Association of platinum-based chemotherapy with live birth and infertility in female survivors of adolescent and young adult cancer

Beth Zhou; Brian Kwan; Milli J Desai; Vinit Nalawade; Joe Henk; Nina Viravalli; James D Murphy; Paul C Nathan; Kathryn J Ruddy; Ksenya Shliakhtsitsava; H Irene Su; Brian W Whitcomb

doi:10.1016/j.fertnstert.2024.01.039

Association of platinum-based chemotherapy with live birth and infertility in female survivors of adolescent and young adult cancer

Fertil Steril. 2024 Feb 3:S0015-0282(24)00080-3. doi: 10.1016/j.fertnstert.2024.01.039. Online ahead of print.

Authors

Affiliations

¹ Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, California.
² Division of Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health, University of California San Diego, San Diego, California; Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, California.
³ Moores Cancer Center, University of California San Diego, San Diego, California; Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California.
⁴ OptumLabs, Eden Prarie, Minnesota.
⁵ Department of Paediatrics, Division of Haematology/Oncology, the Hospital for Sick Children, Toronto, Ontario, Canada.
⁶ Department of Oncology, Mayo Clinic, Rochester, Minnesota.
⁷ Division of Hematology-Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas.
⁸ Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, California; Moores Cancer Center, University of California San Diego, San Diego, California.
⁹ Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts. Electronic address: bwhitcom@umass.edu.

PMID: 38316209
DOI: 10.1016/j.fertnstert.2024.01.039

Abstract

Objective: To estimate the effect of platinum-based chemotherapy on live birth (LB) and infertility after cancer, in order to address a lack of treatment-specific fertility risks for female survivors of adolescent and young adult cancer, which limits counseling on fertility preservation decisions.

Design: Retrospective cohort study.

Setting: US administrative database.

Patients: We identified incident breast, colorectal, and ovarian cancer cases in females aged 15-39 years who received platinum-based chemotherapy or no chemotherapy and matched them to females without cancer.

Intervention: Platinum-based chemotherapy.

Main outcome measures: We estimated the effect of chemotherapy on the incidence of LB and infertility after cancer, overall, and after accounting for competing events (recurrence, death, and sterilizing surgeries).

Results: There were 1,287 survivors in the chemotherapy group, 3,192 in the no chemotherapy group, and 34,147 women in the no cancer group, with a mean age of 33 years. Accounting for competing events, the overall 5-year LB incidence was lower in the chemotherapy group (3.9%) vs. the no chemotherapy group (6.4%). Adjusted relative risks vs. no chemotherapy and no cancer groups were 0.61 (95% confidence interval [CI] 0.42-0.82) and 0.70 (95% CI 0.51-0.93), respectively. The overall 5-year infertility incidence was similar in the chemotherapy group (21.8%) compared with the no chemotherapy group (20.7%). The adjusted relative risks vs. no chemotherapy and no cancer groups were 1.05 (95% CI 0.97-1.15) and 1.42 (95% CI 1.31-1.53), respectively.

Conclusions: Cancer survivors treated with platinum-based chemotherapy experienced modestly increased adverse fertility outcomes. The estimated effects of platinum-based chemotherapy were affected by competing events, suggesting the importance of this analytic approach for interpretations that ultimately inform clinical fertility preservation decisions.

Keywords: Platinum chemotherapy; cancer; infertility; live birth.