Fertility preservation and timing of cancer treatment

Abstract

e20629 Background: Cancer survival rates have increased steadily over time and young cancer survivors desire quality of life, including the ability to have a family. Cancer treatments, due to its toxic nature, can permanently or temporarily affect fertility. However, advanced fertility preservation measures are available and should be pursued before toxic chemo or radiation therapy. Evidence from observational studies indicate patients want to be informed of the adverse effects of cancer treatments on their fertility. Despite conflicting evidence on the efficacy of early treatment, the urgency of starting treatment early for maximum benefit has been cited as the most common reason for not discussing fertility preservation with patients.Accordingly, we conducted a systematic review and meta-analysis to assess if early treatment leads to better outcomes. Methods: A comprehensive literature search was performed of MEDLINE and Cochrane databases from 1966–2008 for all phase III randomized controlled trials (RCT) comparing early versus late treatment in cancer patients as first line therapy. Data were extracted and pooled on benefits (overall survival) and harms (treatment related mortality). Results: Initial search yielded 570 trials, of which 8 RCTs met the inclusion criteria. 3 RCTs assessed the efficacy of early versus deferred treatment in prostate cancer, 3 in multiple myeloma, and 1 each in lung cancer and chronic lymphocytic leukemia (CLL). Overall, pooled data showed survival benefit with early treatment (Hazard ratio [HR]=1.16,95%CI 1.05–1.28). However, the benefit with early treatment was restricted to prostate cancer(HR=1.21,95%CI 1.09–1.35). There was no survival difference between early and deferred treatment in multiple myeloma (HR=1.11,95%CI 0.67–1.84), CLL (HR=0.89,95%CI 0.49–1.59) or lung cancer (HR=0.95,95%CI 0.72–1.24). Pooled results excluding prostate cancer RCTs did not show a survival benefit with early treatment (HR=0.97,95%CI 0.78–1.21). No trial reported data on harms. There was no significant heterogeneity among trials. Conclusions: The totality of the evidence shows except in prostate cancer, deferment of treatment does not lead to decreased survival, and provides a unique window to oncologists to address the issues related to fertility preservation if desired by patients. No significant financial relationships to disclose.