Incidence of chemotherapy-induced amenorrhea after adjuvant chemotherapy with taxane and anthracyclines in young patients with breast cancer

Chemotherapy-induced amenorrhea is one of long term side effects of adjuvant chemotherapy in patients with breast cancer which may interfere with their future reproductive function. Although amenorrhea is well recognized, the actual incidence following taxanes remains uncertain. In a cross sectional study, we identified breast cancer patients aged 45 years or younger who were treated with adjuvant anthracycline and taxane-based regimens at three different oncology departments from 2001-2008. One hundred and nineteen patients met all eligibility criteria and consented to participate in a regular follow up program. The median age at diagnosis was 33.5 years [range, 25-41]. Seventy [58%] patients developed amenorrhea for at least 12 months following completion of treatment, and regular menses were maintained in another 49 [42%] patients. No statistically significant association was found between age and development of amenorrhea, although those who experienced cessation of menses were older. Although taxane containing chemotherapy was associated with higher rate of amenorrhea compared to FAC, this was not statistically significant [P=0.11]. Also, treatment with tamoxifen and Estrogen Receptor [ER] positive status was significantly correlated with chemotherapy induced amenorrhea

Current regimen of pulse therapy for pemphigus: minor modifications, improved results.

BACKGROUND: If administered properly, dexamethasone cyclophosphamide pulse (DCP) therapy has the potential to effect lifelong recovery from pemphigus. AIMS: The objective of this paper is to highlight various parameters of DCP therapy and also, to report the effects of a few modifications in the regimen. METHODS: An analysis of 123 patients treated with the DCP/DP regimen over a period of five years (1998 to 2002) is presented here. Seventeen patients who did not start/continue the treatment and three patients who died during the treatment have been excluded from the analysis. Twenty patients who had not yet started families were given only dexamethasone pulses (DPs) while 103 patients received DCPs. Low dose (50 mg/day) cyclophosphamide was used as in the standard regimen. The three modifications introduced into the regimen were: (1) an additional daily dose of oral betamethasone sufficient to control the disease activity during phase I, which was progressively tapered off completely as the patient recovered, (2) use of systemic antibiotics if the patient had skin lesions, and oral anti-candida drugs if the patient had oral ulcers until complete healing, and (3) insistence on thorough cleaning of the skin and scalp with a normal soap and shampoo, and proper maintenance of oral hygiene in spite of skin/mucosal lesions. The regimen consisted of DCP/DP repeated in exactly 28-day cycles, along with 50 mg cyclophosphamide per day, insistence on completing the treatment and avoiding irregular pulses in all patients. The number of DCPs/DPs during phase I varied in different patients depending upon the dose of betamethasone used and the rate of recovery, but phase II (nine DCPs/DPs in exactly 28-day cycles along with 50 mg cyclophosphamide per day) and phase III (only 50 mg cyclophosphamide per day) was fixed at nine months each. This was followed by posttreatment follow-up (phase IV). RESULTS: At present, all the patients are in complete remission. The confirmed period of posttreatment, disease-free follow-up period has already been more than five years in 62 patients, 3-5 years in 41 patients, 2-3 years in three patients and less than two years in six patients. Eight DCP patients and three DP patients developed a relapse (the relapse rates thus being 7.7 and 15% respectively) and received a second course of pulse therapy. They are also in remission at present. The duration of phase I was three months in 62 patients, 4-5 months in 28 patients, 6-9 months in 13, 10-12 months in nine patients and more than 12 months in 11 patients. The maximum daily dose of betamethasone used in these patients was nil in 17 patients, 1-2 mg in 85, 3-4 mg in 16, and> 4 mg in five patients. CONCLUSIONS: The modifications employed in this study could ensure the cure of all pemphigus patients by using DCP therapy administered at a private clinic.

Relationship between progesterone receptor level in endometrium and bleeding pattern in depot medroxyprogesterone acetate users.

Bleeding disturbance is the major reason for discontinuation among depot medroxyprogesterone acetate (DMPA) users. However, the causes of progestin-induced bleeding are not well understood. The aim of the study was to examine the correlation between the occurrence of uterine bleeding and progesterone receptor (PR) levels in the endometrium. Forty-five matched pairs of age and body mass index in DMPA users with bleeding and amenorrhea were studied. The endometrial PR levels were evaluated. The PR score was assessed semi-quantitatively. Forty-two subject pairs met the criteria. There was no difference in serum estradiol and progesterone levels between the groups. No correlation between the number of bleeding days and PR score nor between the number of bleeding days and serum estradiol and progesterone level was detected. The stromal PR score in DMPA subjects with amenorrhea was significantly higher than those with bleeding (p < 0.05). By contrast, the PR score in glandular endometrium was not significantly different between the groups (p > 0.05). In conclusion, after a second dose of DMPA, subjects with amenorrhea had a higher stromal PR score than those with uterine bleeding.

Hormonoterapia de reemplazo con dos esquemas de terapia combinada continua / Estrogen replacement therapy with 2 combined continued therapy schedules

El propósito del estudio fue evaluar los patrones de sangrado con dos regímenes de TCC con diferentes dosis de progestina. En un estudio prospectivo, randomizado, de doce meses de duración analizamos 78 mujeres climatéricas (con amenorrea >6 meses, test de progesterona negativo y grosor endometrial igual o menor que 6 mm). Las pacientes fueron divididas en dos grupos: grupo A (n= 41) que recibió diariamente 2 mg de estradiol (E2) oral más 2,5 mg de medroxiprogesterona acetato (MPA) y el grupo B (n= 37) 2 mg de estradiol (E2) más 5 mg de MPA. En ambos grupos el número de mujeres en amenorrea aumentó progresivamente en los trimestres sucesivos de tratamiento. En el grupo A el porcentaje aumentó de un 26,9 por ciento en el primer trimestre a un 60,9 por ciento en el cuarto (p< 0,05) y en el grupo B de un 21,6 por ciento a un 73 por ciento (p< 0,001), respectivamente. El grupo B alcanzó un porcentaje de amenorrea más significativo.El análisis combinado de ambos grupos mostró un significativo descenso en el promedio de días con sangrado o con goteo en los trimestres sucesivos: de 10.05 (0-62) días en el primer trimestre a 4,34 (0-42) días en el cuarto (p< 0,01). El grosor endometrial no experimentó cambios significativos en ninguno de ambos grupos. Los patrones de sangrado individuales no mostraron correlación con la edad, peso, grosor endometrial, ni con los meses transcurridos desde la menopausia (NS). Ambos regímenes ensayados indujeron amenorrea progresiva, la que fue significativamente mayor en el grupo B, que recibió la dosis más alta de MPA

Efectos sobre la sintomatología climatérica, pérfil lipídico y patrones mamográficos / Effects on climacteric sintomatology, lipid profile and mammography patterns

Se compara dos esquemas de HTR-CC por vía oral con el objeto de evaluar su eficacia clínica, modificaciones del pérfil lipídico y de los patrones mamográficos. Estudio prospectivo, doble ciego de 12 meses de duración en mujeres con sintomatología climatérica, amenorrea mayor que 6 meses y prueba de progesterona negativa. Se evalúa 78 mujeres que completaron el estudio, divididas en dos grupos: grupo A (n= 41) que recibió diariamente 2 mg de estradiol (E2) oral más 2,5 mg de medroxiprogesterona acetato (MPA) y el grupo B: 2 mg de estradiol (E2) más 5 mg de MPA. Ambos grupos terapéuticos demostraron similar eficacia en la disminución de los síntomas vasomotores (SVM) con una reducción del 92 por ciento y del 93 por ciento, respectivamente (p< 0,001); de los síntomas urogenitales: 84 por ciento en ambos grupos (p< 0,01) y de los síntomas funcionales: 75 por ciento en ambos grupos (p< 0,01). El colesterol total disminuyó 12,04 por ciento en el grupo A (p< 0,001) y 7,06 por ciento en el B (p< 0,05), siendo su descenso más significativo en el grupo A, con menor dosis de MPA. El HDL-colesterol aumentó significativamente en ambos grupos, en forma marcada en el grupo A: 12,3 por ciento (p< 0,001) que en el B: 8,5 por ciento (p< 0,05). Los niveles de triglicéridos no experimentaron cambios significativos. Al ingreso un 37,2 por ciento de las mujeres, en forma global, tenía elevado el índice de riesgo cardiovascular (> 5), el número de mujeres con factor de riesgo disminuyó al 7,7 por ciento después de los doce meses de terapia. Un 56 por ciento en el grupo A y un 40,6 por ciento en el grupo B presentaron un leve a moderado aumento de la densidad mamaria, las restantes mujeres no experimentaron modificaciones de sus patrones mamográficos. Ambos esquemas demostraron similar eficacia en el control de la sintomatología climatérica, independientemente de la dosis de MPA empleada. El agregado de MPA continua, no contrarrestó los efectos beneficiosos del E2 sobre el colesterol total y el HDL-colesterol, si bien los resultados fueron mejores al utilizar la dosis más baja de 2,5 mg

Further study on the effect of norethisterone enanthate, an injectable contraceptive on body functions.

One hundred and fortythree healthy Bengali women have received norethisterone enanthate, as injectable contraceptive in doses of 200 mg. intramuscularly at intervals of 10 to 12 weeks. The drug have been found to be almost 100 percent effective in the control of fertility. Menstrual disturbance, e.g. amenorrhoea, irregular bleeding and spotting, appeared to be the main complaints of the clients during the initial period of the therapy; but these did not persist long. There was no ill effect of the drug on lactation. No significant change in body weight, blood pressure, platelet count, fasting blood sugar, serum cholesterol and total plasma protein level was observed following administration of norethisterone enanthate over one year.