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William J. Gradishar, MD, FACP, FASCO


Interrupting Breast Cancer Therapy to Attempt Pregnancy: Use of Assisted Reproductive Technologies

By: Bryna Goeking
Posted: Friday, February 2, 2024

The POSITIVE trial, an international, single-arm, prospective study, found that interruption of endocrine therapy in patients with hormone receptor (HR)-positive breast cancer to attempt pregnancy did not seem to increase the short-term risk of recurrence. To learn more about the role of fertility preservation and the use of assisted reproductive technologies in this patient population, Hatem A. Azim, MD, PhD, of the School of Medicine, Monterrey Institute of Technology, Mexico, and colleagues evaluated the use of ovarian stimulation for embryo/oocyte cryopreservation. Embryo/oocyte cryopreservation at breast cancer diagnosis followed by embryo transfer after endocrine therapy interruption seemed to be the sole approach linked to an increased chance of pregnancy. These findings were presented at the 2023 San Antonio Breast Cancer Symposium (Abstract GS02-11).

“This is the largest prospective study to investigate fertility preservation and assisted reproductive technologies in patients with HR-positive breast cancer,” Dr. Azim and colleagues noted. “[These] data [are] of paramount importance for oncofertility counseling of young breast cancer patients.”

The cumulative incidence of breast cancer–free interval events at 3 years was similar for women who underwent ovarian stimulation for cryopreservation at diagnosis and before enrollment, 9.7% (95% confidence interval = 6.0%–15.4%), and those who did not, 8.7%, the investigators reported.

The POSITIVE trial analyzed patients older than age 42 with stage I to III HR-positive breast cancer who had already received 18 to 30 months of endocrine therapy prior to treatment. The pregnancy status of 497 of 516 patients (96%) was followed for at least 6 months. Of the 497 patients, 368 (74%) reported at least one pregnancy. Younger patients had a shorter time to pregnancy than older patients.

Pregnancy rates were highest for patients who underwent cryopreserved embryo transfer (82.4%) and fertilization in vitro and embryo transfer/intracytoplasmic sperm injection (67.5%). A 24-month landmark analysis showed no impact of ovarian stimulation on the breast cancer–free interval.

Disclosure: For full disclosures of the study authors, visit

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