Factors Associated With the Discussion of Fertility Preservation in a Cohort of 1,357 Young Breast Cancer Patients Receiving Chemotherapy

PURPOSE

Female breast cancer (BC) patients exposed to gonadotoxic chemotherapy are at risk of future infertility. There is evidence of disparities in the discussion of fertility preservation for these patients. The aim of the study was to identify factors influencing the discussion of fertility preservation (FP).

MATERIAL AND METHODS

We analyzed consecutive BC patients treated by chemotherapy at Institut Curie from 2011-2017 and aged 18-43 years at BC diagnosis. The discussion of FP was classified in a binary manner (discussion/no discussion), based on mentions present in the patient's electronic health record (EHR) before the initiation of chemotherapy. The associations between FP discussion and the characteristics of patients/tumors and healthcare practitioners were investigated by logistic regression analysis.

RESULTS

The median age of the 1357 patients included in the cohort was 38.7 years, and median tumor size was 30.3 mm. The distribution of BC subtypes was as follows: 702 luminal BCs (58%), 241 triple-negative breast cancers (TNBCs) (20%), 193 HER2+/HR+ (16%) and 81 HER2+/HR- (6%). All patients received chemotherapy in a neoadjuvant (n=611, 45%) or adjuvant (n= 744, 55%) setting. A discussion of FP was mentioned for 447 patients (33%). Earlier age at diagnosis (discussion: 34.4 years versus no discussion: 40.5 years), nulliparity (discussion: 62% versus no discussion: 38%), and year of BC diagnosis were the patient characteristics significantly associated with the mention of FP discussion. Surgeons and female physicians were the most likely to mention FP during the consultation before the initiation of chemotherapy (discussion: 22% and 21%, respectively). The likelihood of FP discussion increased significantly over time, from 15% in 2011 to 45% in 2017. After multivariate analysis, FP discussion was significantly associated with younger age, number of children before BC diagnosis, physicians' gender and physicians' specialty.

CONCLUSION

FP discussion rates are low and are influenced by patient and physician characteristics. There is therefore room for improvement in the promotion and systematization of FP discussion.

Abstract P6-16-02: Fertility preservation in young breast cancer patients: Real life data on 1390 patients treated in the Institut Curie

Introduction: Adverse effects of chemotherapy on fertility are a critical concern for young breast cancer (BC) patients. Fertility preservation (FP) is currently offered to BC patients, though literature data concerning reproductive outcomes are scarce. Also, very few data are available on whether these procedures are associated with delay to treatment, or whether they impact oncologic outcomes. The objective of our study is to evaluate: (i) efficacy of FP procedures in terms of stored material and pregnancy rates, (ii) safety regarding time from BC diagnosis to chemotherapy, and oncologic outcomes in a large real-life cohort of BC patients.

Methods: We retrospectively analyzed medical charts of all consecutive patients aged between 18 and 43 diagnosed with invasive BC between 01/01/2011 and 30/09/2017 and treated with chemotherapy at Institut Curie (Paris and Saint Cloud). Baseline factors (antral follicle count (AFC), AMH), details on fertility preservation procedures, and results (number of frozen oocytes and embryos) were retrieved in 3 academic hospitals (Jean Verdier, Antoine Béclère and Cochin). All medical charts were reviewed in March 2018 to assess time from diagnosis to surgery / chemotherapy, pregnancy outcomes, recurrence and survival. We compared time from first consultation to start of chemotherapy (time diagnosis-to-CT) in case of neoadjuvant chemotherapy (NAC between patients who had or who did not have PF.

Results: On 1.390 patients identified, 622 had NAC, 768 had adjuvant CT. Median age at diagnosis was 38.8 y.o. 136 were BRCA mutated.

- 264 patients (19%) underwent a FP procedure: In Vitro Maturation (IVM) (58%, n=154); ovarian stimulation protocol (STIM) (31%, n=82); others (10%, n=28). The mean number of oocytes preserved was 5 [0-36] and was not different between IMV and STIM.

- Delays from diagnosis to CT were not different in patients who had FP than those who did not, neither in patients with NAC (no FP: 24.1 days VS FP: 22.8, p=0.24) nor in patients with adjuvant CT (no FP: 70.6 days VS FP : 66.8, p=0.11).

- 39 patients had at least one pregnancy: 28 spontaneous, 6 without information, and 5 from oocyte/embryo donation. The pregnancy rate was higher in patients in FP group (n=16 ; 6%) than in no FP group (n=23 ; 2%). 3 reused material : 2 without pregnancy and one had a miscarriage.

- About oncologic outcomes, 90 patients underwent relapse (6,4%), and this rate was not significantly different in the 2 groups (n=12, 4,5% VS n=78, 6.9%).

- Patients with BRCA mutation (BRCAm) had lower AMH (2.9 VS 4.1 ng/mL ; p = 0,03) and antral follicle count (17.6 VS 24 ; p = 0.01). However, there was no difference on the stored material, and pregnancy rate was higher than in patients with no mutation or unkwnown status (7.6 VS 2.6% ; p = 0,01).

Conclusion: Pregnancy rate was higher in patients with FP, however majority of pregnancies was spontaneous, and no live birth was observed after material reuse. FP procedures were not associated with delay to treatment. Though bias cannot be excluded, preliminary data do not show an adverse impact of FP on oncologic outcome. Further follow-up is needed.

Citation Format: Hamy-Petit A-S, Toussaint A, Sautter C, Coussy F, Donnadieu A, Rouzier R, Saule C, Frank S, Bensen A, Grynberg M, Scarabin-Carre V, Santulli P, Balezeau T, Guerin J, Reyrat E, Jamain C, Hours A, Lecourt A, Reyal F. Fertility preservation in young breast cancer patients: Real life data on 1390 patients treated in the Institut Curie [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-16-02.

[Production of a common catalogue for several "Centres Régionaux de Lutte Contre le Cancer": a "Fédération des Centres de Lutte Contre le Cancer" project]

The "Fédération des Centres de Lutte Contre le Cancer", (FNCLCC) has been undertaken 2 years ago, the set-up of an information system allowing the partition of data from tumour libraries managed by the twenty "Centres Régionaux de Lutte Contre le Cancer" (CRLCC). This organization was establihed on a secure transmission of basis informations about samples kept in tumour libraries.