A pilot study of predictive markers of chemotherapy-related amenorrhea among premenopausal women with early stage breast cancer.
BACKGROUND
Premenopausal women treated for early stage breast cancer (ESBC) are at risk for chemotherapy-related amenorrhea (CRA). Prospectively-validated, predictive markers of CRA are needed.


METHODS
Premenopausal women with ESBC and planned chemotherapy (>/= 25% risk of amenorrhea) were evaluated. Follicle stimulating hormone (FSH), estradiol, Inhibin A and B, anti-Müllerian hormone (AMH), and quality of life (QOL) were prospectively evaluated pre-, post-, 6 months and 1 year post-chemotherapy and correlated with age and menstrual status. CRA was defined as absence of menses 1 year post-chemotherapy.


RESULTS
Forty-four women were evaluated at the time of analysis. Median age at diagnosis and FSH 1 year post-chemotherapy were higher among women with CRA (44 yrs [33-51] vs. 40 yrs [31-43]; p = 0.03; 39.8 vs. 5.0 mLU/mL, p = 0.0058, respectively). Median estradiol 1 year post-chemotherapy was higher among women who resumed menses (108.3 vs. 41.3 pg/mL, p = 0.01). Pre-chemotherapy median Inhibin B and AMH were lower among women with CRA (33.2 vs. 108.8 pg/mL; p = 0.03; 0.16 vs. 1.09 ng/mL, p = 0.02, respectively). The risk of CRA was increased among women with lower pre-chemotherapy Inhibin B (RR = 1.67, p = 0.15) and AMH (RR = 1.83, p = 0.05). Amongst women whose pre-chemotherapy Inhibin B and AMH values were below the median, the incidence of CRA was 87.5%.


CONCLUSIONS
RESULTS indicate that pre-chemotherapy Inhibin B and AMH are lower among women experiencing CRA and may be predictive of CRA among premenopausal women facing chemotherapy for ESBC.
Anders
Carey
C
Division of Medical Oncology, Duke University Department of Medicine, Durham, North Carolina, USA. ander118@mc.duke.edu
Marcom
P Kelly
PK
Peterson
Bercedis
B
Gu
Lin
L
Unruhe
Sue
S
Welch
Renee
R
Lyons
Peggy
P
Behera
Millie
M
Copland
Susannah
S
Kimmick
Gretchen
G
Shaw
Heather
H
Snyder
Stacey
S
Antenos
Monica
M
Woodruff
Teresa
T
Blackwell
Kimberly
K
D000328:Adult; D000367:Age Factors; D000568:Amenorrhea / Q000139:chemically induced*; D054304:Anti-Mullerian Hormone / Q000097:blood; D000970:Antineoplastic Agents / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood*; D001943:Breast Neoplasms / Q000188:drug therapy*; D004958:Estradiol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007118:Immunoassay; D007265:Inhibins / Q000097:blood; D008875:Middle Aged; D010865:Pilot Projects; D017697:Premenopause; D011788:Quality of Life
D000970:Antineoplastic Agents; D015415:Biomarkers; C422362:inhibin A; C422364:inhibin B; D004958:Estradiol; D007265:Inhibins; D054304:Anti-Mullerian Hormone; D005640:Follicle Stimulating Hormone