Having a healthy child without running risks for the mother is feasible but for now only 5 out of a hundred women are aware that it is possible to preserve fertility
They have to face a diagnosis of breast cancer before the age of 40, when they have not yet had children or have not completed their desire for a family. It happens at approx three thousand young Italian women every year and only five out of a hundred then become mothers after the disease. An opportunity that exists, however, safe for patients (who can also suspend hormone treatments to carry on a pregnancy) and for the unborn, but which in our country is still little exploited. Despite the fact that in recent years some scientific research has arrived from the Policlinico San Martino in Genoa which has improved the approach to fertility preservation all over the world. After demonstrating that it is possible to have a healthy child without risk for the mother treated for breast cancer, Ligurian researchers have recently taken a step forward. The results of the “POSITIVE” study, presented during the San Antonio Breast Cancer Symposium (the most important international conference on breast cancer) held in December in the United States, in fact indicated that young women affected by early stage breast cancer can discontinue adjuvant (i.e. following surgery) hormone therapy for two years to try to become pregnant.
Stopping hormone therapy to have a baby
The research involved 518 women aged 42 and younger with hormone receptor-positive early-stage breast cancer. In these cases, endocrine therapy is given to reduce the risk of the disease coming back. The study demonstrated that the three-year recurrence rate was 8.9%, similar to that of the “SOFT/TEXT” study (9.2%) which included premenopausal women receiving the same therapy and used as a comparison . 74% of women had at least one pregnancy, which ended successfully in 64% of cases. In about 70% of cases, breast cancer has positive hormone receptors and requires adjuvant treatment with endocrine therapy for a period of five years, which on the one hand reduces the risk of recurrenceon the other hand, it suppresses ovarian function and, therefore, the possibility of having a child — he explains Lucia DelMastro, full professor and director of the Medical Oncology Clinic of the IRCCS Policlinico San Martino Hospital, University of Genoa —. The trials conducted to date had demonstrated the safety of pregnancy at the end of anticancer treatments. For the first time, the “POSITIVE” study shows that, after at least a year and a half, It is possible to suspend endocrine therapy for two years with the aim of having a child, and then resume treatment. Congenital anomalies were observed in 2% of the children, similar to the general population, and 60% of the women breastfed.
Becoming a mother is an underrated desire
Breast cancer is the most frequent neoplasm in women, the cases are continuously increasing (in Italy an estimated 55,700 new diagnoses were made in 2022), but fortunately the mortality rate is decreasing and healings are close to 90%. In 80% of cases the disease strikes after the age of 50, but the incidence in 30-40 year olds is growing: 5% concerns women under 40 and the desire to become mothers after the disease continues to be underestimated. Today, in our country, the low percentage of young patients who manage to have a child after breast cancer contrasts sharply with the 50% of women who, at the time of diagnosis, declare that they want motherhood – continues Del Mastro -. What are the reasons? Surely there is the fact that, before the “POSITIVE” study, women with endocrine-responsive neoplasms had to wait at least five years before trying to conceive, thus moving towards a more mature age. This study demonstrates that stopping hormone therapy is a safe procedure and can increase the percentage of young women who are able to have a baby before ending their treatment. Not only. In our country, structured collaborations must be created between Oncology and Medically Assisted Reproduction Centers, to promptly respond to patient requests. The key aspect of fertility preservation techniques is timing: for example, the cryopreservation of oocytes must take place before the start of chemotherapy. The creation of a network makes it possible to define dedicated and recognized pathways, currently present only in some hospitals.
Precious time: a network between Centers is needed
In short, we must implement pathways dedicated to the prevention of infertility in cancer patients in all Regions because time is a decisive factor, both for treating cancer and for preserving fertility. this is the appeal that comes from the congress Back From San Antonio, which opens in Genoa and brings together the leading Italian specialists to discuss the news that emerged at the American congress last December. San Martino in Genoa is a virtuous example in Italy and internationally,” he explains Salvatore Giuffrida, director general of the IRCCS Policlinico Genovese —. Almost twenty years ago we were the first hospital in Italy to set up this collaboration between the Oncology facility and the Medically Assisted Procreation Center, creating the functional unit of oncofertility. In fact, in the Ligurian capital, 10% of young women manage to have a child after breast cancer, double the national average, which stands at 5%.
How to preserve fertility
If until a few years ago the only solution to have children was freeze the eggs before therapy to then proceed, once healed, to fertilization in vitro, it is now possible to protect ovarian function from the toxic effects of chemotherapy by administering to patients drugs (hormone analogues of LHRH, widely used as antineoplastic therapy in breast cancer) which put the ovaries at rest during treatments, so that they are not damaged . Furthermore, it is not always mandatory to terminate the pregnancy to treat the mother, even in the case of chemotherapy. It was precisely in Genoa that it was defined one of the three main techniques of fertility preservation, ie the use of LH-RH analogue drugswhich significantly reduce the risk of harming reproductive function and developing premature menopause,” she points out Matthew Lambertini, associate professor of medical oncology at San Martino -. The other techniques consist of the cryopreservationi.e. from freezing, oocytes or ovarian tissue.
New therapies for breast cancer
Important innovations were also presented at the American conference on the front of therapies for breast cancer. The updated data from the “monarchE” study on abemaciclibwhich belongs to the class of cyclin inhibitorsin the adjuvant, in combination with standard endocrine therapy for the treatment of high-risk, hormone receptor-positive, HER2-negative, node-positive early breast cancer,” he explains Saverio Cinieri, president of the Italian Association of Medical Oncology (Aiom) —. After a median observation period of 3.5 years from the end of treatment, the risk of developing an invasive disease recurrence was reduced by 33.6%. The addition of abemaciclib in the adjuvant also reduced the risk of developing anemia by 34.1%. metastatic disease. These are very important results, because they concern patients with cancer at a higher risk of recurrence after surgery. The progress in the treatment of metastatic disease is also significant – continues Cinieri -. The updated results of the “DESTINY-Breast03” study have shown that trastuzumab deruxtecan, a drug-conjugated monoclonal antibody, leads to a significant improvement in overall survival compared with T-DM1, another HER2 antibody conjugate and previous standard of care, in patients with previously treated HER2-positive metastatic breast cancer. Trastuzumab deruxtecan has reduced the risk of death by 36%. compared to T-DM1. Not only. Progression-free survival quadrupled compared to reference therapy to 28.8 months. An advantage of magnitude never seen before in breast cancer. Finally, favorable results have also emerged with the use of a new class of drugs, the so-called SERDs (selective estrogen receptor degraders) oral: Camizestrant and elacestrant are useful drugs for women with hormone-sensitive breast cancer in the metastatic phase – concludes Cinieri -. Again for this subgroup of patients, the efficacy of PI3K inhibitorssuch as capivasertib, as an adjunct to standard endocrine therapy.
January 13, 2023 (change January 13, 2023 | 4:36 pm)
© Time.News