TY - JOUR
T1 - Efficacy and Safety of Controlled Ovarian Stimulation With or Without Letrozole Co-administration for Fertility Preservation: A Systematic Review and Meta-Analysis
T2 - Frontiers in Oncology
AU - Bonardi, B.
AU - Massarotti, C.
AU - Bruzzone, M.
AU - Goldrat, O.
AU - Mangili, G.
AU - Anserini, P.
AU - Spinaci, S.
AU - Arecco, L.
AU - Del Mastro, L.
AU - Ceppi, M.
AU - Demeestere, I.
AU - Lambertini, M.
N1 - Cited By :2
Export Date: 11 March 2021
Correspondence Address: Lambertini, M.; Department of Internal Medicine and Medical Specialties (DiMI), Italy; email: matteo.lambertini@unige.it
Correspondence Address: Lambertini, M.; Department of Medical Oncology, Italy; email: matteo.lambertini@unige.it
Funding details: 5 × 1,000
Funding details: Institut national de la recherche scientifique, INRS
Funding details: European Society for Medical Oncology, ESMO
Funding details: Université Libre de Bruxelles
Funding text 1: This work was partially funded by grants from the Italian Ministry of Health 5 × 1,000 funds 2017 (Italy) and Fonds
Funding text 2: ML acknowledges the support from the European Society for Medical Oncology (ESMO) for a Translational Research Fellowship at Universit? Libre de Bruxelles (ULB) in Brussels (Belgium) during the conduction of this study. Funding. This work was partially funded by grants from the Italian Ministry of Health 5 ? 1,000 funds 2017 (Italy) and Fonds National de la Recherche Scientifique (FNRS, Belgium). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Funding text 3: ML acknowledges the support from the European Society for Medical Oncology (ESMO) for a Translational Research Fellowship at Université Libre de Bruxelles (ULB) in Brussels (Belgium) during the conduction of this study.
PY - 2020
Y1 - 2020
N2 - Background: The co-administration of letrozole during controlled ovarian stimulation (COS) with gonadotropins is used to limit the potentially harmful effects of a supra-physiological rise in estrogen levels on hormone-sensitive cancers. However, the efficacy and safety of adding letrozole to COS remain debated. Methods: This is a systematic review and meta-analysis of published studies that compared the efficacy and safety of COS with co-administration of letrozole vs. COS without letrozole in all patient populations. A secondary analysis was done including only the studies in breast cancer patients. The primary efficacy endpoint was the number of retrieved mature Metaphase II (MII) oocytes. Secondary efficacy and safety endpoints were total number of oocytes, maturation rate, fertilization rate, number of cryopreserved embryos, peak estradiol levels, progesterone levels, and total gonadotropin dose. Data for each endpoint were reported and analyzed thorough mean ratio (MR) with 95% confidence interval (CI). Results: A total of 11 records were selected including 2,121 patients (990 patients underwent COS with letrozole and 1,131 COS without letrozole). The addition of letrozole to COS did not have any negative effect on the number of mature oocytes collected (MR = 1.00, 95% CI = 0.87–1.16; P = 0.967) and the other efficacy endpoints. COS with letrozole was associated with significantly decreased peak estradiol levels (MR = 0.28, 95% CI = 0.24–0.32; P < 0.001). Similar results were observed in the secondary analysis including only breast cancer patients. Conclusions: These findings are reassuring on the efficacy and safety of COS with gonadotropins and letrozole and are particularly important for fertility preservation in women with hormone-sensitive cancers. © Copyright © 2020 Bonardi, Massarotti, Bruzzone, Goldrat, Mangili, Anserini, Spinaci, Arecco, Del Mastro, Ceppi, Demeestere and Lambertini.
AB - Background: The co-administration of letrozole during controlled ovarian stimulation (COS) with gonadotropins is used to limit the potentially harmful effects of a supra-physiological rise in estrogen levels on hormone-sensitive cancers. However, the efficacy and safety of adding letrozole to COS remain debated. Methods: This is a systematic review and meta-analysis of published studies that compared the efficacy and safety of COS with co-administration of letrozole vs. COS without letrozole in all patient populations. A secondary analysis was done including only the studies in breast cancer patients. The primary efficacy endpoint was the number of retrieved mature Metaphase II (MII) oocytes. Secondary efficacy and safety endpoints were total number of oocytes, maturation rate, fertilization rate, number of cryopreserved embryos, peak estradiol levels, progesterone levels, and total gonadotropin dose. Data for each endpoint were reported and analyzed thorough mean ratio (MR) with 95% confidence interval (CI). Results: A total of 11 records were selected including 2,121 patients (990 patients underwent COS with letrozole and 1,131 COS without letrozole). The addition of letrozole to COS did not have any negative effect on the number of mature oocytes collected (MR = 1.00, 95% CI = 0.87–1.16; P = 0.967) and the other efficacy endpoints. COS with letrozole was associated with significantly decreased peak estradiol levels (MR = 0.28, 95% CI = 0.24–0.32; P < 0.001). Similar results were observed in the secondary analysis including only breast cancer patients. Conclusions: These findings are reassuring on the efficacy and safety of COS with gonadotropins and letrozole and are particularly important for fertility preservation in women with hormone-sensitive cancers. © Copyright © 2020 Bonardi, Massarotti, Bruzzone, Goldrat, Mangili, Anserini, Spinaci, Arecco, Del Mastro, Ceppi, Demeestere and Lambertini.
KW - breast cancer
KW - controlled ovarian stimulation
KW - fertility
KW - gonadotropins
KW - letrozole
U2 - 10.3389/fonc.2020.574669
DO - 10.3389/fonc.2020.574669
M3 - Article
SN - 2234-943X
VL - 10
JO - Front. Oncol.
JF - Front. Oncol.
ER -