Highlights
- •Ovarian stimulation (OS) with letrozole for fertility preservation is efficient.
- •Follicular size at ovulation trigger influences oocyte maturation rate.
- •Standard OS seems safe in an adjuvant setting regardless of tumor endocrine status.
Abstract
Introduction
Fertility preservation (FP) is recommended in young breast cancer (BC) patients before
(neo)adjuvant treatment. Letrozole-associated controlled ovarian hyperstimulation
(LetCOH) is used worldwide to collect mature oocytes for FP, but its efficacy and
safety compared to conventional protocols (cCOH) are still debated.
Aims
To compare efficacy and safety of FP procedure using LetCOH or cCOH in BC patients
in terms of oocyte maturation rate and disease-free survival rates after at least
two years of follow-up.
Methods
This multicenter retrospective study compared outcomes of 107 cycles in 97 non-metastatic
BC patients aged ≤40 years who underwent cCOH (n = 56) or LetCOH (n = 41) for FP in
CHU-Lille and Erasme Hospital, respectively, between December 2012 and January 2017.
Results
Patients and oncological characteristics were similar except for tumor size and HER2
status which were less favorable in the LetCOH group. Patients underwent adjuvant
chemotherapy in 96.4% and 48.8% of the cases in cCOH and LetCOH groups, respectively.
Hence, 51.2% of LetCOH patients underwent neoadjuvant chemotherapy (p < 0.001). Estradiol
peak at ovulation trigger was lower in LetCOH compared to cCOH group while oocyte
maturation rates were significantly higher (p < 0.001), without impacting the final
number of mature oocytes collected. Seven and four patients relapsed in LetCOH and
cCOH groups, respectively, and one patient died in each group after a median follow-up
of four years.
Conclusion
LetCOH is as effective as cCOH for FP. At this time point, there were no safety concerns
regarding cCOH in the adjuvant setting but a longer follow-up is warranted.
Keywords
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Article info
Publication history
Published online: August 20, 2022
Accepted:
July 14,
2022
Received in revised form:
July 12,
2022
Received:
May 11,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
