Symposium December 59 2017 This presentation is the intellectual property of the author presenter Contact them at matteolambertinibordetbe for ID: 800426
Download The PPT/PDF document "San Antonio Breast Cancer" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
San Antonio Breast Cancer Symposium, December 5-9, 2017
This presentation is the intellectual property of the author/presenter. Contact them at matteo.lambertini@bordet.be for permission to reprint and/or distribute
Pooled analysis of five randomized trials investigating temporary ovarian suppression with gonadotropin-releasing hormone analogs during chemotherapy as a strategy to preserve ovarian function and fertility in premenopausal early breast cancer patients
Matteo Lambertini1, Halle C.F. Moore2, Robert C.F. Leonard3, Sibylle Loibl4, Pamela Munster5, Marco Bruzzone6, Luca Boni7, Joseph M. Unger8, Richard A. Anderson9, Keyur Mehta4, Susan Minton10, Francesca Poggio6, Kathy S. Albain11, Douglas J.A. Adamson12, Bernd Gerber13, Amy Cripps14, Gianfilippo Bertelli15, Sabine Seiler4, Marcello Ceppi6, Ann H. Partridge16, and Lucia Del Mastro6
1
Institut Jules
Bordet
and
Université
Libre de Bruxelles (U.L.B.),
Brussels
,
Belgium
.
2
Cleveland Clinic Foundation,
Taussig
Cancer
Institute
, Cleveland, OH.
3
Imperial College, London, UK.
4
GBG -
German
Breast
Group
,
Neu-Isenburg
,
Germany.
5
UCSF - University of California, San Francisco, CA.
6
Ospedale Policlinico San Martino-IST, Genova,
Italy
.
7
AOU Careggi and Istituto Toscano Tumori, Firenze,
Italy
.
8
SWOG Statistical Center, Fred
Hutchinson
Cancer
Research
Center, Seattle, WA
.
9
MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK.
10
Moffitt Cancer Center, Tampa, FL.
11
Loyola
University
Medical
Center, Cardinal
Bernardin
Cancer
Center,
Maywood
, IL.
12
Tayside
Cancer Centre,
Ninewells
Hospital, Dundee, UK.
13
University Hospital Rostock, Rostock, Germany.
14
Nexgen
Oncology, Dallas, TX.
15
Singleton Hospital, Swansea, UK.
16
D
ana-
Farber
Cancer
Institute
, Boston, MA.
Slide2San Antonio Breast Cancer Symposium, December 5-9, 2017
This presentation is the intellectual property of the author/presenter. Contact them at matteo.lambertini@bordet.be for permission to reprint and/or distribute
DisclosuresLambertini Matteo:Consultant or advisor: TevaTravel grant: Astellas
Slide3San Antonio Breast Cancer Symposium, December 5-9, 2017
This presentation is the intellectual property of the author/presenter. Contact them at matteo.lambertini@bordet.be for permission to reprint and/or distribute
“Fertility preservation and pregnancy-related issues are high priority areas of concern for young women with breast cancer”Paluch-Shimon S et al, Breast 2017;35:203-17Background
Slide4San Antonio Breast Cancer Symposium, December 5-9, 2017
This presentation is the intellectual property of the author/presenter. Contact them at matteo.lambertini@bordet.be for permission to reprint and/or distribute
BackgroundPremature ovarian insufficiency (POI) is a common side effect of chemotherapy in premenopausal patients with substantial negative impact on their quality of lifeOocyte/embryo cryopreservation are standard strategies for fertility preservation but they do not prevent the risk of chemotherapy-induced POITemporary ovarian suppression with GnRHa during chemotherapy has been studied in several RCTs as a strategy to preserve ovarian
function and potential fertilityHowever, data are mixed and its role remains controversialPaluch-Shimon S et al, Breast 2017;35:203-17. Loren AW et al, J Clin Oncol 2013;31:2500-10. Peccatori F et al, Ann Oncol 2013;24 Suppl 6;vi160-70. Lambertini M et al, Ann Oncol 2015;26:2408-19. Lambertini M et al, Eur J Cancer 2017;71:25-33.
Slide5San Antonio Breast Cancer Symposium, December 5-9, 2017
This presentation is the intellectual property of the author/presenter. Contact them at matteo.lambertini@bordet.be for permission to reprint and/or distribute
Study Objectives and EndpointsSystematic review and meta-analysis of individual patient data from RCTs to evaluate the efficacy (ovarian function and fertility preservation) and the safety (survival outcomes) of GnRHa use during chemotherapy Primary endpointsPOI rate (according to the definition used as primary endpoint in each trial)Post-treatment pregnancy rateSecondary endpointsAmenorrhea rates one year and two years after the end of chemotherapyDisease-free survival (DFS) and overall
survival (OS)
Slide6San Antonio Breast Cancer Symposium, December 5-9, 2017
This presentation is the intellectual property of the author/presenter. Contact them at matteo.lambertini@bordet.be for permission to reprint and/or distribute
Study CharacteristicsPROMISE-GIM61,2POEMS/SWOG S02303Moffitt-led trial4GBG-37 ZORO5Anglo Celtic Group OPTION6Definition of POI
No resumption of menstrual activity and postmenopausal levels of FSH and E2Amenorrhea for the prior 6 months and postmenopausal levels of FSHNo maintenance of menses and no resumption of mensesNo re-appearance of two consecutive menstrual periods within 21 to 35 daysAmenorrhea with elevated FSHTiming of POI after chemotherapy12 months24 months24 months6 monthsBetween 12 and 24 monthsSample size2812574860227ER status for eligibility
ER-positive and ER-negative
ER-negative only
ER-positive and ER-negative
ER-negative only
ER-positive and ER-negative
Upper age limit for eligibility
≤ 45 years
≤ 49 years
≤ 44 years
≤ 45 years
None
Type
of
GnRHa
Triptorelin
Goserelin
Triptorelin
Goserelin
Goserelin
1. Del Mastro L et al,
JAMA
2011;306:269-76. 2. Lambertini M et al,
JAMA
2015;314:2632-40. 3. Moore HCF et al,
N Engl J Med 2015;372:923-32. 4. Munster P et al, J Clin Oncol 2012;30:533-38. 5. Gerber B et al, J Clin Oncol 2011;29:2334-41. 6. Leonard RCF et al, Ann Oncol 2017;28:1811-16.
Slide7San Antonio Breast Cancer Symposium, December 5-9, 2017
This presentation is the intellectual property of the author/presenter. Contact them at matteo.lambertini@bordet.be for permission to reprint and/or distribute
Baseline CharacteristicsGnRHa group(n=436)No. (%)Control group(n=437)No. (%)p value* Age, median (interquartile range), years38 (34-42)39 (35-42)0.258
Age distribution, years≤ 40≥ 41 297 (68.1) 139 (31.9) 283 (64.8) 154 (35.2)0.316 Estrogen receptor statusPositive NegativeMissing177 (40.6)257 (58.9)2 (0.5)173 (39.6)262 (59.9)2 (0.5)0.782
Type of chemotherapy
Anthracycline only-based
Anthracycline- and
taxane
-based
Non anthracycline-based
Missing
194 (44.5)
227 (52.1)
6 (1.4)
9 (2.1)
198 (45.3)
210 (48.0)
13 (3.0)
16 (3.7)
0.196
Cumulative cyclophosphamide dose
, median (
interquartile range
), mg/m
2
4000 (3420
-5185)
3960 (3082-5400)0.585*Calculated by excluding missing data
Slide8San Antonio Breast Cancer Symposium,
December 5-9, 2017This presentation is the intellectual property of the author/presenter. Contact them at matteo.lambertini@bordet.be for permission to reprint and/or
distribute Premature-Ovarian Insufficiency Rate14.1%GnRHa groupn=363 Control groupn=359 30.9%OR* 0.38 (95% CI 0.26-0.57)p<0.001 Subgroup analysis*Odds ratio (OR) adjusted for age, estrogen receptor status, type and duration of chemotherapy
administered
Slide9San Antonio Breast Cancer Symposium, December 5-9, 2017
This presentation is the intellectual property of the author/presenter. Contact them at matteo.lambertini@bordet.be for permission to reprint and/or distribute
Amenorrhea Rates36.8%GnRHa groupn=386 Control groupn=374 40.4%OR* 0.92 (95% CI 0.66-1.28); p=0.623 18.2%GnRHa groupn=214 Control groupn
=21030.0%OR* 0.51 (95% CI 0.31-0.85); p=0.009One-Year AmenorrheaTwo-Year Amenorrhea*Odds ratio (OR) adjusted for age, estrogen receptor status, type and duration of chemotherapy administered
Slide10San Antonio Breast Cancer Symposium, December 5-9, 2017
This presentation is the intellectual property of the author/presenter. Contact them at matteo.lambertini@bordet.be for permission to reprint and/or distribute
Post-Treatment Pregnancy RateGnRHa Group: 37/359 (10.3%)vs.Control Group: 20/367 (5.5%)IRR* 1.83 (95% CI 1.06-3.15)p=0.030 GnRHa group(n = 37)No. (%)Control group(n = 20)No. (%)Age distribution, years≤ 40
≥ 41 37 (100)0 (0.0) 20 (100)0 (0.0)Estrogen receptor status PositiveNegative 6 (16.2)31 (83.8) 2 (10.0)18 (90.0)*Incidence rate ratio (IRR)
Slide11Disease-free survivalOverall survivalSan Antonio
Breast Cancer Symposium, December 5-9, 2017This presentation is the intellectual property of the author/presenter. Contact them
at matteo.lambertini@bordet.be for permission to reprint and/or distribute Survival Outcomes*Hazard ratio (HR) adjusted for age, estrogen receptor status, type and duration of chemotherapy administered and tumor stage HR* 1.01 (95% CI 0.72-1.42)p=0.999 HR* 0.67 (95% CI 0.42-1.06)p=0.083
Slide12San Antonio Breast Cancer Symposium, December 5-9, 2017
This presentation is the intellectual property of the author/presenter. Contact them at matteo.lambertini@bordet.be for permission to reprint and/or distribute
ConclusionsAdministration of GnRHa during chemotherapy was associated with a significant reduction in the risk of chemotherapy-induced POIA greater number of women in the GnRHa group had a post-treatment pregnancySimilar DFS and OS were observed between groups irrespective of the estrogen receptor status of the diseaseThis strategy should be considered as an option to reduce the likelihood of chemotherapy-induced POI and potentially improve future fertility in premenopausal early breast cancer patients undergoing (neo)
adjuvant chemotherapy
Slide13San Antonio Breast Cancer Symposium, December 5-9, 2017
This presentation is the intellectual property of the author/presenter. Contact them at matteo.lambertini@bordet.be for permission to reprint and/or distribute
AcknowledgmentsAll the patients enrolled in the trials and their familiesAll the investigators and research teamsThe Gruppo Italiano Mammella (GIM) study group, the SWOG, the Anglo Celtic Group and the German Breast GroupItalian Association for Cancer Research (AIRC) for supplemental funding
Slide14San Antonio Breast Cancer Symposium, December 5-9, 2017
This presentation is the intellectual property of the author/presenter. Contact them at matteo.lambertini@bordet.be for permission to reprint and/or distribute
AcknowledgmentsEuropean Society for Medical Oncology (ESMO) for a Translational Research Fellowship at Institut Jules Bordet (Brussels, Belgium)San Antonio Breast Cancer Symposium (SABCS) Scientific Committee for a SABCS Clinical Scholar Award