Use of tamoxifene-controlled ovarian hyperstimulation for fertility preservation before breast cancer treatment: A prospective cohort study with a 5-year follow-up

• Published in: Breast (Edinburgh) Vol. 77; p. 103776
• Main Authors: Dezellus, A., Mirallie, S., Leperlier, F., Sauterey, B., Bouet, P.-E., Dessaint, A., Duros, S., Gremeau, A.S., Mouret-Reynier, M.-A., Durand, L.M., Venat, L., De Blay, P., Robert, M., Freour, T., Campone, M., Blanc-Lapierre, A., Bordes, V.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-10-2024; Elsevier
• Subjects: Adolescent; Adult; Antineoplastic Agents, Hormonal - administration & dosage; Breast cancer; Breast Neoplasms - drug therapy; Chemotherapy, Adjuvant; Cryopreservation - methods; Female; Fertility preservation; Fertility Preservation - methods; Follow-Up Studies; Humans; Letrozole - administration & dosage; Letrozole - therapeutic use; Neoadjuvant chemotherapy; Neoadjuvant Therapy - methods; Oocyte Retrieval - methods; Original; Ovarian stimulation; Ovulation Induction - methods; Pregnancy; Pregnancy Rate; Prospective Studies; Tamoxifen; Tamoxifen - administration & dosage; Young Adult; Neoadjuvant chemotherapy; Breast cancer; Fertility preservation; Ovarian stimulation; Tamoxifen
• ISSN: 0960-9776; 1532-3080; 1532-3080
• DOI: 10.1016/j.breast.2024.103776

Fertility issues are of great concern for young women undergoing treatment for breast cancer (BC). Fertility preservation (FP) protocols using controlled ovarian stimulation (COS) with letrozole have been widely used with overall good results. However, letrozole cannot be used in every country in this context. This study aimed to assess the efficacy of tamoxifen for COS in women with early BC undergoing FP.
This multicentric prospective study included patients aged 18–40, diagnosed with stage I, II and III invasive BC, undergoing tamoxifen-COS before adjuvant or neoadjuvant chemotherapy (NAC). The primary endpoint was the efficacy of tamoxifen-COS protocol evaluated by the number of oocytes collected and vitrified. Secondary endpoints included the time interval before chemotherapy, breast cancer (BC) recurrence rates, and reproductive outcomes.
Ninety-five patients were included between 2014 and 2017, aged 31.5 ± 4 years on average. 37.9 % received NAC and 62.1 % received adjuvant chemotherapy. FP procedure was successful in 89.5 % of the cycles. The mean number of collected and vitrified oocytes was 12.8 ± 7.9 and 9.8 ± 6.2, respectively. The mean duration of COS was 10.4 ± 1.9 days. Median time before chemotherapy initiation was 3.6 weeks (IQR 3.1; 4.1) for women receiving NAC. Five-year relapse-free and overall survival rates were in-line with those expected in this population. Twenty-one women had spontaneous full-term pregnancies, while 5 underwent IVF cycles with frozen-thawed oocytes, without pregnancy.
Tamoxifen-COS protocols appear to be feasible before adjuvant or NAC treatment in young BC patients and efficient in terms of oocyte yield.
•Fertility issues are of great concern for young women undergoing treatment for breast cancer.•In breast cancer (BC) patients, international guidelines advocate for controlled ovarian stimulation (COS) with an aromatase inhibitor (AI) or tamoxifen.•AI are not permitted in this indication in some countries and efficacy of tamoxifen-COS have been less evaluated at the time of initiating the study.•In this observational prospective study, 95 young women underwent tamoxifene-COS before BC chemotherapy and were followed for a period of 5 years.•Tamoxifen-COS protocols are feasible before adjuvant or neoadjuvant chemotherapy in young BC patients, and appear to be efficient in terms of oocyte yield.