BACKGROUND: Aromatase inhibitors (AIs) may promote ovarian function recovery (OFR). True incidence, predictors and impact on the outcome of OFR are unknown. PATIENTS AND METHODS: We carried out a prospective study to assess ovarian function in estrogen receptor (ER)-positive BC patients on tamoxifen who had at least 2 years of chemotherapy-induced amenorrhea (CIA) and postmenopausal E2 levels. Patients switched to exemestane and underwent a series of investigations including vaginal ultrasound, antimullerian hormone, follicle stimulating hormone (FSH), and E2. E2 measurements were made using a clinical assay (direct) and a highly sensitive (indirect) immunoassay for comparison. RESULTS: Both E2 assays (indirect versus direct) showed a similar incidence of OFR 32% (95% CI 19.5-44.5) versus 30% (95% CI 17.7-42.3) and median time to OFR 5.4 months (95% CI 1.2-9.6) versus 6.0 months (95% CI 4.8-7.1).On multivariate analysis, the mean age at the start of exemestane treatment was the only marker associated with probability of OFR (OR: 0.44, 0.24-0.78; P = 0.006). According to a receiver operating characteristic (ROC) analysis, age <48 years predicted for OFR (sensitivity: 59%; 1-specificity: 17%; AUC: 0.796; P = 0.001). Patients with OFR had higher mean E2 levels (43.6 versus 5.76 pmol/l; P = 0.001) and a reduced disease-free survival [DFS; HR 9.3 (95% CI 3.3-48.0; P = 0.04)] than those without it. CONCLUSION: Even with a clinical and biochemical profile compatible with menopause, switching from tamoxifen to an AI should be avoided in patients <48 with CIA.
BACKGROUND: Aromatase inhibitors (AIs) may promote ovarian function recovery (OFR). True incidence, predictors and impact on the outcome of OFR are unknown. PATIENTS AND METHODS: We carried out a prospective study to assess ovarian function in estrogen receptor (ER)-positive BC patients on tamoxifen who had at least 2 years of chemotherapy-induced amenorrhea (CIA) and postmenopausal E2 levels. Patients switched to exemestane and underwent a series of investigations including vaginal ultrasound, antimullerian hormone, follicle stimulating hormone (FSH), and E2. E2 measurements were made using a clinical assay (direct) and a highly sensitive (indirect) immunoassay for comparison. RESULTS: Both E2 assays (indirect versus direct) showed a similar incidence of OFR 32% (95% CI 19.5-44.5) versus 30% (95% CI 17.7-42.3) and median time to OFR 5.4 months (95% CI 1.2-9.6) versus 6.0 months (95% CI 4.8-7.1).On multivariate analysis, the mean age at the start of exemestane treatment was the only marker associated with probability of OFR (OR: 0.44, 0.24-0.78; P = 0.006). According to a receiver operating characteristic (ROC) analysis, age <48 years predicted for OFR (sensitivity: 59%; 1-specificity: 17%; AUC: 0.796; P = 0.001). Patients with OFR had higher mean E2 levels (43.6 versus 5.76 pmol/l; P = 0.001) and a reduced disease-free survival [DFS; HR 9.3 (95% CI 3.3-48.0; P = 0.04)] than those without it. CONCLUSION: Even with a clinical and biochemical profile compatible with menopause, switching from tamoxifen to an AI should be avoided in patients <48 with CIA.
Authors: Meritxell Bellet; Kathryn P Gray; Prudence A Francis; István Láng; Eva Ciruelos; Ana Lluch; Miguel Angel Climent; Gustavo Catalán; Antoni Avella; Uriel Bohn; Antonio González-Martin; Roser Ferrer; Roberto Catalán; Analía Azaro; Agnita Rajasekaran; Josefa Morales; Josep Vázquez; Gini F Fleming; Karen N Price; Meredith M Regan Journal: J Clin Oncol Date: 2016-01-04 Impact factor: 44.544
Authors: N L Henry; R Xia; M Banerjee; C Gersch; D McConnell; D Giacherio; A F Schott; M Pearlman; V Stearns; A H Partridge; D F Hayes Journal: Ann Oncol Date: 2013-04-23 Impact factor: 32.976
Authors: Irene E G van Hellemond; Ingeborg J H Vriens; Petronella G M Peer; Astrid C P Swinkels; Carolien H Smorenburg; Caroline M Seynaeve; Maurice J C van der Sangen; Judith R Kroep; Hiltje de Graaf; Aafke H Honkoop; Frans L G Erdkamp; Franchette W P J van den Berkmortel; Maaike de Boer; Wilfred K de Roos; Sabine C Linn; Alexander L T Imholz; Vivianne C G Tjan-Heijnen Journal: Int J Cancer Date: 2019-01-16 Impact factor: 7.396
Authors: Gwen M H E Dackus; Katarzyna Jóźwiak; Gabe S Sonke; Elsken van der Wall; Paul J van Diest; Sabine Siesling; Michael Hauptmann; Sabine C Linn Journal: J Natl Cancer Inst Date: 2021-11-02 Impact factor: 13.506