Anti-Mullerian hormone (AMH) and ovarian function in young breast cancer (BC) women receiving adjuvant chemoterapy (CT)

Abstract

e11544 Background: Fertility loss is a main side effect of adjuvant CT in young women with BC. AMH was evaluated as a potential marker of residual ovarian function after CT. Method: AMH (ng/mL), FSH (mIU/mL), E2 (pg/mL) and menstrual activity were evaluated before CT and every 3 months after CT in pre-menopausal BC patients ( pts ) enrolled in a phase III study evaluating the role of triptorelin in the prevention of CT-induced early menopause. Means were compared with Student t test for paired data, anova or ancova. The effect of age, CT regimen, FSH and AMH on time to menstrual resumption was investigated by means of the Cox's proportional hazards model. Results: Among 26 evaluable pts at baseline, mean age was 39 years (range 27-45). Baseline mean values were: FSH 5.67 (SD 4.88), E2 151.81 (SD 134.9), AMH 2.67 (SD 1.85). Levels of AMH were significantly lower (1.26) in old pts ( ≥ 41 yrs) as compared to younger ones (2.97 and 3.63 in 25–36 yrs and 37–40 yrs old women, respectively) (p=0.018). After CT, mean value of AMH significantly decreased from 2.04 ( SD 1.44 ) to 0.59 ( SD 0.59 ) (p=0.0003 ); FSH value increased, from of 8.64 (SD 12.99) to 23.13 (SD 25.80) (p=0.017) and E2 values decreased from 159.71 (SD 147.03) to 73.29 (SD 129.53) (p=0.02). The mean decrease of AMH levels was not affected by the type of CT regimens: -1.50, -1.52 and -1.33 after FEC ⋄ Paclitaxel, FEC ⋄ Taxotere and FEC/CMF, respectively (p=0.97). Among 10 pts with both early (0–5 months) and delayed (6–11 months) post-CT evaluations, no change in AMH values was observed with longer follow up: mean values were 1.49, 0.35 and 0.36, at baseline, after 0–5 months and after 6–11 months, respectively. Menstrual activity resumption occurred in 48% of patients. At multivariate analysis factors significantly associated with the lower probability of menstrual activity resumption after CT were: old age (p=0.05) and chemotherapy with FEC ⋄ docetaxel ( p=0.05 ). In this preliminary analysis baseline and after CT values of AMH were not significantly associated with menstrual resumption. Conclusions: Adjuvant CT significantly affects the levels of AMH in young women with BC. Further studies are needed to assess the role of AMH as a surrogate of ovarian toxicity induced by CT. No significant financial relationships to disclose.