Matteo Lambertini, MD, PhD:Virginia, if I can go back to the fertility question and the fertility guidelines, do you think that there is any discordant message from the different guidelines in terms of how we counsel patients in this regard? What is your take on the safety and the efficacy of the different strategies?

Virginia G. Kaklamani, MD, DSc: They’re very similar, which is a good thing. What they’re saying, which I think is extremely important, is that we have to discuss fertility with our patients. If we do not discuss fertility with our patients, they won’t necessarily feel comfortable discussing it with us. So we have to start the conversation. Once we discuss it and understand what their view is and what they’re interested in doing—and I don’t know the issues in Italy with insurance, but here it’s a major issue, because a lot of insurance companies won’t pay for fertility treatments, and this is around an $8,000 to $10,000 expense for our patients. Then we, obviously, discussed GnRH [gonadotropin-releasing hormone] agonists. We talk about GnRH agonists, and then the other thing [is] the one difference between ASCO [American Society of Clinical Oncology] and NCCN [National Comprehensive Cancer Network] is their view on GnRH and whether this should be used for fertility preservation or not. ASCO is saying, “Oh, be careful, we don’t have a lot of data,” but NCCN says, “Oh, yes, please do use that because it can help with fertility,” which is what I know both of us discussed doing. The other thing that NCCN discusses, which I think is so important, especially coming out of the San Antonio [Breast Cancer] Symposium late last year, was pregnancy being safe and the fact that we can encourage our patients with ER [estrogen receptor]-positive disease to consider conceiving, probably, 2 years or so after they have started endocrine therapy, which I think is also important for those women.

Matteo Lambertini, MD, PhD:Yes. On the GnRH agonist part, I think that we have to be very clear with our patients that they have been developed as a way, during chemotherapy, to preserve ovarian function, to reduce the risk of early menopause, not as a fertility-preservation procedure. Meaning that, for women interested in fertility preservation, [to increase the] chances to have a pregnancy, cryopreservation options are the first to be discussed, and GnRH agonists are not an alternative to [the] cryopreservation option but can be used after the cryopreservation procedure. On the other side, women not interested in fertility, but [who] want to preserve and [want to] avoid the [adverse] effects of early menopause…I think that we have clear data from the different randomized studies that GnRH agonist [use during] chemotherapy protects, in a significant way and in a clinically relevant way, the ovarian function of our patients.

Transcript edited for clarity.