Fertility-preserving procedures in BRCA mutation-positive breast cancer

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Published: 11 Sep 2017
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Dr Matteo Lambertini - Institut Jules Bordet, Brussels, Belgium

Dr Lambertini talks with ecancer at the ESMO 2017 Congress in Madrid about reproductive potential and performance of fertility-preserving procedures in BRCA mutation-positive breast cancer patients. 

He goes on to highlight the need for better research efforts to create personalised approached to treatment for patients with BRCA mutation-positive breast cancer. 

At ESMO 2017 we presented the results of our study investigating the reproductive potential and performance of fertility-preserving procedures in patients with BRCA mutated breast cancer. We know that fertility preservation and pregnancy related issues is one of the five priority areas of concern for young women with breast cancer but these issues can be particularly challenging for patients with germline BRCA mutations. There are at least two important reasons: the first one is that there are preclinical data suggesting that the presence of a BRCA mutation can have a negative impact on female fertility and ovarian function. The second important reason is that we have very limited data so far on the efficacy and safety of the different strategies for fertility preservation specifically in BRCA mutated patients.

So here at ESMO we presented the results of our study in which we included 101 patients of whom 29 were BRCA mutated. We investigated first the anti-müllerian hormone at baseline in the BRCA positive and in the BRCA negative cohort and the anti-müllerian hormone is considered as the most sensitive marker of ovarian reserve in young patients. We observed that patients in the BRCA positive cohort, even though the result was not statistically significant, we observed a numerically higher median AMH level in the BRCA negative cohort as compared to the BRCA positive cohort. Then secondly we’ve evaluated the fertility outcomes in patients who underwent ovarian tissue cryopreservation or oocyte cryopreservation by comparing the BRCA mutated and the BRCA non-mutated population. Again a small number, because as mentioned only 29 patients had BRCA mutation, but even though we could not find any significant difference between the two groups it was very interesting to show that in all the endpoints evaluated patients in the BRCA positive cohort tended to have a lower performance of the different fertility preserving procedures.

Do you feel that this is being adequately communicated to patients before treatment just either as a risk factor and for their fertility, depending on treatment or predisposition?

I think that this is an issue that will become even more important in the next year because a higher number of patients will be tested very early after breast cancer diagnosis so also at the time of onco-fertility counselling will be available to have the information also on the presence or not of a BRCA mutation. Of course we need more research efforts in this field but our data suggests that these patients may require personalised approaches also in terms of access to fertility preserving procedures.

Do you know of the existence of any patient advocacy groups, any charities, who are focused on preserving fertility for breast cancer patients?

I’m not aware about a specific patient advocate group in the BRCA population related to fertility issues but, as mentioned, the Breast Cancer in Young Women Conference, which is the most important conference for the treatment of breast cancer in young patients, usually there is also a patient advocate group so young breast cancer advocates that attend the conference. At the last meeting that was in November 2016 these patients clearly highlighted that fertility and pregnancy issues is one of the five priority areas of concern for their treatment and management. So as physicians we should be aware about this and we should do our efforts to improve the onco-fertility counselling of this patient population.

Besides the fact that we observe a lower reproductive potential, lower performance in BRCA mutated patients the most important take home message of our study is that actually fertility preservation procedures work also in BRCA mutated breast cancer patients. So the presence of a BRCA mutation does not exclude these patients access to the different fertility preserving procedures.