scholarly journals Diagnostic and predictive accuracy of anti-mullerian hormone for ovarian function after chemotherapy in premenopausal women with early breast cancer

2022 ◽  
Author(s):  
Richard A. Anderson ◽  
Tom W. Kelsey ◽  
Anne Perdrix ◽  
Nathalie Olympios ◽  
Orianne Duhamel ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Diagnostic Accuracy ◽  
Early Breast Cancer ◽  
Ovarian Function ◽  
Predictive Accuracy ◽  
Premenopausal Women ◽  
Future Fertility ◽  
Forest Models ◽  
Random Forest Models ◽  
Pre Treatment

Abstract Purpose Accurate diagnosis and prediction of loss of ovarian function after chemotherapy for premenopausal women with early breast cancer (eBC) is important for future fertility and clinical decisions regarding the need for subsequent adjuvant ovarian suppression. We have investigated the value of anti-mullerian hormone (AMH) as serum biomarker for this. Methods AMH was measured in serial blood samples from 206 premenopausal women aged 40–45 years with eBC, before and at intervals after chemotherapy. The diagnostic accuracy of AMH for loss of ovarian function at 30 months after chemotherapy and the predictive value for that of AMH measurement at 6 months were analysed. Results Undetectable AMH showed a high diagnostic accuracy for absent ovarian function at 30 months with AUROC 0.89 (96% CI 0.84–0.94, P < 0.0001). PPV of undetectable AMH at 6 months for a menopausal estradiol level at 30 months was 0.77. In multivariate analysis age, pre-treatment AMH and FSH, and taxane treatment were significant predictors, and combined with AMH at 6 months, gave AUROC of 0.90 (95% CI 0.86–0.94), with PPV 0.79 for loss of ovarian function at 30 months. Validation by random forest models with 30% data retained gave similar results. Conclusions AMH is a reliable diagnostic test for lack of ovarian function after chemotherapy in women aged 40–45 with eBC. Early analysis of AMH after chemotherapy allows identification of women who will not recover ovarian function with good accuracy. These analyses will help inform treatment decisions regarding adjuvant endocrine therapy in women who were premenopausal before starting chemotherapy.

scholarly journals Adverse reproductive health outcomes in a cohort of young women with breast cancer exposed to systemic treatments

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Cristina Silva ◽  
Ana Cristina Ribeiro Rama ◽  
Sérgio Reis Soares ◽  
Mariana Moura-Ramos ◽  
Teresa Almeida-Santos
Keyword(s):  
Breast Cancer ◽  
Reproductive Health ◽  
Health Outcomes ◽  
Young Women ◽  
Hormonal Therapy ◽  
Ovarian Function ◽  
Premenopausal Women ◽  
Systemic Treatments ◽  
Future Fertility

Abstract Background Breast cancer is the most common cancer in young women. Fortunately current survival rates of BC are significant which makes future fertility very important for quality of life of BC survivors. Chemotherapy carries a significant risk of infertility in BC patients so it is important to support fertility preservation decisions in premenopausal women. Amenorrhea has long been used as a surrogate marker of infertility in cancer patients but more reliable ovarian reserve (OR) markers are available. This study aimed to prospectively measure levels of OR in a cohort of young women with breast cancer exposed to chemotherapy, to identify adverse reproductive health outcomes in this population and to assess the influence of patient and treatment-related factors in those outcomes. Methods This prospective observational study included premenopausal women with breast cancer aged 18–40 years at diagnosis and proposed for (neo) adjuvant chemotherapy. Patients were evaluated before, during and a minimum of 9 months after the end of chemotherapy. Reproductive health outcomes: menses, hormonal and ultrasound OR markers, recovery of ovarian function and Premature Ovarian Insufficiency (POI). Results A total of 38 patients were included (mean age 32.9 ± 3.5 years). Levels of OR significantly decreased during the study. At the last follow up, 35 patients had AMH below the expected values for age; eight presented postmenopausal FSH; ten had not recovered their ovarian function and five met the defined criteria for POI. Age and baseline AMH were positively correlated with AMH at the last follow-up. AMH levels were higher in the group of patients treated with trastuzumab and lower in those under hormonal therapy, at the last follow-up. Conclusions Significant effects of systemic treatments on several reproductive outcomes and a strong relation of those outcomes with patient’s age and baseline level of AMH were observed. Our results point to a possible lower gonadotoxicity when treatment includes targeted therapy with trastuzumab. Also, this investigation highlights the lack of reliable OR markers in women under hormonal therapy.

scholarly journals Recognizing menopause in women with amenorrhea induced by cytotoxic chemotherapy for endocrine-responsive early breast cancer

2012 ◽  
Vol 19 (2) ◽  
pp. R21-R33 ◽  
Author(s):  
Francesco Torino ◽  
Agnese Barnabei ◽  
Liana De Vecchis ◽  
Marialuisa Appetecchia ◽  
Lidia Strigari ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Breast Cancer ◽  
Ovarian Function ◽  
Premenopausal Women ◽  
Cytotoxic Agents ◽  
Endocrine Treatment ◽  
Ovarian Toxicity ◽  
Variable Extent ◽  
Negative Effect ◽  
Anticancer Treatment

Cytotoxic anticancer treatment may induce amenorrhea or menopause to a variable extent. These side effects may not only impair or impede fertility but also cause sexual dysfunction, bone loss, and menopausal symptoms, with a strikingly negative effect on quality of life in many women. Aromatase inhibitors (AIs) are a recommended adjuvant endocrine treatment option in postmenopausal patients affected by early breast cancer (EBC) but are contraindicated in premenopausal women and in those with residual ovarian function. Women over 40 years of age with chemotherapy-induced amenorrhea (CIA) and routine hormonal levels consistent with menopause may receive an AI as adjuvant endocrine treatment. For these women, the tools available to identify menopause do not appear to be completely reliable. This review focused on the pathophysiology of ovarian toxicity induced by cytotoxic agents and on potentially useful methods to diagnose chemotherapy-induced menopause in patients treated with adjuvant chemotherapy for endocrine-responsive EBC. Moreover, practical approaches are proposed to distinguish true menopausal women, who would benefit from AIs, from those with transient or persistent CIA.

scholarly journals Use and effectiveness of adjuvant ovarian function suppression (OFS) in premenopausal women with early breast cancer

2017 ◽  
Vol 28 ◽  
pp. v55
Author(s):  
A.R. Ferreira ◽  
J. Ribeiro ◽  
A. Mayer ◽  
M. Brito ◽  
A. Miranda ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Breast Cancer ◽  
Ovarian Function ◽  
Premenopausal Women ◽  
Ovarian Function Suppression

Association of response to neoadjuvant chemotherapy (NAC) in premenopausal patients with hormone receptor-positive early breast cancer with chemotherapy-induced ovarian function suppression by NAC.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e11017-e11017
Author(s):  
Yutaka Yamamoto ◽  
Risa Yamaguchi ◽  
Yoshitaka Fujiki ◽  
Mutsuko Ibusuki ◽  
Keiichi Murakami ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Early Breast Cancer ◽  
Primary Tumor ◽  
Ovarian Function ◽  
Response Rate ◽  
Premenopausal Women ◽  
Ovarian Function Suppression ◽  
Endocrine Effect ◽  
Premenopausal Patients

e11017 Background: The purpose of this study is to assess the additive endocrine effect by chemotherapy-induced ovarian function suppression (CIOS) for premenopausal women with early breast cancer in neoadjuvant chemotherapy (NAC). Methods: We retrospectively compared the clinical efficacy to NAC between premenopausal and postmenopausal patients with early breast cancer to evaluate the endocrine effect by CIOS. One-hundred twenty two patients received NAC with anthracycline-containing regimen and/or taxane in Kumamoto University Hospital between April 2004 and March 2011. Results: Objective response rate by NAC in premenopausal ER-positive/HER2-negative patients is greater than that in postmenopausal ER-/HER2+ patients (premenopausal 93% vs. postmenopausal 63%, p=0.0121). Reduction rate of primary tumor by NAC on imaging studies in premenopausal ER+/HER2- patients is greater than that in postmenopausal ER-/HER2+ patients (premenopausal 54% vs. postmenopausal 40%, p=0.006). However, no significant difference in response rate between in premenopausal patients with other subtypes and postmenopausal patients with those was found (ER+/HER2+; premenopausal 50% vs. postmenopausal 48%, ER-/HER2+; premenopausal 43% vs. postmenopausal 77%, Triple-negative; premenopausal 86% vs. postmenopausal 65%). All of premenopausal women were suppressed ovarian function within two months after initiation of NAC. Expression levels of progesterone receptor on primary tumor in premenopausal ER+ cancer were significantly decreased after NAC compared with that in postmenopausal ER+ cancer (premenopausal -40.3% vs. postmenopausal +3.6%, p<0.001). Conclusions: These data suggests that CIOS by NAC contributes the additive effects through the endocrine fashion in premenopausal patients with ER+/HER2- breast cancer.

Effectiveness of Adjuvant Ovarian Function Suppression in Premenopausal Women With Early Breast Cancer: A Multicenter Cohort Study

2019 ◽  
Vol 19 (5) ◽  
pp. e654-e667
Author(s):  
Arlindo R. Ferreira ◽  
Joana Ribeiro ◽  
Ana Miranda ◽  
Alexandra Mayer ◽  
José Luís Passos-Coelho ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cohort Study ◽  
Early Breast Cancer ◽  
Ovarian Function ◽  
Premenopausal Women ◽  
Multicenter Cohort Study ◽  
Ovarian Function Suppression ◽  
Multicenter Cohort

scholarly journals The PREgnancy and FERtility (PREFER) Study Investigating the Need for Ovarian Function and/or Fertility Preservation Strategies in Premenopausal Women With Early Breast Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Eva Blondeaux ◽  
Claudia Massarotti ◽  
Valeria Fontana ◽  
Francesca Poggio ◽  
Luca Arecco ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Fertility Preservation ◽  
Early Breast Cancer ◽  
Hormone Receptor ◽  
Ovarian Function ◽  
Premenopausal Women ◽  
Primary Objective ◽  
Hormone Receptor Positive ◽  
Acceptance Rates ◽  
To Receive

BackgroundOffering ovarian function and/or fertility preservation strategies in premenopausal women with newly diagnosed breast cancer candidates to undergo chemotherapy is standard of care. However, few data are available on uptake and main reasons for refusing these options.MethodsThe PREFER study (NCT02895165) is an observational, prospective study enrolling premenopausal women with early breast cancer, aged between 18 and 45 years, candidates to receive (neo)adjuvant chemotherapy. Primary objective is to collect information on acceptance rates and reasons for refusal of the proposed strategies for ovarian function and/or fertility preservation available in Italy.ResultsAt the study coordinating center, 223 patients were recruited between November 2012 and December 2020. Median age was 38 years (range 24 – 45 years) with 159 patients (71.3%) diagnosed at ≤40 years. Temporary ovarian suppression with gonadotropin-releasing hormone agonists (GnRHa) was accepted by 58 out of 64 (90.6%) patients aged 41-45 years and by 151 out of 159 (95.0%) of those aged ≤40 years. Among patients aged ≤40 years, 57 (35.8%) accepted to access the fertility unit to receive a complete oncofertility counseling and 29 (18.2%) accepted to undergo a cryopreservation technique. Main reasons for refusal were fear of delaying the initiation of antineoplastic treatments and contraindications to the procedure or lack of interest in future childbearing. Patients with hormone-receptor positive breast cancer had a tendency for a higher acceptance rates of ovarian function and/or fertility preservation strategies than those with hormone-receptor negative disease.ConclusionsMore than 90% of premenopausal women with early breast cancer, and particularly those with hormone receptor-positive disease, were concerned about the potential risk of chemotherapy-induced premature ovarian insufficiency and/or infertility and accepted GnRHa administration. Less than 1 out of 5 women aged ≤40 years accepted to undergo cryopreservation strategies.

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