Fast menstrual resumption after interruption of endocrine therapy

Women who interrupt endocrine therapy to become pregnant almost all recover menses within 6 months. Younger age is associated with a shorter time to and a higher chance of pregnancy, as was shown by results of the POSITIVE trial.

The primary outcomes of the POSITIVE trial (NCT02308085) showed that, in women with previous HR-positive early breast cancer, temporary interruption of endocrine therapy to attempt pregnancy does not impact disease outcomes [1]. However, patient characteristics influencing menstrual resumption and time to pregnancy are not clear. In addition, uncertainty exists regarding the efficacy and safety of ovarian stimulation for fertility preservation and the use of assisted reproductive technologies to achieve pregnancy after endocrine therapy interruption. Therefore, the data of POSITIVE was further evaluated. Results were presented by Dr Hatem Azim (Monterrey Institute of Technology, Mexico) [2].

Of 516 patients included in POSITIVE, 273 (53%) reported amenorrhea at enrolment (which was after 18–30 months adjuvant endocrine therapy). Of these patients, 255 (94%) recovered menses within 1 year. A total of 368 (74%) patients reported at least 1 pregnancy. Age at enrolment was the only factor significantly associated with time to pregnancy. After 1 year, 64% of patients younger than 35 years were pregnant, compared with 38% of patients between 40–42 years; after 2 years this was 80% versus 50% (HR 0.40; 95% CI 0.29–0.56).

A total of 179 patients had undergone ovarian stimulation for embryo/oocyte cryopreservation at diagnosis and prior to enrolment, of whom 68 (37.9%) reported cryopreserved embryo transfer after enrolment. In addition, 215 patients reported using any assisted reproductive technology after enrolment, of whom 80 (37.2%) underwent ovarian stimulation for IVF or ICSI. Older age (>35 years) was significantly associated with a lower chance of pregnancy (OR 0.50; 95% CI 0.29–0.86). In addition, cryopreserved embryo transfer after enrolment was significantly associated with increased odds of becoming pregnant (OR 2.41; 95% CI 1.17–4.95). Ovarian stimulation did not influence breast cancer outcomes. “However, longer follow-up is needed,” Dr Azim acknowledged.

In summary, most patients presenting with amenorrhea due to endocrine therapy resumed menses within 6 months after interrupting endocrine therapy. Younger age and cryopreserved embryo transfer were associated with, respectively, shorter time to pregnancy and higher pregnancy rates. “These data are of paramount importance for oncofertility counselling of young breast cancer patients,” concluded Dr Azim

1. Partridge AH, et al. N Engl J Med 2023;388:1645-1656.
2. Azim HA, et al. Fertility preservation and assisted reproductive technologies (ART) in breast cancer (BC) patients (pts) interrupting endocrine therapy (ET) to attempt pregnancy. Abstract GS02-11, SABCS 2023, 5–9 December, San Antonio, TX, USA.

 

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Posted on 11 January 2024