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Meta-Analysis
. 2023 Dec;8(6):102031.
doi: 10.1016/j.esmoop.2023.102031. Epub 2023 Oct 23.

Safety of pregnancy after breast cancer in young women with hormone receptor-positive disease: a systematic review and meta-analysis

L Arecco  1 , E Blondeaux  2 , M Bruzzone  2 , M M Latocca  3 , E Mariamidze  4 , S Begijanashvili  5 , E Sokolovic  6 , G Gentile  7 , G Scavone  3 , S Ottonello  3 , A Boutros  8 , I Vaz-Luis  9 , C Saura  10 , R A Anderson  11 , I Demeestere  12 , H A Azim Jr  13 , E de Azambuja  14 , F A Peccatori  15 , L Del Mastro  16 , A H Partridge  17 , M Lambertini  18
Affiliations
Meta-Analysis

Safety of pregnancy after breast cancer in young women with hormone receptor-positive disease: a systematic review and meta-analysis

L Arecco et al. ESMO Open. 2023 Dec.

Abstract

Background: Despite increasing evidence on the safety of pregnancy after anticancer treatments in breast cancer survivors, many physicians and patients remain concerned about a potential risk of pregnancy specifically in the case of hormone receptor-positive breast cancer.

Materials and methods: A systematic literature search of Medline, Embase and Cochrane library with no language or date restriction up to 31 March 2023 was carried out. To be included, articles had to be retrospective and prospective case-control and cohort studies as well as clinical trials comparing survival outcomes of premenopausal women with or without a pregnancy after prior diagnosis of hormone receptor-positive breast cancer. Disease-free survival (DFS) and overall survival (OS) were the outcomes of interest. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. Study protocol is registered in PROSPERO (n. CRD42023394232).

Results: Out of 7796 screened studies, 8 were eligible to be included in the final analysis. A total of 3805 patients with hormone receptor-positive invasive early breast cancer were included in these studies, of whom 1285 had a pregnancy after breast cancer diagnosis. Median follow-up time ranged from 3.8 to 15.8 years and was similar in the pregnancy and non-pregnancy cohorts. In three studies (n = 987 patients) reporting on DFS, no difference was observed between patients with and those without a subsequent pregnancy (HR 0.96, 95% CI 0.75-1.24, P = 0.781). In the six studies (n = 3504 patients) reporting on OS, patients with a pregnancy after breast cancer had a statistically significant better OS than those without a pregnancy (HR 0.46, 95% CI 0.27-0.77, P < 0.05).

Conclusions: This systematic review and meta-analysis of retrospective cohort studies provides updated evidence that having a pregnancy in patients with prior history of hormone receptor-positive invasive early breast cancer appears safe without detrimental effect on prognosis.

Keywords: breast cancer; hormone receptor-positive disease; oncofertility; pregnancy; premenopausal patients.

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Conflict of interest statement

EB reports research support (to the institution) from Gilead outside the submitted work. EM reports honoraria from Roche, Sevie, Novartis. IVL reports honoraria from AstraZeneca (Inst), Amgen (Inst), Pfizer (Inst), Novartis (Inst), Sandoz (Inst); research funding from Resilience (Inst) and travel support from Novartis outside the submitted work. Executive board member BIG. CS reports grants from AstraZéneca, Daiichi Sankyo, Eisai Europe Ltd., Gilead, Novartis, Pharmalex, Pfizer Inc, Phillips Health Works, Pierre Fabre, PintPharma, Puma Biotechnology Inc, Roche Farma, SA Seagen Int, Solti, Synthon Biopharmaceuticals, Zymeworks; consulting fees from AstraZéneca, Daiichi Sankyo, Eisai Europe Ltd., Gilead, Novartis, Pharmalex, Pfizer Inc, Phillips Health Works, Pierre Fabre, PintPharma, Puma Biotechnology Inc, Roche Farma, SA Seagen Int., Solti, Synthon Biopharmaceuticals, Zymeworks; honoraria from AstraZéneca, Daiichi Sankyo, Eisai Europe Ltd., Gilead, Novartis, Pharmalex, Pfizer Inc, Phillips Health Works, Pierre Fabre, PintPharma, Puma Biotechnology Inc, Roche Farma, SA Seagen Int., Solti, Synthon Biopharmaceuticals, Zymeworks. RAA reports personal fees and non-financial support from Roche Diagnostics, personal fees from Ferring Pharmaceuticals, IBSA and Merck Serono, outside the submitted work. ID reports trial grant and reagents (to the institution) from Roche Diagnostics; academic trial grant from Ferring; speaker’s honoraria from Novartis; support for attending meetings from Ferring and Theramex. EdA reports financial honoraria and/or advisory board from Roche/GNE, Novartis, SeaGen, Zodiac, Libbs, Pierre Fabre, Lilly, Astra-Zeneca, MSD, Gilead Sciences. Travel grants from Roche/GNE and Astra-Zeneca. Research grant to my institution from Roche/GNE, Astra-Zeneca, GSK/Novartis, Gilead Sciences. Non-financial: ESMO director of membership 2023-2024; BSMO President 2023-2026. LDM reports grants from Eli lilly, Novartis, Roche, Daiichi Sankyo, Seagen, Astrazeneca, Gilead, Pierre Fabre; consulting fees from Eli lilly, Gilead, Daiichi Sankyo; honoraria from Roche, Novartis, Pfizer, Eli lilly, Astrazeneca, MSD, Seagen, Gilead, Pierre Fabre, Eisai, Exact Sciences, Ipsen, GSK, Agendia, Stemline. AHP reports research grants from Breast Cancer Research Foundation, Susan G. Komen, US NIH/NCI, PCORI; royalties from UpToDate. ML reports advisory role for Roche, Lilly, Novartis, Astrazeneca, Pfizer, Seagen, Gilead, MSD and Exact Sciences, speaker honoraria from Roche, Lilly, Novartis, Pfizer, Sandoz, Libbs, Daiichi Sankyo and Takeda, travel grants from Gilead and Daiichi Sankyo, and research support (to the institution) from Gilead outside the submitted work. All other authors have declared no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram of study selection process. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2
Forest plot describing event-free survival of patients who had a pregnancy after hormone receptor-positive breast cancer as compared to the non-pregnancy cohort. CI, confidence interval; HR, hazard ratio.
Figure 3
Figure 3
Forest plot describing overall survival of patients who had a pregnancy after hormone receptor-positive breast cancer as compared to the non-pregnancy cohort. CI, confidence interval; HR, hazard ratio.
See this image and copyright information in PMC

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