A prospective longitudinal analysis of the predictors of amenorrhea after breast cancer chemotherapy: Impact of BRCA pathogenic variants
Abstract Background Better tools for post‐chemotherapy amenorrhea risk assessment are needed for fertility preservation decision‐making. Our aim was to determine the predictors of amenorrhea risk at 12 and 18 months post‐chemotherapy in women with breast cancer. Methods 142 women with breast cancer...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-09-01
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| Series: | Cancer Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/cam4.6527 |
| _version_ | 1797361287543390208 |
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| author | Kutluk H. Oktay Volkan Turan Giuliano Bedoschi Nadia Abdo Heejung Bang Shari Goldfarb |
| author_facet | Kutluk H. Oktay Volkan Turan Giuliano Bedoschi Nadia Abdo Heejung Bang Shari Goldfarb |
| author_sort | Kutluk H. Oktay |
| collection | DOAJ |
| description | Abstract Background Better tools for post‐chemotherapy amenorrhea risk assessment are needed for fertility preservation decision‐making. Our aim was to determine the predictors of amenorrhea risk at 12 and 18 months post‐chemotherapy in women with breast cancer. Methods 142 women with breast cancer were longitudinally followed for their menstrual changes at 6, 12, and 18 months after the completion of adjuvant chemotherapy with an Anthracycline‐Cyclophosphamide‐based (AC‐based) or Cyclophosphamide‐Methotrexate +5‐Fluorouracil regimen. Pre‐ and/or post‐chemo AMH levels, age, BMI, tamoxifen use, regimen type, and germline BRCA pathogenic variant (gBRCApv) status were evaluated for the prediction of amenorrhea at 6–18 months. Results In multivariable‐adjusted logistic regression, age (p = 0.03) and AMH (p = 0.03) at 12 months, and gBRCApv status (p = 0.03) at 18 months were significant predictors of amenorrhea (areas under the ROC curve of 0.77 and 0.76, for 12 and 18 months, respectively) among 102 evaluable subjects. An undetectable AMH immediately post‐chemotherapy was predictive of amenorrhea with <18 month follow‐up. In longitudinal analysis estimating time trends, baseline AMH and gBRCApv status was associated with the risk of amenorrhea over 6–18 months; the AMH >2.0 ng/mL group showed attenuated time‐trend risk of amenorrhea versus AMH ≤2.0 group (ratio of ORs = 0.91, 95% CI = 0.86–0.97, p = 0.002), while the gBRCApv + showed a steeper time trend, versus the controls (ratio of ORs = 1.12, 95% CI = 1.04–1.20, p = 0.003). Conclusions In addition to the pre‐ and post‐treatment AMH levels, gBRCApv status is a novel potential predictor of amenorrhea at 12 and 18 months after chemotherapy. The higher likelihood of amenorrhea in women gBRCApv suggests that they are more prone to losing their fertility post‐chemotherapy. |
| first_indexed | 2024-03-08T15:51:39Z |
| format | Article |
| id | doaj.art-5cf52d5921e24264a77709703954d016 |
| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2024-03-08T15:51:39Z |
| publishDate | 2023-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj.art-5cf52d5921e24264a77709703954d0162024-01-09T05:21:16ZengWileyCancer Medicine2045-76342023-09-011218192251923310.1002/cam4.6527A prospective longitudinal analysis of the predictors of amenorrhea after breast cancer chemotherapy: Impact of BRCA pathogenic variantsKutluk H. Oktay0Volkan Turan1Giuliano Bedoschi2Nadia Abdo3Heejung Bang4Shari Goldfarb5Department of Obstetrics and Gynecology and Reproductive Sciences Yale University School of Medicine New Haven Connecticut USADepartment of Obstetrics and Gynecology Istanbul Health and Technology University School of Medicine Istanbul TurkeyDepartment of Obstetrics and Gynecology, Ribeirao Preto School of Medicine University of Sao Paulo Ribeirao Preto BrazilMemorial Sloan Kettering Cancer Center New York New York USADivision of Biostatistics, Department of Public Health Sciences University of California Davis California USAMemorial Sloan Kettering Cancer Center New York New York USAAbstract Background Better tools for post‐chemotherapy amenorrhea risk assessment are needed for fertility preservation decision‐making. Our aim was to determine the predictors of amenorrhea risk at 12 and 18 months post‐chemotherapy in women with breast cancer. Methods 142 women with breast cancer were longitudinally followed for their menstrual changes at 6, 12, and 18 months after the completion of adjuvant chemotherapy with an Anthracycline‐Cyclophosphamide‐based (AC‐based) or Cyclophosphamide‐Methotrexate +5‐Fluorouracil regimen. Pre‐ and/or post‐chemo AMH levels, age, BMI, tamoxifen use, regimen type, and germline BRCA pathogenic variant (gBRCApv) status were evaluated for the prediction of amenorrhea at 6–18 months. Results In multivariable‐adjusted logistic regression, age (p = 0.03) and AMH (p = 0.03) at 12 months, and gBRCApv status (p = 0.03) at 18 months were significant predictors of amenorrhea (areas under the ROC curve of 0.77 and 0.76, for 12 and 18 months, respectively) among 102 evaluable subjects. An undetectable AMH immediately post‐chemotherapy was predictive of amenorrhea with <18 month follow‐up. In longitudinal analysis estimating time trends, baseline AMH and gBRCApv status was associated with the risk of amenorrhea over 6–18 months; the AMH >2.0 ng/mL group showed attenuated time‐trend risk of amenorrhea versus AMH ≤2.0 group (ratio of ORs = 0.91, 95% CI = 0.86–0.97, p = 0.002), while the gBRCApv + showed a steeper time trend, versus the controls (ratio of ORs = 1.12, 95% CI = 1.04–1.20, p = 0.003). Conclusions In addition to the pre‐ and post‐treatment AMH levels, gBRCApv status is a novel potential predictor of amenorrhea at 12 and 18 months after chemotherapy. The higher likelihood of amenorrhea in women gBRCApv suggests that they are more prone to losing their fertility post‐chemotherapy.https://doi.org/10.1002/cam4.6527amenorrheaanti‐mullerian hormoneBRCAbreast cancerchemotherapyfertility preservation |
| spellingShingle | Kutluk H. Oktay Volkan Turan Giuliano Bedoschi Nadia Abdo Heejung Bang Shari Goldfarb A prospective longitudinal analysis of the predictors of amenorrhea after breast cancer chemotherapy: Impact of BRCA pathogenic variants Cancer Medicine amenorrhea anti‐mullerian hormone BRCA breast cancer chemotherapy fertility preservation |
| title | A prospective longitudinal analysis of the predictors of amenorrhea after breast cancer chemotherapy: Impact of BRCA pathogenic variants |
| title_full | A prospective longitudinal analysis of the predictors of amenorrhea after breast cancer chemotherapy: Impact of BRCA pathogenic variants |
| title_fullStr | A prospective longitudinal analysis of the predictors of amenorrhea after breast cancer chemotherapy: Impact of BRCA pathogenic variants |
| title_full_unstemmed | A prospective longitudinal analysis of the predictors of amenorrhea after breast cancer chemotherapy: Impact of BRCA pathogenic variants |
| title_short | A prospective longitudinal analysis of the predictors of amenorrhea after breast cancer chemotherapy: Impact of BRCA pathogenic variants |
| title_sort | prospective longitudinal analysis of the predictors of amenorrhea after breast cancer chemotherapy impact of brca pathogenic variants |
| topic | amenorrhea anti‐mullerian hormone BRCA breast cancer chemotherapy fertility preservation |
| url | https://doi.org/10.1002/cam4.6527 |
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