Ovarian function in premenopausal women treated with adjuvant chemotherapy for breast cancer.

1996 ◽  
Vol 14 (5) ◽  
pp. 1718-1729 ◽  
Author(s):  
J Bines ◽  
D M Oleske ◽  
M A Cobleigh
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Breast Cancer Survivors ◽  
Ovarian Function ◽  
Menopausal Status ◽  
Premenopausal Women ◽  
Premature Menopause ◽  
Premenopausal Breast Cancer ◽  
Wide Range ◽  
Definition Of

PURPOSE Adjuvant chemotherapy for breast cancer causes significant changes in ovarian function. More young women survive breast cancer than ever before and they are at risk of the sequelae of early menopause. We attempted to (1) define menopausal status in the setting of adjuvant chemotherapy; (2) define chemotherapy-related amenorrhea (CRA); (3) document rates of permanent amenorrhea, temporary amenorrhea, and oligomenorrhea among different regimens; and (4) analyze variables that influence ovarian function. DESIGN We reviewed reports of the effects of adjuvant chemotherapy for breast cancer on ovarian function in premenopausal women. We searched Medline and Cancerlit from 1966 to 1995 on the following terms: breast neoplasms; chemotherapy, adjuvant; menstruation disorders; premature menopause, and amenorrhea. Further references were obtained from reports retrieved in the initial search. RESULTS A uniform definition of menopause and CRA is lacking. The wide range of CRA rates reported in adjuvant chemotherapy trials is a result, at least in part, of this problem. The average CRA rate reported in regimens based on cyclophosphamide, methotrexate, and fluorouracil (CMF) is 68% (95% confidence interval [CI], 66% to 70%), with a range of 20% to 100%. CRA incidence varies with age, cytotoxic agent, and cumulative dose. CONCLUSION Ovarian damage is the most significant long-term sequela of adjuvant chemotherapy in premenopausal breast cancer survivors. We suggest a common definition of the following important terms: menopausal status, CRA (early and late), temporary CRA, and oligomenorrhea in the setting of adjuvant treatment. With uniform definitions in place, regimens can be more precisely compared with respect to this important complication.

scholarly journals Chemotherapy in Premenopausal Breast Cancer Patients

Breast Care ◽  
2015 ◽  
Vol 10 (5) ◽  
pp. 307-310 ◽  
Author(s):  
Ann H. Partridge
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Menopausal Status ◽  
Premenopausal Women ◽  
Optimal Strategies ◽  
Cytotoxic Chemotherapy ◽  
Breast Cancer Patients ◽  
Premenopausal Breast Cancer ◽  
Hormone Receptor Positive ◽  
Breast Cancer Outcomes

Evidence has long demonstrated that premenopausal women obtain the greatest benefit from adjuvant chemotherapy overall, with risk reduction increasing with decreasing age. The chemoendocrine effect of chemotherapy has only more recently been documented as impacting on outcomes for women with hormone receptor-positive breast cancer, and recent data have elucidated the optimal strategies for manipulating the menopausal status to improve disease outcomes, without necessarily including cytotoxic chemotherapy. Still, many premenopausal women will require adjuvant cytotoxic chemotherapy, and the effects of treatment on women diagnosed with breast cancer in the premenopausal setting can have important implications both on their breast cancer outcomes and on comorbidities and psychosocial outcomes. This article describes the most recent information and issues surrounding the indications, effects, and special considerations for adjuvant chemotherapy in premenopausal women with breast cancer, in an effort to inform their care.

The relative value of anti-Müllerian hormone to predict premature menopause in patients receiving adjuvant chemotherapy for breast cancer: Results from the OPTION trial.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1094-1094 ◽  
Author(s):  
Robert C. F. Leonard ◽  
Douglas Adamson ◽  
Gianfilippo Bertelli ◽  
Michelle McLinden ◽  
Nan Haiying ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Multivariate Logistic Regression Analysis ◽  
Premenopausal Women ◽  
Menstrual Bleeding ◽  
Premature Menopause ◽  
Ovarian Activity ◽  
Ovarian Protection ◽  
Pre Treatment

1094 Background: The OPTION trial in premenopausal women tested the ovarian protection effect of goserelin (G) given randomly before and during adjuvant chemotherapy for breast cancer. Methods: Using standard chemotherapy, women were randomised in 2 strata, under 40 yrs and over 40 yrs at diagnosis. 227 patients were recruited by end December 2009. 173 met the criteria for 1 year follow-up for this analysis; 140 patients of these had provided adequate data on menstrual bleeding; 87 patients were aged under 40 and 53 patients were aged over 40 at the time of chemotherapy. Cessation of menstruation during chemotherapy was defined as at least two consecutive cycles with no menstrual bleeding since the previous cycle and no return of menstrual bleeding prior to the final cycle of chemotherapy. Of those patients who had ceased periods during chemotherapy, those with no further menstrual bleeding at 12 months follow up were deemed to be menopausal. Patients were randomised to receive G or no G at start of chemotherapy. Primary endpoint was recovery of menses at 12 months from start of chemotherapy. AMH was measured in 117 women pre-treatment, and at 1 year after starting chemotherapy. Results: There were no differences in pretreatment AMH between control and goserelin-treated groups, thus further analyses were performed on all women grouped together. AMH was lower following chemotherapy (0.40±0.65 vs 1.38±1.82ng/ml; mean±SD; P<0.001)). Pre-treatment AMH was a significant predictor of post-treatment amenorrhoea (P=0.001). By multivariate logistic regression analysis with age and AMH, age remained significant (P=0.003) whereas AMH did not (P=0.07). Grouping pre-treatment and post-chemo AMH into quartiles showed that AMH became undetectable in 94% of women with lowest pre-treatment AMH vs 46.2% of women with the highest pretreatment AMH. We have previously demonstrated in a small cohort that pretreatment AMH can predict long-term (5 year) ovarian activity in women with breast cancer. Conclusions: The present data confirm the value of pretreatment AMH in assessing the likelihood of ongoing ovarian activity after chemotherapy for early breast cancer.

Evidence of a castration-mediated effect of adjuvant cytotoxic chemotherapy in premenopausal breast cancer.

1987 ◽  
Vol 5 (11) ◽  
pp. 1771-1778 ◽  
Author(s):  
H Brincker ◽  
C Rose ◽  
F Rank ◽  
H T Mouridsen ◽  
A Jakobsen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Premenopausal Women ◽  
Cytotoxic Chemotherapy ◽  
Axillary Node ◽  
Similar Degree ◽  
Premenopausal Breast Cancer ◽  
Free Survival ◽  
Adjuvant Trial

This prospective randomized trial, conducted by the Danish Breast Cancer Cooperative Group, is the largest study, so far, of adjuvant chemotherapy in premenopausal breast cancer. The trial is unique in that it is nationwide and based on a nonselected population of patients, and is the only adjuvant trial studying the effect of cyclophosphamide monotherapy. After total mastectomy with axillary node sampling, followed by local radiotherapy, 1,032 pre- and perimenopausal women with operable breast cancer were randomized to observation alone, or to adjuvant chemotherapy for 1 year with either cyclophosphamide monotherapy or with a combination of cyclophosphamide, methotrexate, and 5-fluorouracil (CMF). As of January 1987, median follow-up was 68 months. From early on both cyclophosphamide alone and CMF were found to improve recurrence-free survival (RFS) significantly and to a similar degree (P = .0001). However, an overall survival advantage did not become evident until 5 years after the start of treatment. So far, this advantage appears to be more pronounced in CMF (P = .0065) than in cyclophosphamide-only patients (P = .08). Thus, the study confirms the findings of the National Surgical Adjuvant Breast Project (NSABP) and Milan trials that adjuvant chemotherapy prolongs the survival of premenopausal women with early breast cancer. A retrospective analysis revealed that, in contrast with CMF, cyclophosphamide alone did not improve RFS significantly in subsets of patients without amenorrhea, with estrogen-receptor (ER) negative tumors, and with tumors of low histological differentiation. Assuming that cyclophosphamide alone is a less tumoricidal treatment than CMF, these findings suggest that the effect of adjuvant cytotoxic chemotherapy is mediated partly through chemical castration, and partly through a purely cytotoxic effect.

ER as a predictor of early breast cancer (EBC) outcomes in patients.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 590-590
Author(s):  
Joyce O'Shaughnessy ◽  
David M. Loesch ◽  
Devchand Paul ◽  
Christopher T. Stokoe ◽  
John E. Pippen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Older Women ◽  
Ovarian Function ◽  
Premenopausal Women ◽  
Age Group ◽  
Breast Cancers ◽  
Asco 2012 ◽  
Low Levels ◽  
Er Status

590 Background: Some ER-negative (ER-) breast cancers express low levels of estrogen receptors and approximately 12% express androgen receptors (Traina, T, et al. ASCO, 2012). Whether young premenopausal women (age <40) with ER- breast cancer (BC) who are more likely to retain ovarian function after adjuvant chemotherapy have a worse outcome than older women with ER- disease has not been widely investigated. Methods: We analyzed 2 adjuvant US Oncology BC studies: 99-016, 1830 BC patients randomized to doxorubicin/cyclophosphamide (AC)→Paclitaxel (P) (AC/P) vs AP→weekly P (no cyclophosphamide [C]) (AP/wP); and 01-062, 2611 patients randomized to AC→docetaxel (T) vs AC→T plus capecitabine (XT). ER+ patients received standard endocrine therapy following chemotherapy. Five-year DFS results did not show significant differences between the treatment arms on either study. The outcomes were analyzed for 5-year DFS by age ≤40yrs and >40yrs and by ER status. Results: In the two studies combined, ER- patients ≤40 had a superior DFS (84%) than ER- patients >40 (80%), while ER+ patients ≤40 had a worse 5-yr DFS (83%) than ER+ patients >40 (89%), although these findings were of borderline significance (see Table below). In 99-016, omitting C did not adversely affect outcomes in either age group, regardless of ER status. Conclusions: We did not observe worse outcomes in ER- patients ≤40 years compared to those >40 years in 2 US Oncology adjuvant chemotherapy trials, suggesting no adverse impact of assumed greater ovarian function following adjuvant chemotherapy in patients ≤40yrs. ER+ patients ≤40 had a worse DFS than ER+ patients >40. Omitting C in ER- patients ≤40 or >40 did not adversely affect outcome. [Table: see text]

Risk of Menopause During the First Year After Breast Cancer Diagnosis

1999 ◽  
Vol 17 (8) ◽  
pp. 2365-2365 ◽  
Author(s):  
Pamela J. Goodwin ◽  
Marguerite Ennis ◽  
Kathleen I. Pritchard ◽  
Maureen Trudeau ◽  
Nicky Hood
Keyword(s):  
Breast Cancer ◽  
Adjuvant Therapy ◽  
Clinical Decision Making ◽  
Prolonged Exposure ◽  
Menopausal Status ◽  
Premenopausal Women ◽  
Staging System ◽  
Breast Cancer Diagnosis ◽  
Premature Menopause ◽  
Systemic Adjuvant Therapy

PURPOSE: Premenopausal women with breast cancer often enter a premature menopause during initial treatment of their malignancy, with resulting loss of childbearing capacity, onset of menopausal symptoms, and subsequent prolonged exposure to long-term risks of menopause. Adjuvant therapy is believed to contribute to this early menopause. PATIENTS AND METHODS: One hundred eighty-three premenopausal women with locoregional breast cancer (tumor-node-metastasis staging system classification, T1-3 N0-1 M0) who had undergone surgical treatment and provided information on menopausal status at diagnosis and 1 year later were enrolled. Systemic adjuvant therapy was recorded. Univariate and multivariate predictors of menopause were examined. RESULTS: Age, weight gain, tumor stage, nodal stage, and systemic adjuvant therapy (chemotherapy, tamoxifen) were all significant univariate correlates of menopause. In multivariate analysis, age, chemotherapy, and hormone therapy (tamoxifen) made significant independent contributions to the onset of menopause. CONCLUSION: Age and systemic chemotherapy are the strongest predictors of menopause in women with locoregional breast cancer. They independently contribute to menopause. A graphic representation of our multivariate model allows an estimation of risk of menopause according to patient age and planned adjuvant treatment, and it may facilitate clinical decision-making.

scholarly journals Potential Mechanisms of Ovarian Protection with Gonadotropin-Releasing Hormone Agonist in Breast Cancer Patients: A Review

2019 ◽  
Vol 13 ◽  
pp. 117955811986458 ◽  
Author(s):  
Francesca Poggio ◽  
Matteo Lambertini ◽  
Claudia Bighin ◽  
Benedetta Conte ◽  
Eva Blondeaux ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Ovarian Function ◽  
Gonadotropin Releasing Hormone ◽  
Premature Menopause ◽  
Breast Cancer Patients ◽  
Premenopausal Breast Cancer ◽  
Releasing Hormone ◽  
Gonadotropin Releasing Hormone Agonist ◽  
Ovarian Protection

The use of chemotherapy in premenopausal cancer patients may lead to chemotherapy-induced premature ovarian failure. Pharmacological temporary ovarian suppression obtained with the gonadotropin-releasing hormone agonist (GnRHa) administered concomitantly with chemotherapy has been investigated as a technique capable to reduce the gonadotoxicity, reducing the risk of developing premature menopause. In recent years, important evidence has become available on the efficacy and safety of this strategy that should now be considered a standard option for ovarian function preservation in premenopausal breast cancer patients. However, in women interested in fertility preservation, this is not an alternative to cryopreservation strategies, which remains the first option to be proposed. The purpose of this review is to summarize the mechanisms of GnRHa in the preservation of fertility in premenopausal cancer patient candidates to receive chemotherapy, highlighting the areas of doubt that require further investigation.

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