Oncofertility Information Available for Recently Approved Novel Non Cytotoxic and Immunotherapy Oncology Drugs.

We reviewed the available animal and human reproductive function studies of recently approved noncytotoxic oncology drugs. We reviewed the oncofertility information in the prescribing information for the US Food and Drug Administration (FDA)-approved products and/or the product information and consumer medicine information for Therapeutic Goods Administration (TGA)-approved drugs of 32 novel oncology drugs approved between 2014 and 2018 in the United States and/or Australia supplemented by a literature review for additional reproductive effects. No human studies were available on the reproductive effects of all 32 drugs. A systematic literature review of animal reproductive toxicity studies provided only very limited data with nine drugs displaying impaired male fertility, three impaired female fertility, and nine producing impaired fertility in both male and female animals. Two drugs in the study are reported to have no demonstrable impact on fertility in animal reproductive toxicity studies and nine are reported to have unknown effects on fertility. Of the 32 newly listed drugs, only 4 had recommendations regarding potential human fertility risks and accordingly advised clinicians about fertility preservation procedures for patients. The lack of human data and limited animal reproductive toxicity data raises concerns about the potential impact of these novel oncology drugs on human fertility and reproductive function. Consequently, adequate oncofertility recommendations, including for fertility preservation procedures, counselling for psychological or cost implications, and future prognosis for fertility are hindered by this paucity of relevant data. More data on human reproductive effects of novel oncology drugs is urgently required to facilitate effective use of the growing array of oncofertility care options available.

Reproductive outcomes following treatment for a gynecological cancer diagnosis: a systematic review.

PURPOSE: Fertility treatments are available for women diagnosed with a gynecological malignancy, which is important for women who desire a biological family subsequent to treatment. The objective of this study was to report reproductive outcomes following fertility-sparing treatment for a gynaecological cancer. METHODS: Electronic databases were searched to identify studies that reported on reproductive outcomes after treatment for a gynecological malignancy. RESULTS: In total, 77 studies were included which reported on reproductive outcomes after treatment for cervical cancer, endometrial cancer, gestational trophoblastic disease, and ovarian cancer. The main treatments included vaginal or abdominal radical trachelectomy, progestin therapy, salpingo-oophorectomy, and chemotherapy. The mean age at diagnosis for the study population and at birth were 30.5 years and 30.3 years, respectively. There were 4749 pregnancies (42%) reported for the included studies, with a miscarriage rate of 15% and a medical termination rate of 5%. The live birth rate was 74% with a 10% preterm rate. IMPLICATIONS FOR CANCER SURVIVORS: Patients should be offered timely discussions, information, and counseling regarding the impact of gynecological cancer treatment on a patient's fertility. Furthermore, fertility-sparing strategies and fertility preservation should be discussed prior to starting treatment.