Effects of controlled ovarian stimulation on toxicity of TAC chemotherapy in early breast cancer patients
Authors de Groot S, Louwé LA, Ramautar AIE, Portielje JEA, Ogilvie AC, Batman E, Fiocco M, Kroep JR
Received 17 September 2017
Accepted for publication 23 April 2018
Published 26 September 2018 Volume 2018:10 Pages 3931—3935
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Professor Nakshatri
Stefanie de Groot,1 Leoni A Louwé,2 Ashna IE Ramautar,1 Johanneke EA Portielje,1,3 Aernout C Ogilvie,4 Erdogan Batman,5 Marta Fiocco,6,7 Judith R Kroep1
1Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands; 2Department of Gynecology, Leiden University Medical Center, Leiden, the Netherlands; 3Department of Medical Oncology, Haga Hospital, Den Haag, the Netherlands; 4Department of Medical Oncology, OLVG Hospital, Amsterdam, the Netherlands; 5Department of Medical Oncology, Alrijne Hospital, Leiden, the Netherlands; 6Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands; 7Mathematical Institute, Leiden University, Leiden, the Netherlands
Background: Oocyte and embryo cryopreservation, using controlled ovarian stimulation (COS), are common fertility preservation methodologies in breast cancer patients receiving gonadotoxic neo (adjuvant) chemotherapy (CT). The effects of COS and peak estradiol levels on CT-induced side effects are unknown.
Patients and methods: Eighteen patients with stage II and III breast cancer underwent oocyte or embryo cryopreservation at Leiden University Medical Center before receiving docetaxel, adriamycin, and cyclophosphamide (TAC) CT (COS group). A control group (N=18) was retrospectively selected from breast cancer patients, aged between 18 and 40, who underwent TAC CT without fertility preservation. CT -induced toxicity in the 2 groups was compared using χ2 analysis. Associations between peak estradiol levels and distinct stimulation protocols and side effects in the COS group were investigated by using regression analysis.
Results: Patient characteristics between both groups were similar, except for a lower age in the COS group vs the control group (30.5 vs 35.2 years, P=0.005). No differences were seen in grade III/IV side effects between both groups. In the COS group, an increase in thrombopenia grade I/II was seen, while grade I/II stomatitis and constipation were significantly lower in the COS group as compared with the control group (P=0.006 and P=0.008, respectively). In the COS group, no association was found between the peak estradiol levels and distinct stimulation protocols and side effects of CT.
Conclusion: COS prior to TAC CT was not associated with an increase in grade III/IV side effects. Interestingly, COS may have a protective effect on mucositis and constipation. Moreover, the peak estradiol levels and distinct stimulation protocols had no effect on grade III/IV side effects in our study.
Keywords: chemotherapy, toxicity, fertility preservation, controlled ovarian hyperstimulation
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