Abstract
PurposeDocetaxel, a chemotherapeutic agent, induces high rates of transient chemotherapy-induced amenorrhea (CIA) when used as adjuvant chemotherapy for premenopausal women with breast cancer. Clinical laboratory data to assess the hormonal environment implicated in inducing transient CIA was assessed.MethodsAn observational study was conducted in 35 premenopausal women with hormone-responsive breast cancer who were receiving adjuvant docetaxel/cyclophosphamide (TC) chemotherapy. Serum estradiol and follicular stimulating hormone (FSH) levels were measured at one (n = 6) or two (n = 29) time point(s) around the completion of chemotherapy.ResultsAs early as week 6 after the start of chemotherapy, just before the third TC cycle, serum estradiol levels were invariably suppressed (median of 5.5 pg/ml, n = 15, range <5–18.7 pg/ml) and FSH levels increased (median of 63.9 mIU/ml, range 24.5–127.4 mIU/ml), indicative of ovarian suppression to the menopausal levels. Subsequently, at 9 and 12 weeks, serum estradiol levels were suppressed to a median of 6.6 pg/ml (n = 49, range <5–17.3 pg/ml), while FSH levels were high (median of 66.8 mIU/ml, range 29.2–134.5 mIU/ml). There was a significant Spearman’s correlation (ρ = 0.95, n = 29, p < 0.01) of high serum FSH levels (24.5–134.5 mIU/ml) between two time points of repeated measurements in 29 patients. TC chemotherapy induced rapid ovarian suppression with the formation of a high and stable plateau in serum FSH levels from week 6 to week 12.ConclusionsRecovery from transient CIA post-therapy may be partially attributed to high, stable FSH levels that occurred as early as after completion of the second TC chemotherapy cycle.
Highlights
Breast cancer is a heterogeneous disease for which optimal treatment must be tailored to a specific breast cancer type (Goldhirsch et al 2007; Nguyen et al 2008)
Serum estradiol levels decreased to below 18.7 pg/ml and follicular stimulating hormone (FSH) levels increased to a median of 63.9 mIU/ml (24.5– 127.4 mIU/ml) as early as week 6, after two cycles of chemotherapy
At week 9, serum estradiol levels decreased to a median of 6.6 pg/ml and serum FSH levels increased to a median of 66.8 mIU/ml
Summary
Breast cancer is a heterogeneous disease for which optimal treatment must be tailored to a specific breast cancer type (Goldhirsch et al 2007; Nguyen et al 2008). Docetaxel-containing chemotherapy, TC (docetaxel/cyclophosphamide), has been reported to be Chemotherapy-induced amenorrhea (CIA) varies in type and onset. At the 12-month assessment, after either first or secondgeneration chemotherapy, 41% of patients who were not amenorrheic at the 6-month assessment had CIA (Parulekar et al 2005). Docetaxel-containing chemotherapy caused amenorrhea at a relatively high rate soon after chemotherapy completion, but at the later periods, 12 and 36 months, the rate of CIA was relatively lower (Berliere et al 2008; Han et al 2009). Most (92%) premenopausal women treated with AC followed by docetaxel in the NSABP B-30 clinical trial were reported to become amenorrheic for a short period (
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