Incidence and Predictive Factors for Recovery of Ovarian Function in Amenorrheic Women in Their 40s Treated With Letrozole

Krekow, Lea; Hellerstedt, Beth A.; Collea, Rufus; Papish, Steven W.; Diggikar, Shrinivas M.; Resta, Regina; Vukelja, Svetislava J.; Holmes, Frankie A.; Reddy, P. Madhusudhana; Asmar, Lina; Wang, Yunfei; Fox, Patricia S.; Peck, Susan; O’Shaughnessy, Joyce

doi:10.1200/jco.2015.62.2985

Cited by 24 publications

(16 citation statements)

References 31 publications

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“…Prediction of POI is well established to be dependent on age [6] , [7] , [13] but the value of biochemical markers has been unclear [28] . Thus, in a recent analysis, women showing ovarian recovery did not show differential FSH concentrations [29] . We have previously suggested that high-sensitivity AMH assays may be of value in this situation [22] .…”

Section: Discussionmentioning

confidence: 81%

The utility of anti-Müllerian hormone in the diagnosis and prediction of loss of ovarian function following chemotherapy for early breast cancer

Anderson

Mansi

Coleman

et al. 2017

European Journal of Cancer

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AimChemotherapy results in permanent loss of ovarian function in some premenopausal women. Accurate identification in women with hormone-sensitive early breast cancer (eBC) would allow optimisation of subsequent endocrine treatment. We sought to assess whether analysis of anti-Müllerian hormone (AMH) using a sensitive automated assay could identify women who would not regain ovarian function after chemotherapy.MethodsData from women in the Ovarian Protection Trial in Premenopausal Breast Cancer Patients (OPTION) trial of goserelin (a gonadotrophin-releasing hormone (GnRH) analogue) for ovarian protection were analysed. Women were assessed for premature ovarian insufficiency (POI: amenorrhoea with elevated follicle-stimulating hormone (FSH)) at 24 months after diagnosis. The accuracy of AMH for the diagnosis of POI and its prediction from measurement at the end of chemotherapy was calculated.ResultsAMH below the level of detection showed good diagnostic accuracy for POI at 24 months (n = 73) with receiver operating characteristic (ROC) area under the curve of 0.86, sensitivity 1.0 and specificity 0.73 at the assay limit of detection. In women aged >40 at diagnosis who did not receive goserelin, AMH measured at end of chemotherapy also gave good prediction of POI at 24 months (area under the curve (AUC) 0.89 95% CI 0.75–1.0, n = 32), with sensitivity 0.91, specificity 0.82, diagnostic odds ratio (DOR) 42.8. FSH gave slightly lower AUC, and specificity was low at 0.55. Age but not tamoxifen impacted on AMH levels.ConclusionUsing this sensitive AMH assay, the finding of an undetectable AMH level in women aged >40 at the end of chemotherapy for eBC gave a good prediction that ovarian function would not return. This may allow alterations in post-chemotherapy endocrine management.

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Section: Discussionmentioning

confidence: 81%

The utility of anti-Müllerian hormone in the diagnosis and prediction of loss of ovarian function following chemotherapy for early breast cancer

Anderson

Mansi

Coleman

et al. 2017

European Journal of Cancer

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“…V recentně publikované práci bylo pozorováno obnovení ovariální funkce v souboru 177 nemocných u 39 % z nich. Sérová hladina FSH s obnovením ovariální funkce nekorelovala, jejím signifikantním prediktorem byl pouze věk < 45 let a inhibin B [26]. Podobně v prospektivní studii, ve které byly pa cientky s CIA po nejméně dvou letech podání tamoxifenu léčeny exemestanem za monitorace hormonálních hladin, byla incidence obnovení ovariální funkce 32 %, medián doby do OFR byl 5,4 měsíce (95% CI 1,2-9,6) a jediným signifikantním prediktorem byl průměrný věk při zahájení léčby exemestanem < 48 let.…”

Section: Vazomotorické Příznakyunclassified

“…U žen s nejasným menopauzálním stavem je bezpečnou léčbou tamoxifen. Indukce zbytkové ovariální funkce (ovarian function recovery -OFR) inhibitorem aromatázy byla opakovaně popsána různými autory [18,26,27]. Chemoterapií indukovaná amenorea (chemotherapy--induced amenorrhea -CIA) nemusí být 3S43 čiva.…”

Section: Rizika Při Léčbě Pa Cientek Mladších 50 Letunclassified

Treatment with Aromatase Inhibitors in Postmenopausal Women with Breast Cancer and the Possibility of Influencing Side Effects

Krásenská¹

2016

Klin Onkol

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Many side effects of aromatase inhibitors are related to estrogen deprivation. On the other hand as aromatase inhibitors lack estrogenic activity, they are not associated with serious adverse events typical for tamoxifen, such as endometrial cancer and thromboembolic disease. Aromatase inhibitors therapy is often associated with vasomotor symptoms (hot flashes), vaginal dryness, dyspareunia, bone loss, arthralgias and myalgias (musculoskeletal symptoms). Management of these side effects can lead to improved adherence and persistence with therapy.Key words: breast cancer - menopause - aromatase inhibitors - ovarian function recovery - adverse effectsThis work was supported by Czech Ministry of Health - RVO (MOÚ, 00209805).The author declares she has no potential conflicts of interest concerning drugs, products, or services used in the study.The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 10. 7. 2016Accepted: 3. 8. 2016.

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“…Other markers, including FSH, anti-Mullerian hormone (AMH), and inhibin, may provide additional information on ovarian status in female cancer survivors with prior chemotherapy or those on tamoxifen, but alone are not reliable to ensure menopausal status. 19,20 …”

Section: Menopausementioning

confidence: 99%

Survivorship, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology

Denlinger¹,

Sanft²,

Baker³

et al. 2017

J Natl Compr Canc Netw

102

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Many cancer survivors experience menopausal symptoms, including female survivors taking aromatase inhibitors or with a history of oophorectomy or chemotherapy, and male survivors who received or are receiving androgen-ablative therapies. Sexual dysfunction is also common in cancer survivors. Sexual dysfunction and menopause-related symptoms can increase distress and have a significant negative impact on quality of life. This portion of the NCCN Guidelines for Survivorship provide recommendations for screening, evaluation, and treatment of sexual dysfunction and menopausal symptoms to help healthcare professionals who work with survivors of adult-onset cancer in the posttreatment period.

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Incidence and Predictive Factors for Recovery of Ovarian Function in Amenorrheic Women in Their 40s Treated With Letrozole

Abstract: These results emphasize the challenge in determining definitive menopause in women with chemotherapy-induced amenorrhea. The risk of OFR during treatment with AIs in amenorrheic women in their 40s is high, and AI therapy should be avoided in these patients.

Cited by 24 publications

References 31 publications

The utility of anti-Müllerian hormone in the diagnosis and prediction of loss of ovarian function following chemotherapy for early breast cancer

The utility of anti-Müllerian hormone in the diagnosis and prediction of loss of ovarian function following chemotherapy for early breast cancer

Treatment with Aromatase Inhibitors in Postmenopausal Women with Breast Cancer and the Possibility of Influencing Side Effects

Survivorship, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology

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