Reduction of ovarian reserve in young early breast cancer patients: First data of a prospective cohort trial.

Abstract

1084 Background: Breast cancer is the most common malignancy in premenopausal women. Sideeffects of chemotherapy are well known nevertheless the precise effects on ovarian function are inadequately studied by now. Premenopausal women undergoing chemotherapy are at risk for symptoms of sexual hormone deficiency and impaired fertility. Searching for predictive parameters of ovarian reserve after chemotherapy this prospective cohort study has been set up. Methods: 36 young patients with primary breast cancer have been included in this trial after written consent (April 2010 to November 2011) and after the study was approved by the local review board. All women were premenopausal (< 46 years). They all received anthracycline based “A” neo- or adjuvant chemotherapy (as FEC) or combinations with taxanes “T” ( as TAC or FEC/Doc). Before and 6 and 12 months after initiation of chemotherapy age and chemotherapy related changes in hormone (LH, FSH, E2 and Anti-Müllerian hormone) levels, antral follicel count and amenorrhea as parameters of endocrine function and fertility were assessed.The additional impact of parity, BMI and nicotine use on ovarian reserve was also evaluated. Results: There is a correlation of antral follicle count before and 1 year after chemotherapy and a negative correlation of age and follicle count before and after chemotherapy (n.s.). This analysis shows that patients receiving “T” compared to those with “A” have a significant increase of LH (p=0.025) and FSH (mean:24 vs.59 IU/l, p=0.021) between visit 1 and 3. The type of chemotherapy has no influence on antral follicle count and AMH levels within the first 3 visits. BMI is negatively correlated with AMH at all time points (n.s.). BMI, nicotine abuse and age have no influence on the duration of amenorrhea, whereas patients with "T" showed 12 months of amenorrhea instead of 9 months in patients with "A" (n.s.). Conclusions: Our study will contribute to a better understanding and prediction of ovarian reserve of young early breast cancer patients undergoing chemotherapy. The 12 months follow up data suggest to offer fertility preserving measures before chemotherapy especially to patients planned for taxane containing chemotherapy.