Post-chemotherapy serum anti-Müllerian hormone level predicts ovarian function recovery

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.

Anti-Müllerian Hormone and Ovarian Reserve: Update on Assessing Ovarian Function

“…Interestingly, in the slow recovery group, posttreatment AMH levels were lower compared with the fast recovery group ( 93 ). Indeed, lower posttreatment AMH levels also increased the risk of chemotherapy-induced POI ( 89 , 94 ). Although the predictive value of AMH appears independent of age, studies agree that women younger than age 40 years have higher posttreatment AMH levels ( 89 , 94 ).…”

“…Indeed, lower posttreatment AMH levels also increased the risk of chemotherapy-induced POI ( 89 , 94 ). Although the predictive value of AMH appears independent of age, studies agree that women younger than age 40 years have higher posttreatment AMH levels ( 89 , 94 ). Cancer survivors seems to have a similar AMH decline rate as control women despite having lower posttreatment AMH levels ( 95 ).…”

Clinical application of serum anti-Müllerian hormone in women

“…If the pretreatment AMH level is > 3.26 ng/mL, the AMH level 1 year after GnRH agonist therapy is expected to be at least 1 ng/mL regardless of age or pretreatment FSH level. Meanwhile, Kim et al [80] determined that the post-chemotherapy AMH level is an independent predictor of ovarian function recovery among breast cancer patients with amenorrhea after chemotherapy. An AMH level ≥ 0.8 ng/mL may reflect the recovery of menstruation for 5 years.…”

AMH as an ovarian function predictor in premenopausal female breast cancer patients receiving chemotherapy is effective only for those over 35 years old

“…While the recovery of menstruation one year after chemotherapy was correlated with pre-and post-chemo AMH level positively, but not correlated with pre-chemo levels of E2 and FSH. That means patients with higher AMH levels are less likely to have amenorrhea and more likely to return to normal even after chemotherapy, whereas patients with lower AMH levels are more likely to have amenorrhea and less likely to recover after amenorrhea [27]. Although pre-chemo E2 and FSH levels were correlated with amenorrhea, we did not find a correlation between them and menstrual recovery after chemotherapy, which was in line with expectations: the levels of E2 and FSH fluctuated greatly with the physiological cycle, while the levels of AMH were relatively stable [5].…”