Early prediction of menopausal status after chemotherapy in women with early breast cancer in order to optimize adjuvant endocrine therapy
Background: Optimal endocrine therapy for premenopausal breast cancer patients after chemotherapy requires accurate menopausal status assessment. Current methods for determining resumption of ovarian function after chemotherapy are suboptimal. This study aims to evaluate the predictive value of pret...
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Elsevier
2025-10-01
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| Series: | Breast |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S096097762500579X |
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| author | Charissa van Zwol-Janssens Mandy M. van Rosmalen Esther Oomen-de Hoop Jan C. Drooger Annemieke van der Padt-Pruijsten Hanneke J.M. Zuetenhorst Yvonne V. Louwers Jenny A. Visser Joop S.E. Laven Agnes Jager |
| author_facet | Charissa van Zwol-Janssens Mandy M. van Rosmalen Esther Oomen-de Hoop Jan C. Drooger Annemieke van der Padt-Pruijsten Hanneke J.M. Zuetenhorst Yvonne V. Louwers Jenny A. Visser Joop S.E. Laven Agnes Jager |
| author_sort | Charissa van Zwol-Janssens |
| collection | DOAJ |
| description | Background: Optimal endocrine therapy for premenopausal breast cancer patients after chemotherapy requires accurate menopausal status assessment. Current methods for determining resumption of ovarian function after chemotherapy are suboptimal. This study aims to evaluate the predictive value of pretreatment anti-Müllerian hormone (AMH) serum levels for predicting resumption of ovarian function after chemotherapy (CT). Methods: This prospective study included premenopausal women with hormone receptor-positive breast cancer undergoing CT. AMH was measured using the picoAMH assay of Anshlabs. The primary outcome was resumption of ovarian function, defined as menstrual cycle resumption or estradiol levels above 110 pmol/L within 24 months after CT. Results: Among 109 patients, pretreatment AMH was a strong predictor of resumption of ovarian function (AUC 0.86) and an optimal cut-off of 0.62 μg/L was calculated. AMH >0.62 μg/L identified women at higher risk for ovarian function resumption (sensitivity 69.9 %, specificity 88.5 %), with a false negative rate of 11.5 % and false positive rate of 30.1 %. Combining AMH and age improved predictive accuracy only slightly. No additional predictors were identified. Survival analysis confirmed that women with low pretreatment AMH (<0.62 μg/L) or older age (>40.2 years) experienced significantly less frequent and delayed ovarian function resumption. Conclusion: Pretreatment AMH is a valuable tool for predicting ovarian function resumption after chemotherapy in breast cancer patients, so that a GnRH agonist can be recommended appropriately. However, the predictive value of pretreatment AMH for permanent ovarian insufficiency is too limited to determine the postmenopausal status sufficiently accurately to switch upfront to another endocrine treatment, the aromatase inhibitors. |
| format | Article |
| id | doaj-art-5c7af82294d74ebb80c04eab94d841fe |
| institution | Kabale University |
| issn | 1532-3080 |
| language | English |
| publishDate | 2025-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Breast |
| spelling | doaj-art-5c7af82294d74ebb80c04eab94d841fe2025-08-24T05:11:29ZengElsevierBreast1532-30802025-10-018310456210.1016/j.breast.2025.104562Early prediction of menopausal status after chemotherapy in women with early breast cancer in order to optimize adjuvant endocrine therapyCharissa van Zwol-Janssens0Mandy M. van Rosmalen1Esther Oomen-de Hoop2Jan C. Drooger3Annemieke van der Padt-Pruijsten4Hanneke J.M. Zuetenhorst5Yvonne V. Louwers6Jenny A. Visser7Joop S.E. Laven8Agnes Jager9Division Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, the Netherlands; Corresponding author. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University MC, Rotterdam, the NetherlandsDepartment of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University MC, Rotterdam, the NetherlandsDepartment of Medical Oncology, Breast Cancer Center South Holland South, Ikazia Hospital, Rotterdam, the NetherlandsDepartment of Internal Medicine, Breast Cancer Center South Holland South, Maasstad Hospital, Rotterdam, the NetherlandsDepartment of Medical Oncology, Franciscus Hospital, Rotterdam, the NetherlandsDivision Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, the NetherlandsDepartment of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the NetherlandsDivision Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, the NetherlandsDepartment of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University MC, Rotterdam, the NetherlandsBackground: Optimal endocrine therapy for premenopausal breast cancer patients after chemotherapy requires accurate menopausal status assessment. Current methods for determining resumption of ovarian function after chemotherapy are suboptimal. This study aims to evaluate the predictive value of pretreatment anti-Müllerian hormone (AMH) serum levels for predicting resumption of ovarian function after chemotherapy (CT). Methods: This prospective study included premenopausal women with hormone receptor-positive breast cancer undergoing CT. AMH was measured using the picoAMH assay of Anshlabs. The primary outcome was resumption of ovarian function, defined as menstrual cycle resumption or estradiol levels above 110 pmol/L within 24 months after CT. Results: Among 109 patients, pretreatment AMH was a strong predictor of resumption of ovarian function (AUC 0.86) and an optimal cut-off of 0.62 μg/L was calculated. AMH >0.62 μg/L identified women at higher risk for ovarian function resumption (sensitivity 69.9 %, specificity 88.5 %), with a false negative rate of 11.5 % and false positive rate of 30.1 %. Combining AMH and age improved predictive accuracy only slightly. No additional predictors were identified. Survival analysis confirmed that women with low pretreatment AMH (<0.62 μg/L) or older age (>40.2 years) experienced significantly less frequent and delayed ovarian function resumption. Conclusion: Pretreatment AMH is a valuable tool for predicting ovarian function resumption after chemotherapy in breast cancer patients, so that a GnRH agonist can be recommended appropriately. However, the predictive value of pretreatment AMH for permanent ovarian insufficiency is too limited to determine the postmenopausal status sufficiently accurately to switch upfront to another endocrine treatment, the aromatase inhibitors.http://www.sciencedirect.com/science/article/pii/S096097762500579XPremenopausalBreast cancerChemotherapy induced amenorrheaOvarian function |
| spellingShingle | Charissa van Zwol-Janssens Mandy M. van Rosmalen Esther Oomen-de Hoop Jan C. Drooger Annemieke van der Padt-Pruijsten Hanneke J.M. Zuetenhorst Yvonne V. Louwers Jenny A. Visser Joop S.E. Laven Agnes Jager Early prediction of menopausal status after chemotherapy in women with early breast cancer in order to optimize adjuvant endocrine therapy Breast Premenopausal Breast cancer Chemotherapy induced amenorrhea Ovarian function |
| title | Early prediction of menopausal status after chemotherapy in women with early breast cancer in order to optimize adjuvant endocrine therapy |
| title_full | Early prediction of menopausal status after chemotherapy in women with early breast cancer in order to optimize adjuvant endocrine therapy |
| title_fullStr | Early prediction of menopausal status after chemotherapy in women with early breast cancer in order to optimize adjuvant endocrine therapy |
| title_full_unstemmed | Early prediction of menopausal status after chemotherapy in women with early breast cancer in order to optimize adjuvant endocrine therapy |
| title_short | Early prediction of menopausal status after chemotherapy in women with early breast cancer in order to optimize adjuvant endocrine therapy |
| title_sort | early prediction of menopausal status after chemotherapy in women with early breast cancer in order to optimize adjuvant endocrine therapy |
| topic | Premenopausal Breast cancer Chemotherapy induced amenorrhea Ovarian function |
| url | http://www.sciencedirect.com/science/article/pii/S096097762500579X |
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