The phase 3 POSITIVE trial (NCT02308085) has provided important insights into the feasibility and safety of interrupting endocrine therapy in premenopausal breast cancer survivors who are seeking to conceive. Dr. Stephanie L. Graff, director of breast oncology at the Lifespan Cancer Institute, discusses the findings and their implications.
The study focused on premenopausal patients under the age of 42 who had received at least 18 months of endocrine therapy for their hormone receptor (HR)-positive breast cancer. While the trial included patients with stage I, II, or III breast cancer, the majority of participants had early-stage disease. It is important to note that the results may not be directly applicable to patients with more advanced disease.
Participants in the trial underwent a 3-month washout period from their initial medications and were encouraged to seek fertility consultations if pregnancy was not achieved within 1 year. The results showed that patients who had their endocrine therapy interrupted had breast cancer-free and distant relapse-free intervals that were comparable to historical cohorts from other trials.
It is noteworthy that 74% of patients in the trial were able to have at least one pregnancy, with 64% of all women experiencing a live birth. Despite the patients’ relatively young age and prior history of childbirth, the rate of pregnancy complications was relatively low.
Based on the findings from the POSITIVE trial, it can be concluded that interrupting endocrine therapy after 2 years may be safe and appropriate for breast cancer survivors who wish to pursue another pregnancy. This information is valuable for clinicians and patients when making treatment decisions concerning endocrine therapy and fertility preservation.
Sources:
– Stephanie L. Graff, MD, director, breast oncology, Lifespan Cancer Institute, assistant professor of medicine, Warren Alpert Medical School, co-leader, Breast Cancer Translational Research Disease Group, Brown University’s Legorreta Cancer Center
