Abstract
PurposeTo assess the incidence of chemotherapy-induced ovarian function failure (COFF) based on estradiol and follicle stimulating hormone (FSH) monitoring in premenopausal women with hormone-receptor positive breast cancer treated with second and third generation (neo-)adjuvant chemotherapy.ResultsWe identified 115 eligible women. Two years after start of chemotherapy, COFF was significantly more often present in women ≥ 40 years (85.6%) as compared to women < 40 years (8.7%). Only age was significantly associated with COFF two years after start of chemotherapy (HR 12.26; 95% CI 5.21–28.86). In 50% of the patients, premenopausal hormone levels were the first or only evidence of ovarian function recovery (OFR).Materials and MethodsWe included all premenopausal women with hormone-receptor positive breast cancer treated with anthracycline-based chemotherapy, with or without taxanes, in our university hospital in the Netherlands in the years 2005-2013. Patients were 3-monthly monitored for ovarian function. Cox proportional hazards model was used to determine the predictive impact of various parameters on the occurrence of COFF.ConclusionsAfter second- or third generation (neo-)adjuvant chemotherapy, COFF was still present in 8.7% of patients < 40 years after two years. FSH and estradiol monitoring may be relevant for those in whom ovarian function suppression is considered an additional effective endocrine treatment.
Highlights
30% of women diagnosed with breast cancer is premenopausal [1]
Age was significantly associated with chemotherapy-induced ovarian function failure (COFF) two years after start of chemotherapy (HR 12.26; 95% CI 5.21–28.86)
After second- or third generationadjuvant chemotherapy, COFF was still present in 8.7% of patients < 40 years after two years
Summary
30% of women diagnosed with breast cancer is premenopausal [1]. In the presence of prognostic unfavorable factors, (neo-)adjuvant systemic therapy is recommended in order to improve breast cancer survival. Systemic therapy may cause amenorrhea and premature menopause. The only clear predictor of chemotherapyinduced amenorrhea described in literature, is age [2, 3, 4, 5]. Older pre- and perimenopausal women (≥ 40 years) have greater odds to experience chemotherapyinduced amenorrhea than younger women Older (≥ 40 years) premenopausal women have a lower chance on ovarian function recovery (OFR) during follow-up than younger women (33% versus 68%, respectively) [2, 3, 4, 5]
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