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Ünal Ç, Ordu Ç, Özmen T, İlgun AS, Çelebi F, Baysal B, Özkurt E, Duymaz T, Erdoğan İyigün Z, Kurt S, Öztürk MA, Pilancı KN, Alço G, Yararbaş K, Kayan Tapan T, Güven DC, Soybir G, Özmen V. Evaluation of Anti-Mullerian Hormone Levels, Antral Follicle Counts, and Mean Ovarian Volumes in Chemotherapy-Induced Amenorrhea among Breast Cancer Patients: A Prospective Clinical Study. Curr Oncol 2023; 30:9217-9229. [PMID: 37887566 PMCID: PMC10605884 DOI: 10.3390/curroncol30100666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/14/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023] Open
Abstract
Estradiol (E2), a follicle-stimulating hormone (FSH), AMH, and inhibin B levels, along with AFC and MOV, are used to determine ovarian reserve in pre-menopausal women. Studies have shown that AMH levels are more sensitive than those of E2, FSH, and inhibin B and that AFC and MOV can be used to evaluate ovarian reserve. AMH, AFC, and MOV measurements were performed before and after adjuvant SC in 3-month periods for one year. Patients were classified as experiencing chemotherapy-induced amenorrhea (CIA) if they did not have menstrual cycles for a period of six months or longer following the conclusion of their chemotherapy treatment. We aimed to evaluate the factors affecting chemotherapy-induced amenorrhea in breast cancer patients treated with adjuvant chemotherapy and the performance of baseline measurements of AMH, AFC, and MOV to predict chemotherapy-induced amenorrhea. The effects of different chemotherapy regimens on the AMH level, AFC, and MOV in CIA patients were investigated. Seventy-one patients were eligible for this study, and the median age was 38 years (range: 23-45). The median follow-up was 37 months (range: 20-51), and CIA developed in 62% of the patients. The AMH level and AFC were significantly decreased one year after SC (p < 0.0001), whereas MOV was not (p = 0.507). AMH levels before chemotherapy (median: 1.520 vs. 0.755, p = 0.001) and at the end of the first year (median: 0.073 vs. 0.010, p = 0.030) and pre-treatment AFC (median: 12 vs. 4.50, p = 0.026) were lower in patients with CIA compared to those without CIA. The AMH levels before SC were the most valuable and earliest factor for predicting CIA development. In addition, there was no difference between the chemotherapy regimens (including or not including taxane) in terms of CIA development.
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Affiliation(s)
- Çağlar Ünal
- Division of Medical Oncology, Department of Internal Medicine, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul 34865, Turkey
| | - Çetin Ordu
- Division of Medical Oncology, Department of Internal Medicine, Gayrettepe Florence Nightingale Hospital, Istanbul 34349, Turkey
| | - Tolga Özmen
- Division of Gastrointestinal and Oncologic Surgery, Harvard Medical School, Boston, MA 02115, USA
- Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Filiz Çelebi
- Department of Radiology, Yeditepe University Hospital, Istanbul 34755, Turkey
| | - Bülent Baysal
- Department of Obstetrics and Gynecology, İstanbul Florence Nightingale Hospital, Istanbul 34381, Turkey
| | - Enver Özkurt
- Department of General Surgery, İstanbul Florence Nightingale Hospital, Istanbul 34381, Turkey
| | - Tomris Duymaz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Bilgi University, Istanbul 34060, Turkey
| | - Zeynep Erdoğan İyigün
- Department of Physical Theraphy and Rehabilitation, Göztepe Medical Park Hospital, Istanbul 34732, Turkey
| | - Sevgi Kurt
- Department of Plastic Surgery, İstanbul Florence Nightingale Hospital, Istanbul 34381, Turkey
| | | | - Kezban Nur Pilancı
- Division of Medical Oncology, Department of Internal Medicine, Memorial Bahçelievler Hospital, Istanbul 34180, Turkey
| | - Gül Alço
- Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul 34349, Turkey
| | - Kanay Yararbaş
- Department of Medical Genetics, Demiroglu Bilim University, Istanbul 34394, Turkey
| | - Tuba Kayan Tapan
- Department of Nutrition and Dietetic, Faculty of Health Science, Demiroglu Bilim University, Istanbul 34394, Turkey
| | - Deniz Can Güven
- Division of Medical Oncology, Department of Internal Medicine, Elazıg Fethi Sekin City Hospital, Elazıg 23280, Turkey
| | - Gürsel Soybir
- Department of General Surgery, Memorial Şişli Hospital, Istanbul 34384, Turkey
| | - Vahit Özmen
- Department of General Surgery, İstanbul School of Medicine, İstanbul University, Istanbul 34093, Turkey
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Zhuang Y, Guo L, Huang W, Bo G, Zhang J, Zhu Z, Feng Y. Altered resting-state hippocampal functional connectivity in breast cancer survivors with chemotherapy-induced amenorrhea. Brain Behav 2023; 13:e3039. [PMID: 37157937 PMCID: PMC10275533 DOI: 10.1002/brb3.3039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/14/2023] [Accepted: 04/20/2023] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION Amenorrhea induced decrease of hormones is associated with cognitive impairment. This study aimed to evaluate hippocampal functional connectivity patterns in chemotherapy-induced amenorrhea (CIA) breast cancer (BC) patients, to evaluate the relationship between the functional connectivity features and hormone levels. METHOD Neuropsychological test, functional magnetic resonance imaging, and assessment of hormone levels were conducted in 21 premenopausal BC patients before chemotherapy (t0 ) and 1 week after completing chemotherapy (t1 ). Twenty matched healthy controls (HC) were also included and underwent the same assessments at similar time intervals. Mixed effect analysis and paired t-test were used to compare differences in brain functional connectivity. RESULTS Voxel-based paired t-tests revealed increased functional connectivity of the right and left hippocampus with the left fusiform gyrus, inferior and middle temporal gyrus, inferior occipital gyrus, left lingual gyrus, and parahippocampal gyrus after chemotherapy (p < .001) in CIA patients. Repeated measures analysis revealed significant group-by-time interactions in the left hippocampus with the bilateral fusiform gyrus, right parahippocampal gyrus, left inferior temporal gyrus, and left inferior occipital gyrus (p < .001). Premenopausal BC patients had no significant differences in cognitive function compared with HC at baseline. However, the CIA patients had high levels of self-rating depression scale, self-rating anxiety scale, total cholesterol, and triglycerides. Further, the CIA patients showed significant differences in hormone and fasting plasma glucose levels and cognitive performances between t0 and t1 (p < .05). Functional connectivity changes between the left hippocampus and the left inferior occipital gyrus was negatively correlated with E2 and luteinizing hormone changes (p < .05). CONCLUSION The CIA patients had cognitive dysfunction mainly in memory and visual mobility. Chemotherapy may affect hippocampal-posterior cortical circuit which mediates visual processing in CIA patients. Moreover, E2 may be involved in this process.
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Affiliation(s)
- Yingying Zhuang
- Department of Medical ImagingMedical Imaging Center, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical UniversityHuai'anJiangsuChina
| | - Lili Guo
- Department of Medical ImagingMedical Imaging Center, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical UniversityHuai'anJiangsuChina
| | - Wei Huang
- Department of Medical ImagingMedical Imaging Center, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical UniversityHuai'anJiangsuChina
| | - Genji Bo
- Department of Medical ImagingMedical Imaging Center, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical UniversityHuai'anJiangsuChina
| | - Jiandong Zhang
- Department of Medical ImagingMedical Imaging Center, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical UniversityHuai'anJiangsuChina
| | - Zhaohuan Zhu
- Department of Medical ImagingMedical Imaging Center, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical UniversityHuai'anJiangsuChina
| | - Yun Feng
- Department of Medical ImagingMedical Imaging Center, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical UniversityHuai'anJiangsuChina
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Wang Y, Li Y, Liang J, Zhang N, Yang Q. Chemotherapy-Induced Amenorrhea and Its Prognostic Significance in Premenopausal Women With Breast Cancer: An Updated Meta-Analysis. Front Oncol 2022; 12:859974. [PMID: 35463307 PMCID: PMC9022106 DOI: 10.3389/fonc.2022.859974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Chemotherapy-induced amenorrhea (CIA) is one of the most common side effects in premenopausal patients with breast cancer, and several factors may contribute to the incidence of CIA. In this meta-analysis, we aimed to summarize clinical risk factors associated with CIA incidence and to evaluate their prognostic effects in patients with breast cancer. Methods Three electronic databases (Cochrane Library, EMBASE, and MEDLINE) were systematically searched for articles published up to October 2021. The articles included clinical trials that evaluated risk factors associated with CIA and their prognostic value in treatment. For the meta-analysis, pooled odds ratio estimates (ORs) and 95% confidence intervals (CIs) were calculated using the inverse variance-weighted approach, in addition to publication bias and the chi-square test. Results A total of 68 studies involving 26,585 patients with breast cancer were included in this meta-analysis, and 16,927 patients developed CIA. From the 68 studies, 7 risk factors were included such as age group, hormone receptor (HR) status, estrogen receptor (ER) status, progesterone receptor (PR) status, tamoxifen administration, chemotherapeutic regimen, and tumor stage. Based on our results, patients with age of ≤40, HR-negative status, ER-negative status, PR-negative status, no use of tamoxifen, and use of anthracycline-based regimen (A) compared with anthracycline-taxane-based regimen (A+T) were associated with less incidence of CIA in patients with breast cancer. Moreover, CIA was associated with favorable disease-free survival (OR = 0.595, 95% CI = 0.537 to 0.658, p < 0.001) and overall survival (OR = 0.547, 95% CI = 0.454–0.660, p < 0.001) in premenopausal patients with breast cancer. Conclusion Age, HR status, ER status, PR status, tamoxifen administration, and chemotherapeutic regimen can be considered independent factors to predict the occurrence of CIA. CIA is a favorable prognostic factor in premenopausal patients with breast cancer. CIA should be a trade-off in the clinical management of premenopausal patients with breast cancer, and further large cohort studies are necessary to confirm these results.
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Affiliation(s)
- Yifei Wang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Yaming Li
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Jingshu Liang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Nan Zhang
- Breast Cancer Center, Jinan Central Hospital, Shandong First Medical University, Jinan, China
| | - Qifeng Yang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China.,Pathology Tissue Bank, Qilu Hospital of Shandong University, Jinan, China.,Research Institute of Breast Cancer, Shandong University, Jinan, China
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Dackus GM, Jóźwiak K, Sonke GS, van der Wall E, van Diest PJ, Siesling S, Hauptmann M, Linn SC. Adjuvant Aromatase Inhibitors or Tamoxifen following Chemotherapy for Perimenopausal Breast Cancer Patients. J Natl Cancer Inst 2021; 113:1506-1514. [PMID: 34101806 PMCID: PMC8562974 DOI: 10.1093/jnci/djab091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/29/2021] [Accepted: 05/10/2021] [Indexed: 11/17/2022] Open
Abstract
Background The benefit of adjuvant aromatase inhibitors (AI) vs tamoxifen has been investigated in randomized clinical trials for premenopausal and postmenopausal patients with early, estrogen receptor–positive (ER+) breast cancer. The optimal endocrine treatment for chemotherapy-treated perimenopausal women, who generally develop chemotherapy-induced amenorrhea, is uncertain. Methods All Dutch women who received adjuvant chemotherapy and endocrine treatment for stage I-III, ER+ (>10% positive cells), invasive breast cancer diagnosed between 2004 and 2007 were identified through the Netherlands Cancer Registry. Included women were considered perimenopausal based on an age at diagnosis of 45 to 50 years (n = 2295). For each patient, AI treatment duration relative to total endocrine treatment duration was calculated. Predominantly tamoxifen-treated patients (AI < 25%) were compared with those receiving AI and tamoxifen for a similar duration (AI 25%-75%) and those mostly using AI (AI > 75%). Adjusted hazard ratios (HRs) for recurrence-free survival (RFS) and overall survival were calculated using time-dependent Cox regression. Results After an average follow-up of 7.6 years, 377 RFS events occurred. Women mostly receiving AI (AI > 75%) had the best RFS (adjusted HR = 0.63, 95% confidence interval = 0.46 to 0.86) followed by those receiving AI 25% to 75% (adjusted HR = 0.85, 95% confidence interval = 0.65 to 1.12) compared with predominantly tamoxifen-treated women. Trend analyses showed that every 10% increase in AI-endocrine treatment ratio reduced RFS event risk by 5% (2-sided Ptrend = .002). In total, 236 deaths occurred; hazard ratios for overall survival showed similar trends. Conclusions These results suggest that the best adjuvant endocrine treatment for chemotherapy-treated, ER+ breast cancer patients diagnosed aged 45-50 years consists of mainly AI followed by a switch strategy and mainly tamoxifen.
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Affiliation(s)
- Gwen Mhe Dackus
- Division of Molecular Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands.,Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Katarzyna Jóźwiak
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands.,Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Haus O, Fehrbelliner Straße 38, 16816, Neuruppin, Germany
| | - Gabe S Sonke
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - Elsken van der Wall
- Division Cancer Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organization, Godebaldkwartier 419, 3511DT, Utrecht, The Netherlands.,Department of Health Technology & Services Research (HTSR), University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - Michael Hauptmann
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands.,Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Haus O, Fehrbelliner Straße 38, 16816, Neuruppin, Germany
| | - Sabine C Linn
- Division of Molecular Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands.,Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
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5
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van Hellemond IEG, Vriens IJH, Peer PGM, Swinkels ACP, Smorenburg CH, Seynaeve CM, van der Sangen MJC, Kroep JR, de Graaf H, Honkoop AH, Erdkamp FLG, van den Berkmortel FWPJ, de Boer M, de Roos WK, Linn SC, Imholz ALT, Tjan-Heijnen VCG. Efficacy of anastrozole after tamoxifen in early breast cancer patients with chemotherapy-induced ovarian function failure. Int J Cancer 2019; 145:274-283. [PMID: 30588619 PMCID: PMC6590217 DOI: 10.1002/ijc.32093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 11/05/2018] [Accepted: 11/28/2018] [Indexed: 12/29/2022]
Abstract
The DATA study (NCT00301457) compared 6 and 3 years of anastrozole in postmenopausal women with hormone receptor-positive early breast cancer after 2-3 years of tamoxifen. Patients with chemotherapy-induced ovarian function failure (CIOFF) were also eligible, but could be at risk of ovarian function recovery (OFR). The current analysis compared the survival of women with CIOFF with definitely postmenopausal women and examined the influence of OFR on survival. Therefore, we selected patients from the DATA study aged 45-57 years at randomization who had received (neo)adjuvant chemotherapy. They were classified by reversibility of postmenopausal status: possibly reversible in case of CIOFF (n = 395) versus definitely postmenopausal (n = 261). The former were monitored by E2 measurements for OFR. The occurrence of OFR was incorporated as a time-dependent covariate in a Cox-regression model for calculating the hazard ratio (HR). We used the landmark method to calculate residual 5-year survival rates. When comparing CIOFF women with definitely postmenopausal women, the survival was not different. Among CIOFF women with available E2 follow-up values (n = 329), experiencing OFR (n = 39) had an unfavorable impact on distant recurrence-free survival (HR 2.27 [95% confidence interval [CI] 0.98-5.25; p = 0.05] and overall survival (HR 2.61 [95% CI 1.11-6.13; p = 0.03]). After adjusting for tumor features, the HRs became 2.11 (95% CI 0.89-5.02; p = 0.09) and 2.24 (95% CI 0.92-5.45; p = 0.07), respectively. The residual 5-year rate for distant recurrence-free survival was 76.9% for women with OFR and 92.1% for women without OFR, and for 5-year overall survival 80.8% and 94.4%, respectively. Women with CIOFF receiving anastrozole may be at increased risk of disease recurrence if experiencing OFR.
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Affiliation(s)
- Irene E G van Hellemond
- Department of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Ingeborg J H Vriens
- Department of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Petronella G M Peer
- Biostatistics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Astrid C P Swinkels
- Clinical Research Department, Netherlands Comprehensive Cancer Organization IKNL, Utrecht, The Netherlands
| | | | - Caroline M Seynaeve
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Judith R Kroep
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hiltje de Graaf
- Department of Medical Oncology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Aafke H Honkoop
- Department of Medical Oncology, Isala Clinics, Zwolle, The Netherlands
| | - Frans L G Erdkamp
- Department of Medical Oncology, Zuyderland Medical Center, Sittard, The Netherlands
| | | | - Maaike de Boer
- Department of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Wilfred K de Roos
- Department of Surgery, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Sabine C Linn
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Vivianne C G Tjan-Heijnen
- Department of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
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Takuwa H, Hagiwara R, Takahara S, Yamauchi A. Assisted reproductive technology is effective for but does not affect the prognosis of young patients with breast cancer: Experience in a single institution. Breast J 2018; 24:1001-1005. [PMID: 30113113 DOI: 10.1111/tbj.13083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 07/12/2017] [Indexed: 11/30/2022]
Abstract
Assisted reproductive technology (ART) helps women preserve fertility after chemotherapy for cancer treatment. We examined the long-term survival of patients with early breast cancer who did or did not receive ART, as well as post-treatment pregnancy and childbirth rates. Our study consisted of 44 young patients (≤35 years of age). Eight patients were pregnant post-treatment; however, none of these patients received ART intervention. ART intervention prevented patient omits of necessary treatment to avoid adverse events. It did not affect the prognosis of patients with breast cancer. Technical improvements are needed to increase the likelihood of pregnancy after breast cancer treatment.
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Affiliation(s)
- Haruko Takuwa
- Department of Breast Surgery, Shiga Medical Center for Adults, Moriyama, Shiga, Japan.,Department of Breast Center, Tazuke Kofukai Medical Research Institute Kitano Hospital, Osaka, Japan
| | - Rika Hagiwara
- Department of Breast Center, Tazuke Kofukai Medical Research Institute Kitano Hospital, Osaka, Japan
| | - Sachiko Takahara
- Department of Breast Center, Tazuke Kofukai Medical Research Institute Kitano Hospital, Osaka, Japan
| | - Akira Yamauchi
- Department of Breast Center, Tazuke Kofukai Medical Research Institute Kitano Hospital, Osaka, Japan
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Abstract
In the era of precision medicine, the prediction of ovarian function recovery from chemotherapy-induced amenorrhoea using feasible biological markers may be helpful to optimise the treatment strategy for young patients with hormone receptor-positive breast cancer. The purpose of this study was to investigate the accuracy of post-chemotherapy biological markers for predicting the recovery of ovarian function in breast cancer patients of the ASTRRA trial, with chemotherapy-induced amenorrhoea. Using data of 82 participants from a single institution in the ASTRRA trial, the post-chemotherapy serum levels of the anti-Müllerian hormone (AMH), oestradiol, inhibin B and other clinical factors associated with chemotherapy-induced amenorrhoea were evaluated. Recovery of ovarian function was defined by the resumption of menstruation manifested by vaginal bleeding. Fifty-two patients regained menstruation within 55 months after enrolment. In univariate analysis, <40 years of age (P = 0.009), oestradiol ≥37 pg/mL (P = 0.003) or AMH ≥800 pg/mL (P = 0.026) were associated with recovery of menstruation. On multivariate analysis, oestradiol (hazard ratio: 3.171, 95% CI: 1.306–7.699, P = 0.011) and AMH (hazard ratio: 2.853, 95% CI: 1.011–8.046, P = 0.048) remained as significant independent predictors for resumption of menstruation. The diagnostic accuracy of age, oestradiol and AMH in predicting the resumption of menstruation was 38.3, 23.3 and 86.7%, respectively. In conclusion, post-chemotherapy AMH level might be a relatively accurate predictor of the recovery of ovarian function, presented by resumption of menstruation in breast cancer patients with chemotherapy-induced amenorrhoea
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Affiliation(s)
- Hyun-Ah Kim
- Department of SurgeryKorea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Jihye Choi
- Department of SurgeryKorea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Chan Sub Park
- Department of SurgeryKorea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Min-Ki Seong
- Department of SurgeryKorea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Sung-Eun Hong
- Department of Translational ResearchKorea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Jae-Sung Kim
- Division of Basic Radiation BioscienceKorea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - In-Chul Park
- Division of Basic Radiation BioscienceKorea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Jin Kyung Lee
- KIRAMS Radiation BiobankKorea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Woo Chul Noh
- Department of SurgeryKorea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
- Correspondence should be addressed to W C Noh:
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Meng K, Tian W, Zhou M, Chen H, Deng Y. Impact of chemotherapy-induced amenorrhea in breast cancer patients: the evaluation of ovarian function by menstrual history and hormonal levels. World J Surg Oncol 2013; 11:101. [PMID: 23688389 PMCID: PMC3666994 DOI: 10.1186/1477-7819-11-101] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 05/09/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chemotherapy-induced amenorrhea (CIA) is one of the most frequent therapy-related adverse events observed in breast cancer patients who have undergone chemotherapy. Although the characteristics of CIA have been studied in Western countries, little is known about CIA in Asian. We conducted a retrospective analysis to assess the characteristics and influencing factors of CIA and its association with menopause in Chinese women who underwent adjuvant chemotherapy for early-stage breast cancer. METHODS Seventy-three premenopausal women who underwent adjuvant chemotherapy for early stage (stages I to III) breast cancer were analyzed. Patient clinical characteristics, treatment regimes, menstrual information, and serum hormone values were collected retrospectively. Characteristic factors relevant to the onset of CIA and menopause were also estimated. RESULTS Approximately 83.6% of patients developed CIA. Older patients (>40 years old) had higher CIA incidence compared with younger patients (P <0.0001). The onset of menopause was correlated with age (P <0.0001) and tamoxifen use (P = 0.0313). On the basis of the Kaplan-Meier analysis, a significant difference was observed in the time of onset of permanent amenorrhea as determined by menstrual history and hormone levels (P = 0.0028). In women aged 46 to 49 years, the beginning of permanent amenorrhea was detected earlier via the clinical method than via the hormonal method (2 months versus 23 months, P <0.0001). In the analysis of patients ≥50 years old, the median time to detection of permanent amenorrhea was 19 months in the hormonal test and 2 months in the clinical test (P = 0.0112). CONCLUSIONS Age at diagnosis is a predictor of the onset of amenorrhea and transformation into menopause among premenopausal breast cancer patients. Adjuvant tamoxifen therapy substantially affects the onset of menopause. A delay of the onset of serum hormone postmenopausal status was observed compared with clinical symptoms. This interval was approximately 21 months in patients aged 46 to 49 years and 17 months in patients aged over 50 years. This interval is significant in the clinical estimate of the menstrual status.
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Affiliation(s)
- Kexin Meng
- Department of Surgical Oncology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China
- Department of Thyroid Breast Surgery, Zhejiang Provincial People’s Hospital, 158 Shangtang Road, Hangzhou, Zhejiang Province 310014, China
| | - Wei Tian
- Department of Surgical Oncology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China
| | - Meiqi Zhou
- Department of Surgical Oncology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China
| | - Hailong Chen
- Department of Surgical Oncology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China
| | - Yongchuan Deng
- Department of Surgical Oncology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China
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9
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Abstract
Because of the heterogeneity in the definition of chemotherapy-induced amenorrhea (CIA) there are distinct differences in the literature with regard to its incidence as well as its dependence on various influencing factors. The occurrence of CIA varies greatly depending on the applied chemotherapy. The pathogenesis of CIA is especially based on a reduction of ovarian reserves. Various sonographic and biochemical factors can be used to exclude or confirm CIA. This is particularly important when an endocrine therapy with tamoxifen is not possible and the use of aromatase inhibitors is under consideration. CIA and especially the frequently thereby resulting early menopause can lead to pronounced restrictions in the quality of life of the affected patients, not least due to the resulting infertility. On the other hand, various studies have shown that CIA may have a positive prognostic significance. Thus, the identification of measures to prevent CIA (for example, through the use of GnRH analogues) is of particular importance.
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Affiliation(s)
- C Liedtke
- Gynecology and Obstetrics, Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Münster, Münster
| | - L Kiesel
- Gynecology and Obstetrics, Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Münster, Münster
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Chirgwin J, Sun Z, Smith I, Price KN, Thürlimann B, Ejlertsen B, Bonnefoi H, Regan MM, Goldhirsch A, Coates AS. The advantage of letrozole over tamoxifen in the BIG 1-98 trial is consistent in younger postmenopausal women and in those with chemotherapy-induced menopause. Breast Cancer Res Treat 2012; 131:295-306. [PMID: 21892704 PMCID: PMC4802157 DOI: 10.1007/s10549-011-1741-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 08/11/2011] [Indexed: 10/17/2022]
Abstract
Letrozole, an aromatase inhibitor, is ineffective in the presence of ovarian estrogen production. Two subpopulations of apparently postmenopausal women might derive reduced benefit from letrozole due to residual or returning ovarian activity: younger women (who have the potential for residual subclinical ovarian estrogen production), and those with chemotherapy-induced menopause who may experience return of ovarian function. In these situations tamoxifen may be preferable to an aromatase inhibitor. Among 4,922 patients allocated to the monotherapy arms (5 years of letrozole or tamoxifen) in the BIG 1-98 trial we identified two relevant subpopulations: patients with potential residual ovarian function, defined as having natural menopause, treated without adjuvant or neoadjuvant chemotherapy and age ≤ 55 years (n = 641); and those with chemotherapy-induced menopause (n = 105). Neither of the subpopulations examined showed treatment effects differing from the trial population as a whole (interaction P values are 0.23 and 0.62, respectively). Indeed, both among the 641 patients aged ≤ 55 years with natural menopause and no chemotherapy (HR 0.77 [0.51, 1.16]) and among the 105 patients with chemotherapy-induced menopause (HR 0.51 [0.19, 1.39]), the disease-free survival (DFS) point estimate favoring letrozole was marginally more beneficial than in the trial as a whole (HR 0.84 [0.74, 0.95]). Contrary to our initial concern, DFS results for young postmenopausal patients who did not receive chemotherapy and patients with chemotherapy-induced menopause parallel the letrozole benefit seen in the BIG 1-98 population as a whole. These data support the use of letrozole even in such patients.
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Affiliation(s)
- Jacquie Chirgwin
- Australian New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
- Box Hill and Maroondah Hospitals, Monash University, Melbourne, VIC, Australia
| | - Zhuoxin Sun
- International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ian Smith
- The Royal Marsden Hospital, Institute of Cancer Research, London, United Kingdom
| | - Karen N. Price
- International Breast Cancer Study Group Statistical Center, Frontier Science and Technology Research Foundation, Boston, MA, USA
| | - Beat Thürlimann
- Breast Center, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - Bent Ejlertsen
- Danish Breast Cancer Cooperative Group (DBCG), Rigshospitalet, Copenhagen, Denmark
| | - Hervé Bonnefoi
- Medical Oncology, Institut Bergonié, Université de Bordeaux, INSERM U916, FNCLCC (Unicancer), Bordeaux, France
| | - Meredith M. Regan
- International Breast Cancer Study Group (IBCSG) Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard School of Public Health and Harvard Medical School, Boston, MA, USA
| | - Aron Goldhirsch
- European Institute of Oncology, Milan, Italy
- Swiss Center for Breast Health, Sant’Anna Clinics, Lugano-Sorengo, Switzerland
| | - Alan S. Coates
- International Breast Cancer Study Group, University of Sydney School of Public Health, Sydney, NSW, Australia
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