Rosalba Torrisi1, Vera Basilico2, Laura Giordano1, Michele Caruso3, Antonino Musolino4, Marta Noemi Monari5, Carlo Carnaghi2,3, Armando Santoro1,6. 1. IRCCS Humanitas Research Hospital Medical Oncology Unit, Rozzano, Italy. 2. Medical Oncology Unit, Istituto Clinico Mater Domini Humanitas, Castellanza, Italy. 3. Medical Oncology Humanitas Centro Catanese di Oncologia, Catania, Italy. 4. Breast Unit, University Hospital of Parma, Parma, Italy. 5. Laboratory of Clinical Analysis, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy. 6. Department of Biomedical Sciences, Humanitas University, Rozzano, Italy.
Abstract
Introduction: Anti-Müllerian hormone (AMH) is the most reliable biomarker of ovarian reserve; however, its role in predicting ovarian recovery after chemotherapy is unclear. Administration of a GnRH analog (GnRHa) during chemotherapy significantly reduces the ovarian failure rate and increases the pregnancy rate. The available data on the behavior of AMH during concurrent administration of chemotherapy and GnRHa are inconsistent. We investigated whether concurrent administration of triptorelin and adjuvant chemotherapy might reduce the expected drop of AMH. Methods: Eligible patients were premenopausal women aged <40 years, with a diagnosis of early breast cancer, and candidates to 4-8 cycles of adjuvant chemotherapy. Triptorelin (3.75 mg i.m.) was started before chemotherapy and administered every 4 weeks thereafter. The principal endpoint was the proportion of patients with an AMH percent change ≤50% between 12 months after chemotherapy and basal levels. The secondary endpoint was the proportion of patients achieving postchemotherapy AMH levels above the threshold of 0.2 ng/mL. Results: Fifty patients were enrolled, 31 of whom had blood samples available at baseline and 1 year after the end of chemotherapy. AMH decreased to nearly undetectable levels after chemotherapy and recovered after 12 months, but they did not exceed 1 tenth of the pretreatment levels. As for the secondary endpoint, 15 of the 31 patients recovered AMH levels above the threshold. Conclusions: This study did not reach its principal endpoint; however, the rate of 48% of patients who recovered AMH above threshold levels favorably compared with those in studies without concurrent GnRHa, supporting a better recovery of AMH with triptorelin.
Introduction: Anti-Müllerian hormone (AMH) is the most reliable biomarker of ovarian reserve; however, its role in predicting ovarian recovery after chemotherapy is unclear. Administration of a GnRH analog (GnRHa) during chemotherapy significantly reduces the ovarian failure rate and increases the pregnancy rate. The available data on the behavior of AMH during concurrent administration of chemotherapy and GnRHa are inconsistent. We investigated whether concurrent administration of triptorelin and adjuvant chemotherapy might reduce the expected drop of AMH. Methods: Eligible patients were premenopausal women aged <40 years, with a diagnosis of early breast cancer, and candidates to 4-8 cycles of adjuvant chemotherapy. Triptorelin (3.75 mg i.m.) was started before chemotherapy and administered every 4 weeks thereafter. The principal endpoint was the proportion of patients with an AMH percent change ≤50% between 12 months after chemotherapy and basal levels. The secondary endpoint was the proportion of patients achieving postchemotherapy AMH levels above the threshold of 0.2 ng/mL. Results: Fifty patients were enrolled, 31 of whom had blood samples available at baseline and 1 year after the end of chemotherapy. AMH decreased to nearly undetectable levels after chemotherapy and recovered after 12 months, but they did not exceed 1 tenth of the pretreatment levels. As for the secondary endpoint, 15 of the 31 patients recovered AMH levels above the threshold. Conclusions: This study did not reach its principal endpoint; however, the rate of 48% of patients who recovered AMH above threshold levels favorably compared with those in studies without concurrent GnRHa, supporting a better recovery of AMH with triptorelin.
Authors: Kutluk Oktay; Brittany E Harvey; Ann H Partridge; Gwendolyn P Quinn; Joyce Reinecke; Hugh S Taylor; W Hamish Wallace; Erica T Wang; Alison W Loren Journal: J Clin Oncol Date: 2018-04-05 Impact factor: 44.544
Authors: Lisa M Shandley; Jessica B Spencer; Amy Fothergill; Ann C Mertens; Amita Manatunga; Elisavet Paplomata; Penelope P Howards Journal: Fertil Steril Date: 2016-11-22 Impact factor: 7.329
Authors: Bo Yu; Nataki Douglas; Michel J Ferin; Gary S Nakhuda; Katherine Crew; Rogerio A Lobo; Dawn L Hershman Journal: Cancer Date: 2010-05-01 Impact factor: 6.860
Authors: Halle C F Moore; Joseph M Unger; Kelly-Anne Phillips; Frances Boyle; Erika Hitre; David Porter; Prudence A Francis; Lori J Goldstein; Henry L Gomez; Carlos S Vallejos; Ann H Partridge; Shaker R Dakhil; Agustin A Garcia; Julie Gralow; Janine M Lombard; John F Forbes; Silvana Martino; William E Barlow; Carol J Fabian; Lori Minasian; Frank L Meyskens; Richard D Gelber; Gabriel N Hortobagyi; Kathy S Albain Journal: N Engl J Med Date: 2015-03-05 Impact factor: 91.245
Authors: Eman A Elgindy; Dahlia O El-Haieg; Ola M Khorshid; Eman I Ismail; Mohamed Abdelgawad; Hassan N Sallam; Ahmed M Abou-Setta Journal: Obstet Gynecol Date: 2013-01 Impact factor: 7.661
Authors: H Irene Su; Kevin Maas; Patrick M Sluss; R Jeffrey Chang; Janet E Hall; Hadine Joffe Journal: J Clin Endocrinol Metab Date: 2013-09-30 Impact factor: 5.958
Authors: Matteo Lambertini; Halle C F Moore; Robert C F Leonard; Sibylle Loibl; Pamela Munster; Marco Bruzzone; Luca Boni; Joseph M Unger; Richard A Anderson; Keyur Mehta; Susan Minton; Francesca Poggio; Kathy S Albain; Douglas J A Adamson; Bernd Gerber; Amy Cripps; Gianfilippo Bertelli; Sabine Seiler; Marcello Ceppi; Ann H Partridge; Lucia Del Mastro Journal: J Clin Oncol Date: 2018-05-02 Impact factor: 44.544