Hormone test predicts ovarian function after chemotherapy for breast cancer

BOSTON — Women with higher levels of anti-Müllerian hormone before receiving chemotherapy for breast cancer appear to have better ovarian function 2 years after diagnosis, according to a study presented here.

“Reproductive function after cancer treatment is a concern for many young women because some chemotherapy regimens carry a risk of premature ovarian failure,” Richard A. Anderson, MD, PhD, professor of clinical reproductive science at the University of Edinburgh, Scotland, said at a press conference at ENDO 2011.

Currently, a blood test to measure levels of anti-Müllerian hormone is used to analyze ovarian reserve in women prior to undergoing in vitro fertilization treatment. Anderson and colleagues evaluated whether measuring anti-Müllerian hormone at diagnosis of breast cancer predicts ovarian activity up to 2 years after chemotherapy.

The study included 50 premenopausal women with early breast cancer who were recruited at diagnosis (mean age, 42.5 years). The women received anthracycline/cyclophosphamide-based chemotherapy regimens. About half of the patients also received a taxane, and 64% received treatment with tamoxifen. Blood samples for anti-Müllerian testing were collected before chemotherapy and tests were conducted 1 and 2 years after starting treatment. Women also kept a daily menstrual diary.

Eleven women withdrew from the study, mainly due to disease recurrence. At 1-year follow-up, the researchers had menstrual data on 40 women, and at 2-year follow-up had data on 29 women.

Pretreatment levels of anti-Müllerian hormone were 0.40 ng/mL. After chemotherapy, levels fell rapidly in 68% of the women and were undetectable after one cycle of chemotherapy. At 1 year, 20 of the 21 women with low pretreatment levels of the hormone were amenorrheic compared with 14 of 19 women with high levels of the hormone who retained menses. At 2 years, 16 of 17 women with low pretreatment levels were amenorrheic vs. six of 12 women with high pretreatment levels.

The researchers also found that women who had low levels of anti-Müllerian hormone before starting chemotherapy were 16 times more likely to stop menstruating after treatment. The relationship between ovarian function and anti-Müllerian hormone remained significant after controlling for age.

“Our data suggest that the anti-Müllerian hormone level test, taken before cancer treatment, can help individualize a woman’s infertility risk after chemotherapy for breast cancer. The results of this study are also likely to apply to other types of cancer.

“This test will be of benefit to women with newly-diagnosed cancer to help decide whether they need to take steps to preserve their fertility,” Anderson said. – by Emily Shafer

Disclosure: Dr. Anderson is a speaker for Beckman Coulter.

For more information:

Anderson RA. #OR17-6. Presented at: The Endocrine Society 93rd Annual Meeting & Expo; June 4-7, 2011; Boston.

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