266O - Safety of assisted reproductive techniques in young BRCA carriers with a pregnancy after breast cancer: Results from an international cohort study

Background

Very limited evidence is available on the safety of assisted reproductive techniques (ART) in breast cancer (BC) patients harboring BRCA1/2 pathogenic variants (PVs). Hence, concerns remain among physicians counseling young BRCA carriers with BC on the safety of ART use.

Methods

This is an international, multicenter, hospital-based, retrospective cohort study including women harboring known BRCA1/2 PVs and diagnosed at ≤40 years with stage I-III BC between January 2000 and December 2020 (NCT03673306). This analysis explored safety of ART to achieve a pregnancy. Maternal and fetal outcomes were compared between patients achieving a pregnancy spontaneously (spontaneous pregnancy group) vs. using ART (ART group).

Results

Out of 4732 patients included across 78 centers worldwide, 543 with a pregnancy after BC entered the present analysis. Among them, 436 conceived naturally and 107 using ART. In the ART group, 45 (42.1%) underwent oocyte/embryo cryopreservation at BC diagnosis, 33 (30.8%) ovarian stimulation following use of anticancer therapies, 21 (19.6%) embryo transfer following oocyte donation and for 8 ART type was missing. As compared to the spontaneous pregnancy group, patients in the ART group were significantly older at the time of conception (37.1 vs. 34.3 years), had more often hormone receptor-positive BC (43.4% vs. 30.8%) and a longer median time from BC diagnosis to conception (4.2 vs. 3.3 years). No statistically significant differences in pregnancy complications were observed between cohorts (p=0.382). However, patients who conceived with ART had more miscarriages (11.3% vs. 8.8%) and less induced abortion (0.9% vs. 8.3%) than those who conceived spontaneously. At a median follow up of 9.1 years (IQR 6.4-13.4), no detrimental effect of ART on disease-free survival (DFS) was observed with 13 and 118 DFS events in the ART and spontaneous pregnancy groups, respectively (log-rank p=0.147; HR 0.64, 95% CI 0.36-1.14; adjusted HR 0.72, 95% CI 0.38-1.33).

Conclusions

This global study showed that ART to have a pregnancy appears to be safe in BC survivors harboring BRCA1/2 PVs, with no apparent worsening of maternal prognosis or fetal outcomes.

Clinical trial identification

NCT03673306.

Legal entity responsible for the study

Institut Jules Bordet.

Funding

AIRC.

Disclosure

M. Lambertini: Financial Interests, Personal, Advisory Board: Roche, AstraZeneca, Lilly, Novartis, Pfizer, Exact Sciences, MSD, Seagen, Gilead; Financial Interests, Personal, Invited Speaker: Takeda, Sandoz, Ipsen, Libbs, Knight, Daiichi Sankyo, Lilly, Pfizer, Novartis, Roche; Financial Interests, Personal, Other, Travel grant to attend ASCO 2022: Gilead; Financial Interests, Institutional, Invited Speaker, 2-year research grant paid to my Institution: Gilead. S. Paluch-Shimon: Financial Interests, Institutional, Advisory Board, Advisory board, invited speaker, honoraria, travel: Roche; Financial Interests, Institutional, Other, Advisory board invited speaker honoraria: Pfizer, Novartis, AstraZeneca; Financial Interests, Institutional, Advisory Board, Advisory board invited speaker honoraria: Exact sciences, Eli Lilly; Financial Interests, Institutional, Other, Advisory board, speaker's bureau, consultancy: Medison; Financial Interests, Institutional, Advisory Board, Advisory board, speaker's bureau: MSD; Financial Interests, Institutional, Advisory Board: Gilead; Financial Interests, Personal and Institutional, Research Grant, Research grant for an RFP independent research put out by SPCC and Pfizer: SPCC (Shared Progress in Cancer Care). I.V. Vaz Luis: Financial Interests, Institutional, Invited Speaker: Amgen, Pfizer/Edimark, Pfizer/Edimark, AstraZeneca; Financial Interests, Institutional, Advisory Board, Consulting/ AB: Novartis; Financial Interests, Institutional, Expert Testimony: Sandoz; Financial Interests, Personal, Other, Travelling: Novartis; Financial Interests, Institutional, Other, Research Funding: Resilience; Financial Interests, Institutional, Funding: Resilience; Non-Financial Interests, Member, Member of WG: ASCO. H. Azim: Financial Interests, Personal, Other, Consultant: Diaccurate; Financial Interests, Personal, Invited Speaker: AstraZeneca; Financial Interests, Personal, Full or part-time Employment, ended June 2022: Pierre Fabre SANTE SA; Financial Interests, Personal, Full or part-time Employment, Biotech focused on R&D - no commercial activities Ended June 2021: Innate Pharma; Financial Interests, Personal, Officer, Biotech focused on R&D - no commercial activities: Emergence Therapeutics; Financial Interests, Personal, Stocks/Shares: Innate Pharma; Non-Financial Interests, Member: American Society of Clinical Oncology. E. Blondeaux: Financial Interests, Institutional, Research Grant, Research grant to my Institution for a research project: Gilead Science. All other authors have declared no conflicts of interest.