Matteo Lambertini, MD, PhD, on Oncofertility Care for Young Women With Breast Cancer

ESMO Congress 2022


Matteo Lambertini, MD, PhD, of the University of Genova and Policlinico San Martino Hospital, talks about why oncofertility counseling should now be considered mandatory in the care of young women with breast cancer. Among the treatments he recommends offering are oocyte/embryo cryopreservation (or ovarian tissue cryopreservation in those not eligible for gamete cryopreservation); ovarian suppression with gonadotropin-releasing hormone agonist during chemotherapy; and long-term follow-up to improve the management of gynecology-related issues faced by these women.


Disclaimer: This video transcript has not been proofread or edited and may contain errors.
Oncofertility care is a crucial component of cancer care in all patient diagnosed at reproductive years. It's clearly stated by all guidelines that we should discuss, we actually must discuss this topic with all newly diagnosed patient, irrespective type and stage of the disease. And oncofertility means discussing the so-called risk of gynotoxicity, the risk of developing in female cancer patient premature ovarian sufficiency. This risk is we know very well out to estimate this risk when we offer chemotherapy with standard chemotherapy agents. We know very well, according to patient age, as well as type of chemotherapy, what is the risk of gynotoxicity. This is the first step of the oncofertility counseling. After this step, and this is something that all medical oncologists should do to raise the issue and to then refer patient interest into fertility preservation strategies to fertility specialists, which is the second step of the oncofertility consult. In the second step, the fertility preservation strategies are being discussed. Among these strategies, the first and standard option is ooctye/embryo cryopreservation. This is the most important and the first of fertility preservation strategies to be discussed with all patient interest to increase their chances of a future pregnancy. A second option is of ovarian tissue cryopreservation, to be proposed to patient that are not eligible to ooctye/embryo cryopreservation for a variety of reasons. And finally, we have the possibility to use [inaudible 00:01:40] during chemotherapy. However, this last strategy is not per se a fertility preservation option, so it does not replace cryopreservation procedures, but should be considered only after cryopreservation procedures or to induce patients that are not interested in fertility preservation, but want to reduce the risk of premature ovarian insufficiency, so all the side effects of early menopause. [inaudible 00:02:02] oncofertility nowadays is not only fertility preservation strategies. I do believe that is something more than that. And with this concept of a kind of enlarged oncofertility care, we want also to include other important aspects for many patient in terms, for example, on how to manage the gynecological toxicity of anticancer treatment like adjuvant endocrine therapy and breast cancer patient, sexual dysfunction, menopause-rated symptoms. So all symptoms that as medical oncologists when we are not really well trained to manage and other important issues like contraception, pregnancy-related issues that are highly relevant to many patients. What is important for oncofertility care is really to build a network. A network between different specialists that will manage the different aspect of these oncofertility care. As medical oncologists, our responsibility is to raise the point of the gynotoxicity, the risk of developing this side effect, and then to build this network with gynecologist fertility specialists, the psychologists, expert in for example, sexual dysfunction, so that we can refer patient with the interest in these different aspects to a more experienced colleagues and physician. As the next step in this field, it's important to highlight that in the current era of, for example, genetic testing or new anticancer treatment, targeted therapies, antibody-drug conjugate, there are a lot of questions to be answered in the field, the risk of gynotoxicity of this new treatment, so the impact also on the ovarian function and ovarian reserve of our patient. These are question that we really need to address quite urgently in the coming month.

Related Videos

Lung Cancer

Tony S.K. Mok, MD, on NSCLC: Review of Recent Data From the SUNRISE and ORIENT-31 Trials

Tony S.K. Mok, MD, of The Chinese University of Hong Kong, discusses two late-breaking abstracts presented at ESMO 2022: the phase II SUNRISE study, which compared sintilimab plus anlotinib vs platinum-based chemotherapy as first-line therapy in patients with metastatic non–small cell lung cancer (NSCLC); and the ORIENT-31 trial, which compared sintilimab with or without IBI305 (a bevacizumab biosimilar) plus chemotherapy in patients with EGFR-mutated nonsquamous NSCLC who experienced disease progression on EGFR tyrosine kinase inhibitors.

Skin Cancer

Neil D. Gross, MD, on Cutaneous Squamous Cell Carcinoma: Recent Findings on Cemiplimab

Neil D. Gross, MD, of The University of Texas MD Anderson Cancer Center, discusses data from a phase II study, which showed that neoadjuvant cemiplimab-rwlc in patients with stage II–IV (M0) resectable cutaneous squamous cell carcinoma is active and may enable function-preserving surgery in some cases (Abstract 789O).

Prostate Cancer

Neal D. Shore, MD, on Prostate Cancer: Biomarker Analysis, Enzalutamide, and Active Surveillance

Neal D. Shore, MD, of Carolina Urologic Research Center/Genesis Care, discusses new data from the ENACT trial, which showed that patients with prostate cancer and the RNA biomarkers PAM50 and AR-A were likely to have better outcomes with enzalutamide treatment. The results suggest that such RNA biomarkers may help to identify patients who may benefit from enzalutamide treatment compared with active surveillance (Abstract 1385P).

Colorectal Cancer

Marinde J.G. Bond, PhD Candidate, on Colorectal Liver Metastases: FOLFOX/FOLFIRI, Bevacizumab, and Panitumumab

Marinde J.G. Bond, PhD Candidate, of the University Medical Center, Utrecht, discusses phase III findings from the CAIRO5 study of the Dutch Colorectal Cancer Group, the first such trial in defined subgroups of patients with initially unresectable colorectal cancer liver metastases and left-sided and RAS/BRAF V600E wild-type tumor. The study compared FOLFOX/FOLFIRI plus either bevacizumab or panitumumab (Abstract LBA21).


Kidney Cancer

Toni K. Choueiri, MD, and Laurence Albiges, MD, PhD, on RCC: Recent Phase III Data on Cabozantinib, Nivolumab, and Ipilimumab From the COSMIC-313 Trial

Toni K. Choueiri, MD, of the Dana-Farber Cancer Institute, and Laurence Albiges, MD, PhD, of France’s Gustave Roussy Cancer Centre, discuss phase III findings showing that cabozantinib in combination with nivolumab and ipilimumab reduced the risk of disease progression or death compared with the combination of nivolumab plus ipilimumab in patients with previously untreated advanced renal cell carcinoma of IMDC (the International Metastatic RCC Database Consortium) intermediate or poor risk. However, the combination of cabozantinib, nivolumab, and ipilimumab vs nivolumab plus ipilimumab did not demonstrate an overall survival benefit to patients (Abstract LBA8).