Anti-Müllerian hormone as a new marker of the individualized ovarian function suppression treatment in the young breast cancer patients / 中国癌症杂志

Background and purpose:The young breast cancer patients were treated with goserelin without individualized regimen, and lack of available clinical marker. The aim of this study was to investigate the role of anti-Müllerian hormone (AMH) in evaluation of individualized treatment of ovarian function suppression in the young breast cancer patients.Methods:Forty-one young patients with estrogen receptor (ER) and progesterone receptor (PR) positive breast cancer from May 2012 to Jan. 2014 were randomly divided into 2 groups to undergo radical resection of breast cancer. According to postoperative treatment, one group was treated with goserelin + chemotherapy (n=20), and the other group received chemotherapy alone (n=21). Thirty female patients in the same age group were selected as normal control group. The time of menopause and menstrual recovery after the goserelin + chemotherapy or chemotherapy alone were observed in 2 groups. In early follicular phase (day 3-5) of the cycle preceding the operation and 3, 6 courses after the goserelin + chemotherapy treatment or chemotherapy treatment, serum levels of AMH, FSH and E2 were measured in 2 groups. Accordingly, serum levels of AMH, FSH and E2 were evaluated as well in normal control group.Results:There were no signiifcant differences in preoperative general conditions and preoperative serum FSH and E2 levels among the 3 groups (P>0.05). Compared with normal control group, the preoperative serum AMH levels of young breast cancer patients were decreased signiifcantly (P=0.04). The menopause time and menstrual recovery time in 2 chemotherapy groups were signiifcantly shorter than that in normal control group (P=0.00). Compared with normal control group and preoperative measurement, the differences in serum FSH and E2 levels were not statistically significant in goserelin + chemotherapy group or chemotherapy alone group (P<0.05). The serum AMH levels measured at different time points of the goserelin + chemotherapy group and chemotherapy alone group were decreased signiifcantly (P<0.05). Compared with the chemotherapy group, the serum AMH levels of the goserelin + chemotherapy group after 6 courses were signiifcantly decreased, and then signiifcantly increased 6 months after menstrual recovery (P<0.05).Conclusion:This study demonstrated that the serum AMH levels were obviously decreased after the ovarian function suppression treatment and increased after the menstrual recovery compared with evaluation of other ovarian reserve index. The serum AMH level could suggest ovarian reserve damage even after ovarian function has recovered to the noticeable level. Thus, AMH could be used clinically to evaluate the ovarian reserve of breast cancer patients as a potential marker for the individualized ovarian function suppression treatment in young breast cancer patients.

Recovery of Ovarian Function with Aromatase Inhibitors: In Young Breast Cancer Patients (<45) with Chemotherapy-induced Amenorrhea / 한국유방암학회지

PURPOSE: The role and safety of aromatase inhibitors (AIs) in young breast cancer patients with chemotherapy-induced amenorrhea (CIA) has not been established. The goal of this study was to investigate the safety and efficacy of AIs in young breast cancer patients with CIA. METHODS: From December 2000 to December 2006, 58 patients with hormone receptor positive breast cancer under the age of 45 were treated with AIs as adjuvant therapy. All patients had amenorrhea for more than three consecutive months at the time of treatment. We evaluated the rates of recovery of ovarian function during the treatment, and analyzed the association of the recovery of ovarian function with age, body mass index (BMI), chemotherapy regimen, radiation therapy, and the use of tamoxifen. RESULTS: Recovery of ovarian function was observed in 16 patients (27.6%). The univariate analysis showed that ovarian function was more frequently recovered in patients younger than 40 yr of age, treated with chemotherapy regimens other than Cyclophosphamide, Methotrexate, 5-Flurouracil (CMF), without a history of tamoxifen therapy, and with a higher BMI. The multivariate analysis confirmed that the type of chemotherapy (p=0.034) and the history of tamoxifen therapy (p=0.043) were independent factors significantly associated with the restoration of ovarian function. CONCLUSION: The results of this study suggest that AIs should be considered, with caution in young women with CIA; these agents may promote the unwanted recovery of ovarian function. Especially, in those patients who were not treated with CMF chemotherapy or tamoxifen, where the rates of recovery of ovarian function were higher.

Experience of Ovarian Function Suppression Therapy: Endocrine Response Preand Perimenopausal Korean Breast Cancer Patients in the Adjuvant Setting / 한국유방암학회지

PURPOSE: Published Early Breast Cancer Trialists' Collaborative Group overview results have been the beneficial effects of tamoxifen and ovarian ablation for pre and perimenopausal women with node negative breast cancer. Chemotherapy and Luteinizing Hormone Releasing Hormone (LHRH) agonists (medical ovarian ablation) have been shown to be effective adjuvant therapies for early stage breast cancer in several clinical trials however, the efficacy and tolerance of LHRH agonists in Korean breast cancer patients has not been evaluated. METHODS: Three thousand one hundred fifty breast cancer patients were treated at Asan Medical Center between January 2003 and December 2005. We selected 185 patients with node negative early breast cancer who were endocrine responsive (more than intermediate intensity), with a tumor size more than 1 cm, and who were reluctant to undergo chemotherapy due to the side effects. They received LHRH agonists (Zoladex(R) 3.6 mg) every 28 days with tamoxifen for two years. We prospectively evaluated mammography, chest PA, and physical examination every six months and evaluated the side effects and quality of life. RESULTS: The mean age was 43.5 yr, and the mean tumor size was 1.62 cm. One hundred sixty-two patients had Stage I, and 23 Stage II disease. The incidence of severe menopausal symptoms was 24.1%, but these symptoms were reported to be "tolerable" during the two year follow-up. Quality of life and physical activity were essentially unchanged. The median follow-up duration was 18 months, and there was no local recurrence or distant metastases during the study. CONCLUSION: Adjuvant therapy with LHRH agonists is safe and tolerable, and may be an alternative to chemotherapy for pre-and perimenopausal women with hormone responsive early breast cancer who are reluctant to undergo chemotherpy.