Copyright
©The Author(s) 2017.
World J Clin Oncol. Jun 10, 2017; 8(3): 241-248
Published online Jun 10, 2017. doi: 10.5306/wjco.v8.i3.241
Published online Jun 10, 2017. doi: 10.5306/wjco.v8.i3.241
Table 1 The risk of infertility and mechanism of damage associated with chemotherapeutic agents that are commonly used in breast cancer treatment
Chemotherapeutic agent | Class | Mechanism of action | Cell cycle effect | Risk of infertility |
Cyclophosphamide | Alkylating agent | DNA cross-link formation and double strand breaks that result in inhibition of DNA function and synthesis leading to cellular apoptosis | Cell cycle non-specific | High risk |
Doxorubicin Epirubicin | Anthracyclines | Inhibition of DNA synthesis and function due to inactivation of DNA topoisomerase II, free oxygen radical formation and induction of DNA double-strand breaks | Cell cycle non-specific | Medium risk |
Carboplatin | Platinum analog | Inhibition of DNA synthesis and function via intra- and interstrand DNA cross-link formation by covalent binding to genome | Cell cycle non-specific | Medium risk |
Paclitaxel Docetaxel | Taxanes | Inhibition of mitotic division by binding to microtubules with enhancement of tubulin polymerization | M phase | Low risk |
Methotrexate | Antimetabolites | Inhibition de novo purine nucleotide synthesis by inactivation of dihydrofolate reductase | S phase | Low risk |
5-fluorouracil | Inhibition of DNA synthesis and function via inactivation of Thymidylate synthase and alteration in RNA processing | S phase | Low risk | |
Trastuzumab | Monoclonal antibodies | Blockage of Human epidermal growth factor receptor 2 subdomain IV, antibody dependent cellular toxicity | NA | Low or no risk |
Pertuzumab | Blockage of Human epidermal growth factor receptor 2 subdomain II, antibody dependent cellular toxicity |
Table 2 Common adjuvant chemotherapy regimens for breast cancer and their impact of fertility
Chemotherapy regimen | Risk of amenorrhea or infertility | |
Age ≤ 35 yr | Age >35 yr | |
CMF | 4%-40% | 80%-100% |
CEF | 47% | 80%-100% |
CAF | No data | 30% |
AC | 13.90% | 68.20% |
AC-T | 9%-13% | 65%-67% |
AC-TH | 0-14% | 56%-67% |
Table 3 Fertility Preservation options for reproductive age women with breast cancer
Fertility preservation option | Current status | Advantages | Disadvantages |
Embryo Cryopreservation | Established | Highest cumulative pregnancy rates | Requires about two weeks delay in the initiation of cancer treatment |
Requires hormonal stimulation for oocyte retrieval | |||
Requires in vitro fertilization with male partner or donor sperm | |||
Oocyte Cryopreservation | Established | No need for male partner or sperm donor | Requires about two weeks delay in the initiation of cancer treatment |
Requires hormonal stimulation for oocyte retrieval | |||
Ovarian Tissue Cryopreservation and Transplantation | Currently experimental, may change as success rates are rising | No need for hormonal stimulation | Requires outpatient laparoscopic surgery for ovarian tissue harvesting and subsequent transplantation |
No need to significantly delay in the initiation of chemotherapy | |||
No need for male partner or sperm donor |
- Citation: Taylan E, Oktay KH. Current state and controversies in fertility preservation in women with breast cancer. World J Clin Oncol 2017; 8(3): 241-248
- URL: https://www.wjgnet.com/2218-4333/full/v8/i3/241.htm
- DOI: https://dx.doi.org/10.5306/wjco.v8.i3.241