Can breast cancer survivors temporarily stop endocrine therapy to attempt pregnancy? | Latest news for Doctors, Nurses and Pharmacists

Young breast cancer survivors can safely discontinue adjuvant endocrine therapy (ET) temporarily to try to conceive, according to top results from the POSITIVE* trial presented at SABCS 2022.

Participants in this international (116 centers in 20 countries), single-arm study were 518 stage I-III hormone receptor (HR)+ breast cancer survivors.
She was 42 years old (median age 37 years), had been on adjuvant ET for 18-30 months, and was desirous of becoming pregnant. They discontinued her ET and he enrolled in the trial within a month, had a 3-month washout period, and then
Interrupt ET for 2 years to allow pregnancy, delivery, and/or breastfeeding before resuming ET.

Seventy-five percent of the participants were nulliparous. Median time from breast cancer diagnosis to study enrollment was 29 months, with 94% diagnosed with stage I-II disease, 66% with node-negative disease, and 62% with neoadjuvant or adjuvant I was undergoing chemotherapy. The most common ET regimens used were tamoxifen alone (41.7%) and tamoxifen plus ovarian suppression (35.7%).

Participants were followed for a median of 41 months, during which 44 participants had a breast cancer-free interval (BCFI) event (first local recurrence, regional recurrence, distant recurrence, or new invasive contralateral breast cancer event from enrollment). time). . [SABCS 2022, abstract GS4-09]

This number did not exceed the prespecified safe threshold of 46 events. Her 3-year BCFI failure rate was 8.9%, compared to her 9.2% observed in an external control group consisting of premenopausal women receiving adjuvant ET enrolled in her SOFT/TEXT trial. , the authors said, similar to the rate of

A total of 497 participants were followed for pregnancy status.His 74% (n = 368) of participants
With one or more pregnancies, 70% will conceive within 2 years. Of participants who became pregnant, 86% (n = 317) had one or more of her births (64% of all enrollees).

19% of participants had one or more miscarriages and 3% had one or more abortions.

The incidence of low birth weight infants and congenital anomalies was low, 8% and 2%, respectively.

At 48 months, 8.3% experienced cancer recurrence or death (9 deaths) before resuming ET. 76 percent resumed ET and 15 percent did not resume ET.

“Forty to 60 percent of women diagnosed with breast cancer under the age of 40 are concerned about their future fertility, especially if the breast cancer occurred before they decided to become mothers.”
Ann Partridge, lead author, Dana-Farber Cancer Institute, Boston, Massachusetts, USA, and Harvard Medical School, said:

Professor Anne Partridge (© MedMeetingImages/Scott Morgan 2022)

“There have been historical concerns that pregnancy may be like pouring gasoline on a fire, especially for women with HR+ breast cancer. [, accessed 14 December 2022]

“[In addition,] Standard 5-10 years of adjuvant ET jeopardizes fertility in women with HR+ disease,” she continued.

“The POSITIVE trial provides important data to support young women with HR+ early-stage breast cancer who are interested in becoming pregnant and who are discontinuing ET to pursue a pregnancy,” said Partridge. “These data [also] It emphasizes the need to incorporate patient-centred reproductive medicine into the treatment and follow-up of young women with breast cancer. ”

The short follow-up period was the limitation, the authors said. “We have followed these women for at least 10 years and not only are they safe for the first few years, [also] in the long run. This is particularly important in the setting of HR+ breast cancer, where he is known to be at risk for late recurrence,” Partridge concluded.

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