy. Patients and Methods A total of 215 women with breast cancer were prospectively evaluated for fertility preservation before adjuvant chemotherapy. Of those, 79 elected to undergo COS with letrozole and gonadotropins for embryo or oocyte cryopreservation. The remaining 136 patients underwent no fertility-preserving procedure and served as controls. Results Study and control groups were similar at enrollment except for a trend for higher estrogen-receptor positivity in the COS group (P = .08). Time between surgery and chemotherapy was longer for IVF patients (45.08 v 33.46 days; P < .01). Peak estradiol l...
417 citations
"Cancer, pregnancy and fertility: ES..." refers background in this paper
...In endocrinesensitive breast cancer, this regimen has been used and was not associated with a higher risk of recurrence, at least during the first 2 years [72]....
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