The BGICC meeting is in a country where there are lots of young women having breast cancer, unlike where I work where the majority of women are postmenopausal. So, one of the key questions for a woman who has breast cancer, and any woman with any cancer anyway, is, ‘If I haven’t had kids will I have kids? If I want to have more kids, can I have more kids?’ So that’s the question that I was asked to address. Fortunately, I have been working very closely with Professor Fedro Peccatori who is a leader in this field so I didn’t need to do a major revision of the field as he had done it just a few months ago and he gave me his slides. But what happened in December was that we had the San Antonio meeting and in San Antonio there was the presentation of the study of Ann Partridge and colleagues that gives us good guidance on the realities of pregnancy in endocrine responsive breast cancer patients. This study is quite reassuring.
The data that we had until now showed that from all the analyses, yes, there is a lesser chance of getting pregnant, for many reasons, in women that have some type of approach – chemotherapy or chemo-endocrine therapy or endocrine therapy alone. But, nevertheless, there is a chance that they can have a kid. I’m not speaking of those that have put the oocytes aside because of chemotherapy and the fear that they will have no recovery of the production of oocytes, but I’m speaking of those that can recover and they are less fertile. The data we had, which is confirmed by the trial of Ann Partridge shown at San Antonio, is that there is no major issue. These women can have children that are perfectly okay. Of course, there are sometimes some issues, but they are not much bigger than in the general population, age matched. In the endocrine setting, patients that have had 18-30 months, that was the admission criteria to the trial, of endocrine manipulation and then stop the treatment, and usually in premenopausal women it has been tamoxifen, these women can then look for pregnancy. A certain proportion of them, I would say half, actually become pregnant and the outcome for the baby, prospectively, is perfectly okay. The risk that these women have by stopping transitorily because they resume, 75% did resume the treatment after the pregnancy, is quite minimal. Yes, there are unfortunately some relapses, as highlighted by Professor Nagi El-Saghir, in his question but if we look at the survival curves of those patients that stopped transitorily and the study data from studies that addressed this patient population, there is no indication of increased risk. They have the risk they had and unfortunately sometimes they do relapse. Very importantly, they don’t die from the relapse – we have nowadays lots of treatments for endocrine responsive disease – so they are still there to be with their kid.
How do you think this will impact future breast cancer treatments?
This study, along with everything that has been worked on until now, will reassure the colleagues that had some questions and doubts about is it safe, is it not safe, when is it safe? Yes, it is safe. We say that after chemotherapy, usually, say, two years after chemotherapy, there should be absolutely no issue related to the chemotherapy besides the potential fact that they have become infertile because of the chemo and then hopefully we can do something about it, or they had oocytes put aside. For the endocrine patients we now know that, yes, we can do a window. This was already suggested a little bit later by the so-called St Gallen, nowadays Vienna, meeting on adjuvant breast cancer – it’s going to happen again this year – with less evidence, prospective evidence. Now we have the prospective evidence.
