Use of tamoxifene-controlled ovarian hyperstimulation for fertility preservation before breast cancer treatment: A prospective cohort study with a 5-year follow-up.

Fertility issues are of great concern for young women undergoing treatment for breast cancer (BC). Fertility preservation (FP) protocols using controlled ovarian stimulation (COS) with letrozole have been widely used with overall good results. However, letrozole cannot be used in every country in this context. This study aimed to assess the efficacy of tamoxifen for COS in women with early BC undergoing FP. This multicentric prospective study included patients aged 18-40, diagnosed with stage I, II and III invasive BC, undergoing tamoxifen-COS before adjuvant or neoadjuvant chemotherapy (NAC). The primary endpoint was the efficacy of tamoxifen-COS protocol evaluated by the number of oocytes collected and vitrified. Secondary endpoints included the time interval before chemotherapy, breast cancer (BC) recurrence rates, and reproductive outcomes. Ninety-five patients were included between 2014 and 2017, aged 31.5 ± 4 years on average. 37.9 % received NAC and 62.1 % received adjuvant chemotherapy. FP procedure was successful in 89.5 % of the cycles. The mean number of collected and vitrified oocytes was 12.8 ± 7.9 and 9.8 ± 6.2, respectively. The mean duration of COS was 10.4 ± 1.9 days. Median time before chemotherapy initiation was 3.6 weeks (IQR 3.1; 4.1) for women receiving NAC. Five-year relapse-free and overall survival rates were in-line with those expected in this population. Twenty-one women had spontaneous full-term pregnancies, while 5 underwent IVF cycles with frozen-thawed oocytes, without pregnancy. Tamoxifen-COS protocols appear to be feasible before adjuvant or NAC treatment in young BC patients and efficient in terms of oocyte yield.

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Déclaration de conflit d'intérêts

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:None of the authors have any conflicts of interest related to this study. Florence Leperlier reports honoraria for lectures and presentations from Ferring Pharmaceuticals, Gedeon Richter, and IBSA, unrelated to this work. Pierre-Emmanuel Bouet reports travel and meeting support from Merck, Gedeon-Richter, Theramex, Ferring, Organon and IBSA. P-E.B. have undertaken consultancy work for Merck and Gedeon-Richter and have received research grants from Theramex, Ferring, MSD, and Genevrier, not related to the present work. Thomas Freour has undertaken consultancy work for Vitrolife France and Gedeon-Richter. T.F. reports travel and meeting support from Gedeon-Richter, Theramex, Ferring and IBSA. T.F. reports honoraria for lectures and presentations from Ferring Pharmaceuticals, Theramex, Gedeon Richter and Merck Serono, unrelated to this work. Marie Robert reports travel fees and congress fees from AstraZeneca, Gilead and Creafirst, and has undertaken consultancy work for AstraZeneca and Lilly. Mario Campone is on the advisory board of AstraZeneca, Novartis, Sanofi, Lilly, Pfizer, Seagen, Gilead and Daiichi-Sankyo. M.C. has undertaken consultancy work for AstraZeneca, Novartis, Daiichi-Sankyo, PET-Therapy, Menarini and DIACCURATE, and he is a speaker for Novartis, Lilly and Amgen. He reports travel support from Pfizer, Novartis, Roche, AstraZeneca and Daiichi-Sankyo.