Most premenopausal ladies with early breast most cancers accepted gonadotropin-releasing hormone agonist (GnRHa) remedy throughout chemotherapy to protect ovarian operate, whereas uptake of cryopreservation methods remained decrease, significantly in older premenopausal sufferers, based on information from the Premenopausal Breast Most cancers Sufferers’ Fertility Preservation (PREFER) research, a big Italian multicenter potential cohort.
The potential cohort evaluated fertility preservation methods on this affected person inhabitants, and information had been shared on the
“Most premenopausal ladies with early breast most cancers accepted using a genetic agonist throughout chemotherapy to protect ovarian operate. Components related to acceptance included youthful age at prognosis, no prior youngsters, newer 12 months of prognosis, and decrease tumor grade,” defined Matteo Lambertini, affiliate professor and marketing consultant in medical oncology on the College of Genova and IRCCS Policlinico San Martino Hospital in Genova, Italy.
Importantly, managed ovarian stimulation for oocyte cryopreservation didn’t negatively affect disease-free survival or general survival.
PREFER Examine: A Nationwide Oncofertility Initiative
Oncofertility counseling is advisable for all premenopausal ladies with newly recognized early breast most cancers who’re candidates for chemotherapy. Commonplace approaches embody cryopreservation of oocytes, embryos, and ovarian tissue, with concurrent GnRHa remedy advisable throughout chemotherapy to protect ovarian operate. Nonetheless, information on the uptake of those methods and causes for affected person refusal have been restricted.
The evaluation introduced on the 2025 symposium represents the primary multicenter analysis of sufferers enrolled in PREFER between November 2012 and December 2024. PREFER was carried out at 23 Italian facilities. Inclusion standards included stage I to III invasive breast most cancers, premenopausal standing at prognosis, age 18 to 45, and candidacy for neoadjuvant or adjuvant chemotherapy. Sufferers with stage IV illness, prior chemotherapy or radiotherapy, extreme psychiatric problems, or incapacity to offer consent had been excluded.
The first goal was to guage affected person wants and decisions concerning ovarian operate and fertility preservation, together with acceptance charges and causes for refusal. Secondary aims included security of managed ovarian stimulation for oocyte cryopreservation in sufferers 40 years or youthful, with disease-free survival and general survival as endpoints. Subgroup analyses had been carried out based on hormone receptor standing.
Key Findings: Fertility Preservation by Age and Hormone Receptor Standing
In sufferers aged 41 to 45 years, 78% of these with hormone receptor-positive illness selected GnRHa alone, whereas 22% had no process. Amongst hormone receptor-negative sufferers, 69% acquired GnRHa alone and 31% declined any intervention. Essentially the most continuously reported purpose for refusal on this age group was completion of household planning (11%).
Amongst sufferers 40 years or youthful with hormone receptor-positive illness, 90% acquired GnRHa, 26% underwent cryopreservation, and eight% had no process. For hormone receptor-negative sufferers, 87% acquired GnRHa, 21% underwent cryopreservation, and 12% had no process. Youthful age strongly predicted oocyte cryopreservation, as did having no prior youngsters, newer 12 months of prognosis, and decrease tumor grade. Hormone receptor-negative standing was related to decrease uptake relative to hormone receptor-positive illness.
Sufferers who underwent oocyte cryopreservation (127 sufferers) had been youthful, with a median age of 33, in contrast with 36 amongst those that didn’t pursue cryopreservation (406 sufferers). Parental standing strongly influenced choices: 87% of sufferers who pursued cryopreservation had no prior youngsters in contrast with 35% who didn’t. Tumor grade and sort of chemotherapy additionally differed between teams, with anthracycline- and taxane-based regimens extra continuously utilized in sufferers not present process cryopreservation.
Security and Medical Implications
Amongst sufferers 40 years or youthful, disease-free survival remained excessive in each teams. 4-year disease-free survival was 95% in sufferers who underwent oocyte cryopreservation versus 87% amongst those that didn’t. General survival at 4 years was 97% in those that had cryopreservation versus 96% in those that didn’t. These outcomes recommend that present process managed ovarian stimulation doesn’t negatively have an effect on outcomes.
“Outcomes from the PREFER research might present novel potential proof to enhance oncofertility counseling for premenopausal ladies with early breast most cancers. From a public well being perspective, these findings might assist optimize collaboration between oncology and fertility items, together with useful resource allocation,” Lambertini concluded.
Reference
- “Fertility and ovarian operate preservation in premenopausal ladies with early breast most cancers: outcomes from the multicenter potential PREgnancy and FERtility (PREFER) research,” by Matteo Lambertini. Introduced at: San Antonio Breast Most cancers Symposium; December 9-12, 2025; San Antonio, TX. Summary GS3-02.
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