Determinants of recovery from amenorrhea in premenopausal breast cancer patients receiving adjuvant chemotherapy in the taxane era

Abstract

631 Background: Chemotherapy (CT)-induced amenorrhea occurs in about 20–70% of premenopausal breast cancer (BC) patients (pts) and its incidence could depend on several factors. Iatrogenic amenorrhea can affect choice of hormone therapy (tamoxifen vs aromatase inhibitors), fertility, and quality of life of BC survivors. A benefit from the ovarian failure in hormone receptor positive BC pts is estimated since the estrogen production is suppressed. Methods: We retrospectively analyzed the incidence of amenorrhea after adjuvant CT and the subsequent recovery of the menses in 145 BC pts. Age, smoke, BMI, number of CT courses, CT regimen, number of childbearing were analyzed as potential predictive factors of ovarian function recovery. Results: Mean age was 43 years (range 23–58) at the beginning of adjuvant CT with a 30% of pts younger than 40 years. The mean value of BMI was 24.6 even though a 34% of pts presented with BMI>25. The majority (87.6%) of pts received an anthracycline-based CT, 35.2% of pts received a CMF regimen and 42.8% a taxane. In 77% of cases, pts had endocrine-responsive disease and the most used adjuvant hormone treatment after CT was tamoxifen (64% versus 11% of aromatase inhibitors). The incidence of CT-induced amenorrhea was 84% and 32% of these pts resumed menses after a mean of 9.5 months. Younger age (< 40 years) and taxane-based CT were associated with increased probability of recovery of menses after CT-induced amenorrhea (p=0.005 and p= 0.02, respectively). On the contrary CMF-based CT was associated with an increased probability of permanent amenorrhea (p=0.06). Multivariate analysis confirmed that younger age is associated with higher chance of ovarian function recovery after CT-induced amenorrhea (HR= 4.2, p= <0.0001). Moreover, childbearing (HR=0.4, p= 0.01) and smoke (HR=0.9, p=0.06) were associated with reduced probability of menses recovery. Conclusions: Recovery of menses after CT-induced amenorrhea occurs more probably in younger women with no pregnancies. Physicians should consider the risk of ovarian function recovery in these patients, especially when prescribing aromatase inhibitors. No significant financial relationships to disclose.