Fertility Challenges and Solutions in Women with Cancer [1st ed. 2020] 978-3-030-24085-1, 978-3-030-24086-8

Table of contents :
Front Matter ....Pages i-ix
Front Matter ....Pages 1-1
Epidemiology and General Considerations of Pregnancy Following Cancer Diagnosis (Barbara Buonomo, Hatem A. Azim Jr, Carlo Alviggi, Fedro A. Peccatori)....Pages 3-7
Safety and Challenges of Pregnancy in Women with a History of Endocrine-Sensitive Breast Cancer (Hatem A. Azim Jr)....Pages 9-15
Pregnancy After Gynecological Cancer (Marieke van der Zalm, Frederic Amant, Joris van Drongelen)....Pages 17-24
Overview of Fertility Preservation Approaches in Cancer Patients (Isabelle Demeestere)....Pages 25-42
Fertility Preservation in Women with Hematological Malignancies (Javier Domingo, Antonio Pellicer)....Pages 43-54
Front Matter ....Pages 55-55
Organizational Strategies to Overcome Barriers to Addressing Fertility Preservation in the Oncology Setting (Joanne Frankel Kelvin)....Pages 57-66
Impact of Systemic Anticancer Therapy on Fertility (Antonio Di Meglio, Ines Vaz-Luis, Barbara Pistilli)....Pages 67-80
Fertility Counseling in Routine Practice: Why, When, and How? (Sukhkamal B. Campbell, Terri L. Woodard)....Pages 81-92
Challenges in Fertility Counseling of Cancer Patients: A Developing Nation Perspective (Ghina Ghazeeri, Dalia Khalife)....Pages 93-101
Front Matter ....Pages 103-103
Ovarian Stimulation in Women with Breast Cancer (Volkan Turan, Kutluk Oktay)....Pages 105-115
Role of GnRH Agonists for Fertility Preservation in Breast Cancer (Cynthia Villarreal-Garza, Edna A. Lopez-Martinez, Hatem A. Azim Jr)....Pages 117-129
Fertility and Pregnancy Counseling of Breast Cancer Patients with Germline BRCA Mutations (Margherita Condorelli, Matteo Lambertini)....Pages 131-147

Citation preview

Fertility Challenges and Solutions in Women with Cancer Hatem A. Azim Jr Isabelle Demeestere Fedro A. Peccatori  Editors

123

Fertility Challenges and Solutions in Women with Cancer

Hatem A. Azim Jr  •  Isabelle Demeestere Fedro A. Peccatori Editors

Fertility Challenges and Solutions in Women with Cancer

Editors Hatem A. Azim Jr School of Medicine Tecnologico de Monterrey Monterrey Mexico

Isabelle Demeestere CUB-Erasme, Fertility Clinic Université Libre de Bruxelles Brussels Belgium

Fedro A. Peccatori Division of Gynecologic Oncology European Institute of Oncology Milan Italy

ISBN 978-3-030-24085-1    ISBN 978-3-030-24086-8 (eBook) https://doi.org/10.1007/978-3-030-24086-8 © Springer Nature Switzerland AG 2020 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Preface

This book addresses a highly controversial and challenging subject, which is related to fertility management of young women with cancer. In light of the improvement in cancer survival and the rising trend of delaying childbearing over the past decade, an increasing number of oncologists and fertility specialists are often faced with young women with cancer inquiring into fertility-related issues in routine clinical practice. Over the past decade, the field of fertility management of cancer patients has evolved enormously moving from managing patients based on anecdotes and perceptions to counseling based on evidence, thanks to a large amount of clinical and experimental research that has been generated and published by several groups around the globe. This book gathers worldwide experts who have made important contributions in the field of fertility management of young cancer patients. Several subjects are discussed spanning from understanding the feasibility and safety of pregnancy in cancer survivors to the various fertility preservation methods that could be used, in addition to fertility counseling of special subgroups of patients like those with germline mutations or with endocrine sensitive tumors. The book also addresses controversies related to the role of ovarian tissue cryopreservation and LHRH analogues. We strongly believe that this book will fulfill its aim in providing busy clinicians with a valuable resource in counseling their patients in routine clinical practice. Monterrey, Mexico Brussels, Belgium  Milan, Italy 

Hatem A. Azim Jr Isabelle Demeestere Fedro A. Peccatori

v

Contents

Part I Overview on Pregnancy in Cancer Survivors and Fertility Preservation Options 1 Epidemiology and General Considerations of Pregnancy Following Cancer Diagnosis����������������������������������������������������������������������������������������   3 Barbara Buonomo, Hatem A. Azim Jr, Carlo Alviggi, and Fedro A. Peccatori 2 Safety and Challenges of Pregnancy in Women with a History of Endocrine-­Sensitive Breast Cancer����������������������������������������������������������   9 Hatem A. Azim Jr 3 Pregnancy After Gynecological Cancer ��������������������������������������������������  17 Marieke van der Zalm, Frederic Amant, and Joris van Drongelen 4 Overview of Fertility Preservation Approaches in Cancer Patients������  25 Isabelle Demeestere 5 Fertility Preservation in Women with Hematological Malignancies����  43 Javier Domingo and Antonio Pellicer Part II Challenges to Fertility Preservation in Women with Cancer 6 Organizational Strategies to Overcome Barriers to Addressing Fertility Preservation in the Oncology Setting����������������������������������������  57 Joanne Frankel Kelvin 7 Impact of Systemic Anticancer Therapy on Fertility������������������������������  67 Antonio Di Meglio, Ines Vaz-Luis, and Barbara Pistilli 8 Fertility Counseling in Routine Practice: Why, When, and How?��������  81 Sukhkamal B. Campbell and Terri L. Woodard 9 Challenges in Fertility Counseling of Cancer Patients: A Developing Nation Perspective��������������������������������������������������������������  93 Ghina Ghazeeri and Dalia Khalife

vii

viii

Contents

Part III Controversial Topics in Fertility Counseling of Breast Cancer Patients 10 Ovarian Stimulation in Women with Breast Cancer������������������������������ 105 Volkan Turan and Kutluk Oktay 11 Role of GnRH Agonists for Fertility Preservation in Breast Cancer���� 117 Cynthia Villarreal-Garza, Edna A. Lopez-Martinez, and Hatem A. Azim Jr 12 Fertility and Pregnancy Counseling of Breast Cancer Patients with Germline BRCA Mutations ���������������������������������������������������������������������� 131 Margherita Condorelli and Matteo Lambertini

About the Editors

Hatem A. Azim Jr, MD, PhD  is a medical oncologist and an adjunct professor at the School of Medicine of the Monterrey Institute of Technology and the American University of Beirut. He also serves as faculty for the European Society for Medical Oncology (ESMO) and the European School of Oncology. He holds a master’s degree from the University of Newcastle Upon Tyne (UK) and a PhD from the Université Libre de Bruxelles (Belgium). Dr. Azim has published more than 120 peer-reviewed articles, contributed to 10 books, and been an invited speaker at the major oncology conferences. In recognition to his research in the field of breast cancer in young women and its relation to pregnancy and fertility, Dr. Azim has received the American Society of Clinical Oncology Merit Award, the ESMO Translational Research Award, and the University of Padua Breast Cancer Research Award. Isabelle Demeestere, MD, PhD  is a gynecologist at the fertility clinic in Erasme Hospital (Brussels, Belgium) and the Director of the Research Laboratory on Human Reproduction at the Université Libre de Bruxelles (ULB). After earning a PhD in fertility preservation for cancer patients, she completed her research training at McGill University, Canada, and became research associate at the FNRS. She was among the earliest innovators in the fertility preservation field and is responsible for the oncofertility unit at Erasme Hospital. She is a member of several scientific societies and author or coauthor of over 60 articles and book chapters in the field. Fedro Alessandro Peccatori, MD, PhD  is a specialist in Medical Oncology and Obstetrics & Gynecology. He acts as Director of the Fertility and Pregnancy Unit at the European Institute of Oncology (IEO) and Scientific Director of the European School of Oncology (ESO) Milan, Italy. Fertility and pregnancy issues in young women with cancer are his main research interests. He has published more than 190 peer-reviewed articles in international journals and has been the editor or author of more than 10 books on cancer and reproduction. He has been invited as speaker for ASCO, ESGO, and ESMO, where he is part of the Adolescent and Young Adults working group.

ix

Part I Overview on Pregnancy in Cancer Survivors and Fertility Preservation Options

1

Epidemiology and General Considerations of Pregnancy Following Cancer Diagnosis Barbara Buonomo, Hatem A. Azim Jr, Carlo Alviggi, and Fedro A. Peccatori

Introduction Nowadays, there is a rising trend of delaying childbearing for personal, educational, and professional reasons. Given that cancer incidence increases with age, more women inquire into the feasibility and safety of pregnancy following cancer diagnosis [1]. In addition, several concerns exist regarding the impact of cancer therapy on pregnancy outcome and the possibility of adverse effects among their offspring. However, it is not only the oncologic treatment that may have a potential negative impact on reproductive rates among cancer survivors. These patients may choose not to start a family for concerns related to the risk of transmitting predisposing genetic mutations to offsprings, for worries about cancer relapse and for the potentially increased risks of obstetric and perinatal complications [2]. Cancer survivors often suffer sexual health problems as well, which could be partly related to psychological challenges [3]. It was shown that decreased arousal, pleasure, and

B. Buonomo (*) Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy Fertility and Procreation Unit, Division of Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy e-mail: [email protected] H. A. Azim Jr Tecnologico De Monterrey, School of Medicine, Monterrey, Mexico C. Alviggi Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy F. A. Peccatori Fertility and Procreation Unit, Division of Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy © Springer Nature Switzerland AG 2020 H. A. Azim Jr et al. (eds.), Fertility Challenges and Solutions in Women with Cancer, https://doi.org/10.1007/978-3-030-24086-8_1

3

4

B. Buonomo et al.

overall satisfaction with sexual function occur at an increased rate among cancer survivors than the general population [4]. This underlines that importance of offering adequate oncofertility counselling for female cancer survivors.

Prevalence of Pregnancy After Cancer The overall probability of a first live birth is significantly lower among cancer survivors than among age-matched controls [2, 5]. On average, pregnancy rates are 40% lower among female cancer survivors compared with the general population adjusting for women’s age, education level, and previous parity. This observation is highly dependent on the cancer type. Women diagnosed with melanoma or thyroid cancer have pregnancy rates highly comparable to that of the general population. On the other hand, women diagnosed with breast cancer have the lowest chance of subsequent pregnancy, which is nearly 70% lower compared to the general population. This is possibly related to the administration of gonadotoxic chemotherapy but also to a general misconception that pregnancy could stimulate cancer recurrence being a hormonally driven disease [1].

Obstetric and Fetal Outcomes Although conceiving after a cancer diagnosis does not appear to increase the risk of cancer recurrence, the vast majority of studies on childbearing among adult cancer survivors are dealing with breast cancer [6, 7]. Survivors of malignant melanoma also seems to do well after pregnancy, but the evidence is more limited [8, 9]. It is unknown whether short intervals between treatment and conception increase the risks of poor pregnancy outcomes. It is generally advised not to conceive within 2 years of diagnosis. This would allow adequate recovery of ovarian function following anticancer therapy but also avoid the time during which the risk of recurrence is relatively higher [10]. Studies have shown that threatened miscarriage is higher in survivors diagnosed at an older age, those with a history of central nervous system (CNS) tumors, abdominopelvic tumors or those who had been treated with radiation therapy. Other factors that influence the risk of miscarriage include older maternal age, congenital uterine abnormalities, autoimmune factors, thrombophilic disorders, and maternal endocrine abnormalities like poorly controlled diabetes or polycystic ovarian syndrome. The findings of increased miscarriage in CNS tumors survivors suggest that brain irradiation may increase poor obstetrical outcomes, possibly through impairment of the hypothalamic-pituitary-ovarian axis [11]. Gestational diabetes is more frequent among CNS tumors, bone sarcoma, and carcinomas survivors, as well as in patients with tumors arising in the abdominal-­ pelvic region. The literature also reports that maternal diabetes is more common in females exposed to chemoradiation [11–15].

1  Epidemiology and General Considerations of Pregnancy Following Cancer…

5

Cesarean sections are more common in females diagnosed with cancer compared with those with no history of cancer. Women exposed to chemotherapy or radiation therapy, or diagnosed with leukemia, are particularly at risk. The combination of psychological and obstetric considerations has probably led to the high frequency of cesarean delivery in this group of patients. Other reasons include physicians’ concerns over medical malpractice, fear of birth trauma, and the potential risk to the child due to difficult vaginal delivery [11]. Some studies reported an increased risk of preterm birth (gestational age