Determinants of recovery from amenorrhea in premenopausal breast cancer patients receiving adjuvant chemotherapy in the taxane era

Abstract

Chemotherapy-induced amenorrhea occurs in about 20-70% of premenopausal breast cancer patients. Chemotherapy-induced amenorrhea can affect choice of hormonal therapy, fertility, and quality of life of breast cancer survivors. We retrospectively analyzed the incidence of amenorrhea after adjuvant chemotherapy and the subsequent recovery of the menses in 145 breast cancer patients. Age, smoking, alcohol consumption, body mass index, chemotherapy regimen, previous hormonal therapies, and previous childbearing were analyzed as potential predictive factors of ovarian function recovery. Median age was 42 years at the beginning of adjuvant chemotherapy with 30.3% of patients below 40 years of age. The majority (87.6%) of patients received anthracycline-based chemotherapy, 35.2% of patients received a cyclophosphamide-methotrexate-5-fluorouracil regimen and 42.8% received a taxane. The incidence of chemotherapy-induced amenorrhea was 80, and 35.3% of these patients resumed menses after a median of 8 months. In multivariate analysis, younger age (<40 years, P=0.01) and taxane-based chemotherapy (P=0.03) were associated with increased probability of recovery of menses after chemotherapy-induced amenorrhea. In contrast, cyclophosphamide-methotrexate-5-fluorouracil-based chemotherapy (P=0.07) and previous childbearing (P=0.04) were associated with an increased probability of permanent chemotherapy-induced amenorrhea. Recovery of menses after chemotherapy-induced amenorrhea occurs more probably in younger women, with no pregnancies and receiving taxanes.

The advantage of letrozole over tamoxifen in the BIG 1-98 trial is consistent in younger postmenopausal women and in those with chemotherapy-induced menopause

“…The study of Abusief et al [14], which included 431 patients treated with doxorubicin and cyclophosphamide with or without paclitaxel demonstrated a chemotherapy-induced menopause rate of 72%, with recovery of ovarian function between 6 and 12 months following completion of chemotherapy in 14% and after more than 12 months in a further 3%. In the study of 145 patients by Minisini et al [18] the median time to recovery was 8 months with an overall recovery rate of 35.3%.…”

“…In a recent further report of the NSABP B-30 results [22], amenorrhea at 12 months was higher for cyclophosphamide containing regimens—69.8% for doxorubicin (D) and cyclophosphamide (C) followed by docetaxel (T), 57.7% for combination TAC and 37.9% for AT. Taxanes probably do not add to the rate of amenorrhea; in fact in the Minisini study [18], patients receiving taxane had a statistically significant increase in chance of recovery of ovarian function.…”

Incidence of chemotherapy-induced amenorrhea associated with epirubicin, docetaxel and navelbine in younger breast cancer patients

“…Similarly, in a study by Han et al [17], a higher incidence of CIA was associated with patients receiving taxane-containing chemotherapy ( P = 0.002). In a study by Minisini et al [20], patients receiving taxanes have an increase risk of CIA, but these patients recover menstrual bleeding more frequently than patients not treated with taxanes. Despite these results, it remained unclear whether the use of taxanes increased the rate of CIA compared to the use of anthracyclines alone [21].…”

Comparison of Ablation Zones among Different Tissues Using 2450-MHz Cooled-Shaft Microwave Antenna: Results in Ex Vivo Porcine Models

“…All statistical analyses were performed by using statistics software (Stata version 11.0, Stata), and P < 0.05 was considered to be statistically significant different. Otherwise, P value less than 0.10 was considered as borderline significant [27]. …”