Lea K Krekow1, Beth A Hellerstedt1, Rufus P Collea1, Steven Papish1, Shrinivas M Diggikar1, Regina Resta1, Svetislava J Vukelja1, Frankie Ann Holmes1, Praveen K Reddy1, Lina Asmar1, Yunfei Wang1, Patricia S Fox1, Susan R Peck1, Joyce O'Shaughnessy2. 1. Lea K. Krekow, Beth A. Hellerstedt, Rufus P. Collea, Steven Papish, Shrinivas M. Diggikar, Regina Resta, Svetislava J. Vukelja, Frankie Ann Holmes, Lina Asmar, Yunfei Wang, Patricia S. Fox, and Joyce O'Shaughnessy, US Oncology Research; Susan R. Peck, McKesson Specialty Health, The Woodlands; Lea K. Krekow, Texas Oncology-The Breast Care Center of North Texas, Bedford; Beth A. Hellerstedt, Texas Oncology-Austin Central, Austin; Shrinivas M. Diggikar, Texas Oncology-Arlington South, Arlington; Svetislava J. Vukelja, Texas Oncology/Tyler Cancer Center, Tyler; Frankie Ann Holmes, Texas Oncology-Houston Memorial City, Houston; Praveen K. Reddy, Texas Oncology Midland Allison Cancer Center, Midland; Joyce O'Shaughnessy, Texas Oncology at Baylor-Charles A. Sammons Cancer Center, Dallas, TX; Rufus P. Collea, New York Oncology Hematology-Albany Medical Center, Albany; Regina Resta, New York Oncology Hematology, Troy, NY; and Steven Papish, Hematology-Oncology Associates of Northern New Jersey, Morristown, NJ. 2. Lea K. Krekow, Beth A. Hellerstedt, Rufus P. Collea, Steven Papish, Shrinivas M. Diggikar, Regina Resta, Svetislava J. Vukelja, Frankie Ann Holmes, Lina Asmar, Yunfei Wang, Patricia S. Fox, and Joyce O'Shaughnessy, US Oncology Research; Susan R. Peck, McKesson Specialty Health, The Woodlands; Lea K. Krekow, Texas Oncology-The Breast Care Center of North Texas, Bedford; Beth A. Hellerstedt, Texas Oncology-Austin Central, Austin; Shrinivas M. Diggikar, Texas Oncology-Arlington South, Arlington; Svetislava J. Vukelja, Texas Oncology/Tyler Cancer Center, Tyler; Frankie Ann Holmes, Texas Oncology-Houston Memorial City, Houston; Praveen K. Reddy, Texas Oncology Midland Allison Cancer Center, Midland; Joyce O'Shaughnessy, Texas Oncology at Baylor-Charles A. Sammons Cancer Center, Dallas, TX; Rufus P. Collea, New York Oncology Hematology-Albany Medical Center, Albany; Regina Resta, New York Oncology Hematology, Troy, NY; and Steven Papish, Hematology-Oncology Associates of Northern New Jersey, Morristown, NJ. Joyce.OShaughnessy@usoncology.com.
Abstract
PURPOSE: This prospective study assessed the impact of 2 years of aromatase inhibitor (AI) therapy on the incidence of ovarian function recovery (OFR) in women age 40 to 49 with estrogen receptor-positive breast cancer who were premenopausal at diagnosis and who underwent chemotherapy-induced amenorrhea during adjuvant treatment. PATIENTS AND METHODS: Women age 40 to 49 with estrogen receptor-positive breast cancer who had ceased menstruating with adjuvant cyclophosphamide-based chemotherapy, had postmenopausal serum estradiol (E2), and had received tamoxifen for ≥ 1 year were treated with letrozole (2.5 mg) daily for ≥ 2 years. Serum follicle-stimulating hormone (FSH) and E2 were measured at baseline and over 2 years. A general linear model was used to assess serial FSH by OFR. Logistic regression was used to assess baseline predictors and OFR. RESULTS: The study enrolled 177 women (145 women age 45 to 49 years and 32 women age 40 to 44 years). Of 173 evaluable patients, 67 (39%; 95% CI, 31% to 46%) regained ovarian function; 11 of these patients (6%; 95% CI, 3% to 10%) resumed menses, and 56 of these patients (32%; 95% CI, 25% to 39%) developed premenopausal E2 without menses. Among AI-naïve patients, serial FSH significantly increased over time (P < .001), did not vary significantly by OFR status (P = .55), but showed mild evidence of a decrease after month 12 for those who resumed menses (P = .0989). Age less than 45 years and inhibin B were significant multivariable baseline predictors of OFR. CONCLUSION: These results emphasize the challenge in determining definitive menopause in women with chemotherapy-induced amenorrhea. The risk of OFR during treatment with AIs in amenorrheic women in their 40s is high, and AI therapy should be avoided in these patients.
PURPOSE: This prospective study assessed the impact of 2 years of aromatase inhibitor (AI) therapy on the incidence of ovarian function recovery (OFR) in women age 40 to 49 with estrogen receptor-positive breast cancer who were premenopausal at diagnosis and who underwent chemotherapy-induced amenorrhea during adjuvant treatment. PATIENTS AND METHODS: Women age 40 to 49 with estrogen receptor-positive breast cancer who had ceased menstruating with adjuvant cyclophosphamide-based chemotherapy, had postmenopausal serum estradiol (E2), and had received tamoxifen for ≥ 1 year were treated with letrozole (2.5 mg) daily for ≥ 2 years. Serum follicle-stimulating hormone (FSH) and E2 were measured at baseline and over 2 years. A general linear model was used to assess serial FSH by OFR. Logistic regression was used to assess baseline predictors and OFR. RESULTS: The study enrolled 177 women (145 women age 45 to 49 years and 32 women age 40 to 44 years). Of 173 evaluable patients, 67 (39%; 95% CI, 31% to 46%) regained ovarian function; 11 of these patients (6%; 95% CI, 3% to 10%) resumed menses, and 56 of these patients (32%; 95% CI, 25% to 39%) developed premenopausal E2 without menses. Among AI-naïve patients, serial FSH significantly increased over time (P < .001), did not vary significantly by OFR status (P = .55), but showed mild evidence of a decrease after month 12 for those who resumed menses (P = .0989). Age less than 45 years and inhibin B were significant multivariable baseline predictors of OFR. CONCLUSION: These results emphasize the challenge in determining definitive menopause in women with chemotherapy-induced amenorrhea. The risk of OFR during treatment with AIs in amenorrheic women in their 40s is high, and AI therapy should be avoided in these patients.
Authors: Crystal S Denlinger; Tara Sanft; K Scott Baker; Shrujal Baxi; Gregory Broderick; Wendy Demark-Wahnefried; Debra L Friedman; Mindy Goldman; Melissa Hudson; Nazanin Khakpour; Allison King; Divya Koura; Elizabeth Kvale; Robin M Lally; Terry S Langbaum; Michelle Melisko; Jose G Montoya; Kathi Mooney; Javid J Moslehi; Tracey O'Connor; Linda Overholser; Electra D Paskett; Jeffrey Peppercorn; M Alma Rodriguez; Kathryn J Ruddy; Paula Silverman; Sophia Smith; Karen L Syrjala; Amye Tevaarwerk; Susan G Urba; Mark T Wakabayashi; Phyllis Zee; Deborah A Freedman-Cass; Nicole R McMillian Journal: J Natl Compr Canc Netw Date: 2017-09 Impact factor: 11.908
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