1.
We thank Dr. Balkar for their thoughtful commentary and for highlighting important considerations noted in our manuscript's limitations addressing treatment‐induced cardiotoxicity and congenital fetal defects. The primary objective of our review was to provide a comprehensive overview of tumor‐directed therapies and their risks on female reproductive potential.
Dr. Balkar highlights the importance of long‐term cardiovascular outcomes in oncofertility management, which may be affected by anthracycline and HER 2 inhibitors. We agree that safe pregnancy includes women's cardiovascular health [1, 2]. Multidisciplinary collaboration and appropriate cardiac monitoring may be warranted during assessment for fertility preservation and future pregnancy. We acknowledge that this is a limitation of our study to provide clinical cardiovascular recommendations during pregnancy and could be further explored in a future manuscript [3, 4].
We also agree that pharmacists play an important role not only in counseling patients on potential teratogenic risk, but also in providing guidance on appropriate washout periods prior to conception. However, the optimal interval between discontinuation of each targeted therapy and safe conception is not well‐established. Although evidence to guide washout periods is limited, recommendations for effective contraception may be used to inform counseling regarding the minimal interval before attempting conception.
For example, doxorubicin is a high‐risk gonadotoxic medication that requires effective contraceptive methods during and for at least 6 months after the last dose [5]. Although limited data are available on the carcinogenicity of trastuzumab, contraception is needed during treatment and for 7 months following the last dose of trastuzumab [6]. While these recommendations are intended to prevent embryo‐fetal toxicity, they can provide a framework to counsel patients and facilitate discussion with reproductive specialists when planning future pregnancy and discussing washout periods.
We appreciate Dr. Balkar's discussion points about women's health during survivorship and a healthy pregnancy. Gonadotoxic tumor‐directed therapies may cause cardiovascular toxicity, which requires additional monitoring and intervention for the health of a safe pregnancy by cardio‐oncology specialists.
Author Contributions
Seonga Song: conceptualization, investigation, methodology, validation, visualization, writing – review and editing, writing – original draft, supervision, resources, data curation. Lilia Davenport: investigation, writing – review and editing, data curation. Samantha Paone: investigation, writing – review and editing, data curation. Jamie Chin‐Hon: conceptualization, investigation, writing – original draft, methodology, validation, visualization, writing – review and editing, formal analysis, project administration, supervision, resources, data curation.
Funding
The authors have nothing to report.
Conflicts of Interest
The authors declare no conflicts of interest.
Linked Articles
This article is linked to Song et al. papers. To view this article, visit https://doi.org/10.1002/phar.70143.
Acknowledgments
The authors would like to acknowledge Vanguie Armijo Mora on collaborations as the oncofertility nurse navigator at Perlmutter Cancer Center.
Song S., Davenport L., Paone S., and Chin‐Hon J., “Response to “Comment on Cancer Treatment Modalities and Female Fertility Preservation”,” Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy 46, no. 8 (2026): e70191, 10.1002/phar.70191.
Scientific Editor: Lindsay DeVane
References
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