Abstract
Abstract Objective: Breast Cancer (BCa) is the most common malignancy in reproductive age women and letrozole, an aromatase inhibitor, has been used to reduce estrogen exposure in women undergoing embryo/oocyte cryopreservation prior to chemotherapy. Our aim was to determine the long-term outcomes and safety of letrozole-FSH protocol. Design: Prospective Materials and Methods: Women with stage 0-3 BCa underwent ovarian stimulation with letrozole 5-mg starting menstrual cycle day (CD)-2 and gonadotropins 150-450 IU, starting CD-4. Oocyte maturation was triggered either with human chorionic gonadotropin (hCG) or a Gonadoropin Releasing Hormone Agonist (GnRHa). Results: Of the 129 women with mean age of 35.2±4.6, 13 vs. 91 underwent oocyte vs. embryo freezing, and 9 underwent both. Ovarian trigger with GnRHa (n=37/115, 32.2%) resulted in higher number of mature oocytes (10.9±6.6 vs. 8.4±6.0, p=0.045,). Of those, 21 underwent 25 frozen embryo transfers (mean age 35.5±4.5) with a clinical pregnancy (CP) rate of 68% and y per ET. CP rates were similar between the self-transfer and gestational carrier groups (7/9 vs. 10/16, p=0.37). No birth defects are encountered. Relapse rates were compared to a similar group of women with BCa (n=141, mean age 35.7±4.7, similar projected 10-year relapse rate at the outset by! adjuvant online) who elected to not to undergo ovarian stimulation. After a mean follow up of 2.4±1.6 vs. 2.9±1.7 years (range 8 mo - 5.6y vs. 4m-6.8y) women who had undergone ovarian stimulation with letrozole and FSH had a significantly lower recurrence rate [2.0% vs. 25.0%, Hazard ratio 0.08, 95%C.I. (0.06, 0.48), p=0.01]. Conclusions: This long term follow up of LF protocol for up to 7 years indicates that the protocol is safe, efficient and is associated with age-appropriate pregnancy success rates. Whether pretreatment with letrozole improves BCa treatment outcomes should be further investigated. Women with BCa can be safely offered this protocol when undergoing fertility preservation prior to chemotherapy. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-14-01.
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