Critical appraisal:Rodgers RJ, Reid GD, Koch J, Deans R, Ledger WL, Friedlander M, et al 2017

Critical Appraisal

Article being appraised

Rodgers RJ, Reid GD, Koch J, Deans R, Ledger WL, Friedlander M, et al. The safety and efficacy of controlled ovarian hyperstimulation for fertility preservation in women with early breast cancer: a systematic review. Hum Reprod 2017 May 1;32(5):1033-1045 Available from: http://www.ncbi.nlm.nih.gov/pubmed/28333356.

Applicable clinical question

In female cancer patients does the use of ovarian stimulation for oocyte retrieval increase the risk of cancer recurrence? In breast cancer patients does the hormone receptor status of the tumor influence this outcome?

Key Facts

Study Design

systematic review — randomised and non-randomised

Study aims:

Can controlled ovarian hyperstimulation (COH) for fertility preservation be effectively conducted in women with
breast cancer without worsening their prognosis?

Number of Patients:

397

study population was premenopausal women diagnosed with Stage I–

IIIB breast cancer who underwent COH in the immediate post-operative
period, prior to the administration of chemotherapy. This is a systematic review of randomized control trials (RCTs), case control
and cohort studies reporting on the primary outcome of mortality/recurrence after COH in women with early breast cancer, or secondary
outcomes of oocyte yield and peak oestrogen concentration. Owing to the small number of RCTs available, other study types were included.
The last electronic search was run in April 2016. Two prospective non-randomized studies reported relapse and breast cancer-related mortality
rates in 397 women with breast cancer, of whom 149 underwent COH. Twelve studies reported the peak oestradiol concentrations of
882 women undergoing COH with letrozole co-administration. Four studies compared the oocyte yield of 248 women who underwent
COH plus letrozole with 254 women who underwent standard COH. Two studies compared peak oestradiol concentrations and oocyte
yield in 61 women who underwent COH with tamoxifen co-administration and 49 women who underwent COH without tamoxifen. One

study compared letrozole and tamoxifen co-administration, and another study compared the co-administration of letrozole and anastrozole.

Results of outcome(s):

Any statements regarding the safety of COH in women with breast cancer are based on a
limited number of observational studies. High quality evidence is unlikely to become available for ethical and practical reasons. Whilst available
data do not indicate a decline in disease-free survival, a small effect cannot be excluded. Breast cancers are heterogeneous in their genetic profile
and receptor status, making the results of studies difficult to generalize to individual cases. The implication of alterations in other hormone levels
such as androgens, progestins or vascular endothelial growth factor secondary to COH in women with breast cancer has not been quantified

Includes an economic evaluation

no