Abstract
Background: It is important to identify factors predicting successful ovarian protection using gonadotropin-releasing hormone (GnRH) agonists during chemotherapy. However, only a few studies have prospectively assessed this issue in young breast cancer patients.Objective: This study evaluated the predictive factors for successful ovarian protection with GnRH agonists during chemotherapy in young estrogen receptor-negative breast cancer patients.Materials and Methods: This prospective study analyzed 67 estrogen receptor-negative breast cancer patients ≤40 years of age who were longitudinally assessed after receiving GnRH agonists during cyclophosphamide-based chemotherapy for ovarian protection. Associations between clinical characteristics or pretreatment hormones and successful ovarian protection [resumption of menstruation and anti-Müllerian hormone (AMH) ≥1 ng/ml].Results: The mean age and pretreatment serum level of AMH were 33.2 years and 4.57 ng/ml, respectively. At 12 months after the completion of chemotherapy, most women (97%) experienced the resumption of menstruation. However, the proportion of patients with AMH ≥1 ng/ml at 12 months was 70.1%. In multivariate analyses, only the pretreatment serum AMH level (P < 0.001) was predictive for AMH ≥1 ng/ml at 12 months. Receiver operating characteristic curve analyses of pretreatment AMH exhibited an area under the curve of 0.866 (95% CI = 0.777–0.955) for AMH ≥1 ng/ml at 12 months. The cutoff value for the prediction of AMH concentration ≥1 ng/ml at 12 months was 2.87 ng/ml of pretreatment AMH with a sensitivity of 0.87 and a specificity of 0.75.Conclusions: Pretreatment AMH (2.87 ng/ml) is a useful predictor for AMH ≥1 ng/ml at 12 months after receiving GnRH agonists in young estrogen receptor-negative breast cancer patients. This finding can help improve decision-making regarding fertility preservation.
Highlights
Breast cancer is a commonly diagnosed malignancy in young premenopausal women
Accumulated evidence supports the efficacy of ovarian protection using gonadotropinreleasing hormone (GnRH) agonists during chemotherapy to prevent chemotherapy-related amenorrhea or early menopause and to preserve fertility for future pregnancies [8,9,10,11,12]
This prospective study included all women with estrogen receptor-negative breast cancer stages I–III who were ≤40 years old and received GnRH agonists for ovarian protection during chemotherapy at Young Breast Cancer Clinic at the Samsung Medical Center in Seoul, Korea, from January 2013 to December 2017
Summary
Considering its more aggressive nature [3], chemotherapy is often required in young breast cancer patients. It is well-known that alkylating agents have a high risk of gonadotoxicity and may result in long-term sequelae such as early menopause [4]. Cryopreservation is the only established and standard method for fertility preservation in young women with breast cancer [6, 7]. Accumulated evidence supports the efficacy of ovarian protection using gonadotropinreleasing hormone (GnRH) agonists during chemotherapy to prevent chemotherapy-related amenorrhea or early menopause and to preserve fertility for future pregnancies [8,9,10,11,12]. Only a few studies have prospectively assessed this issue in young breast cancer patients
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