JOURNAL OF ADOLESCENT AND YOUNG ADULT ONCOLOGY Letter to the Editor

Volume 00, Number 00, 2017

ª Mary Ann Liebert, Inc.
DOI: 10.1089/jayao.2017.0106

Improving Fertility Preservation in Breast Cancer Patients

Katarzyna Pogoda, MD,1,2 Agnieszka Jagiełło-Gruszfeld, MD, PhD,1 Anna Niwińska, MD, PhD,1
Maria Litwiniuk, MD, PhD,3 Jakub Rzepka, MD, PhD,4 and Zbigniew Nowecki, MD1

Dear Editor, Jach et al.3 recommend using GnRH analogs only if the other
options to preserve fertility cannot be applied. We propose that
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About 5%–6% of all breast cancer develops in young women

(p40 years old). Some of them had not yet had a child while
diagnosed with malignancy. Fertility preservation before systemic
therapy, which is used in most patients, is essential for them. There
are a few options to preserve fertility: assisted reproductive tech-
nology (ART) (cryopreservation of embryos, oocytes, or ovarian
tissue) and gonadotropin releasing hormone (GnRH) analogs.1
From many years we have dealt with these problems at Maria
Skłodowska-Curie Memorial Cancer Centre and Institute of
Oncology, Warsaw, Poland.2
Jach et al.3 have recently published the ‘‘Recommendations of
the Fertility Preservation Working Group in Oncological, Hema-
tological and Other Patients Treated with Gonadotoxic Therapies
‘ONCOFERTILITY’ (GROF) of the Polish Society of Oncologi-
cal Gynecology.’’ This document highlights the importance of the
topic and proposes the recommendations. The authors state that
GnRH analogs can be used during chemotherapy only in triple-
negative breast cancer patients (who represent 10%–20% of all
breast cancer). We notice a wider group of young breast cancer
patients who can benefit from GnRH analogs for preserving ovarian
function and fertility. In a meta-analysis of 12 randomized con-
trolled trials, published in 2015, the risk of premature ovarian failure
was significantly reduced in patients treated with concurrent GnRH
analogs comparing with women treated only with chemotherapy
[odds ratio (OR): 0.36; 95% confidence interval (CI): 0.23–0.57;
p < 0.001].4 The chance for pregnancy in the future was higher in
patients using GnRH analogs during chemotherapy (data from five
studies: 33 vs. 19 women; OR: 1.83; 95% CI: 1.02–3.28; p = 0.041).
Pregnancy in women who have undergone treatment for breast
cancer does not increase the risk of either recurrence or death, also
in case of luminal breast cancer. The aforementioned meta-
analysis showed no impact of using temporary ovarian suppres-
sion on prognosis (disease free survival [DFS] hazard ratio [HR]:
1.00; 95% CI: 0.49–2.04; p = 0.939).4 Data from trials analyz-
ing different breast cancer subtypes support this statement
(including POEMS, PROMISE-GIM6, and OPTION trials).5
Finally, according to recently published ESO-ESMO 3rd in-
ternational consensus guidelines for breast cancer in young
women (BCY3) GnRH agonists should be discussed as an option
with all interested patients, irrespective of biologic tumor sub-
type.1 For some women who are unable to have fertility pres-
ervation procedures, access to GRNH agonists will allow an
opportunity to preserve fertility.
fertility preservation procedures can be combined with ovarian
suppression. This strategy can increase the chance for fertility
and gonadal function preservation. In some patients, there is a
chance to become pregnant without ART, and GnRH analogs
improve this possibility. This approach can reduce medical
procedures and costs.
In conclusion, young cancer patients should be referred to a
specialist in fertility preservation as soon as the decision on
systemic therapy is made. ART and GnRH analogs should be
discussed with all of them.
References
1. Paluch-Shimon S, Pagani O, Partridge AH, et al. ESO-
ESMO 3rd international consensus guidelines for breast
cancer in young women (BCY3). Breast. 2017;35:203–217.
2. Pogoda K, Niwińska A, Jagiełło-Gruszfeld A, et al. Clin
Oncol Pract. 2015;11(5):276–91.
3. Jach R, Pabian W, Spaczyński R, et al. Recommendations of
the fertility preservation working group in oncological, he-
matological and other patients treated with gonadotoxic
therapies ‘‘ONCOFERTILITY’’ (GROF) of the polish so-
ciety of oncological gynecology. J Adolesc Young Adult
Oncol. 2017;6(3):388–95.
4. Lambertini M, Ceppi M, Poggio F, et al. Ovarian sup-
pression using luteinizing hormone-releasing hormone
agonists during chemotherapy to preserve ovarian func-
tion and fertility of breast cancer patients: a meta-analysis
of randomized studies. Ann Oncol. 2015;26:2408–419.
5. Moore HC, Unger JM, Philips KA, et al. Goserelin for
oovarian protection during breast-cancer adjuvant chemo-
therapy. N Eng J Med. 2015;10:923–32.
Address correspondence to:
Katarzyna Pogoda, MD
Department of Breast Cancer and Reconstructive Surgery
The Maria Skłodowska-Curie Memorial Cancer Centre
and Institute of Oncology
Roentgen 5 Street
Warsaw 02-781
Poland
E-mail: katarzynapogoda@gazeta.pl

Departments of 1Breast Cancer and Reconstructive Surgery and 2Gastroenterology, Hepatology, and Clinical Oncology, The Maria
Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland.
3
Department of Chemotherapy, Greater Poland Cancer Center, Poznan, Poland.
4
2nd Department of Gynecology and Obstetrics, Centre of Postgraduate Medical Education, Bielański Hospital, Warsaw, Poland.