Diagnostic and predictive accuracy of anti-mullerian hormone for ovarian function after chemotherapy in premenopausal women with early breast cancer

Abstract

Purpose Accurate diagnosis and prediction of loss of ovarian function after chemotherapy for premenopausal women with early breast cancer (eBC) is important for future fertility and clinical decisions regarding the need for subsequent adjuvant ovarian suppression. We have investigated the value of anti-mullerian hormone (AMH) as serum biomarker for this. Methods AMH was measured in serial blood samples from 206 premenopausal women aged 40–45 years with eBC, before and at intervals after chemotherapy. The diagnostic accuracy of AMH for loss of ovarian function at 30 months after chemotherapy and the predictive value for that of AMH measurement at 6 months were analysed. Results Undetectable AMH showed a high diagnostic accuracy for absent ovarian function at 30 months with AUROC 0.89 (96% CI 0.84–0.94, P < 0.0001). PPV of undetectable AMH at 6 months for a menopausal estradiol level at 30 months was 0.77. In multivariate analysis age, pre-treatment AMH and FSH, and taxane treatment were significant predictors, and combined with AMH at 6 months, gave AUROC of 0.90 (95% CI 0.86–0.94), with PPV 0.79 for loss of ovarian function at 30 months. Validation by random forest models with 30% data retained gave similar results. Conclusions AMH is a reliable diagnostic test for lack of ovarian function after chemotherapy in women aged 40–45 with eBC. Early analysis of AMH after chemotherapy allows identification of women who will not recover ovarian function with good accuracy. These analyses will help inform treatment decisions regarding adjuvant endocrine therapy in women who were premenopausal before starting chemotherapy.

A New Model Including AMH Cut-off Levels to Predict Post-treatment Ovarian Function in Early Breast Cancer: A Prospective Cohort Study

“…Dillon et al 29 concluded that AMH0 affected both the level and the speed of recovery of AMH without exploring a specific cut-off point. Anderson et al 30 evaluated BC patients between 40 and 45 years of age and, while emphasizing the validity of post-treatment AMH as a marker for ovarian reserve, showed that AMH0 was a significant predictor of AMH after 30 months. This study mainly focused on the prediction of later ovarian function based on the AMH levels 6 months after treatment, which proved to be an accurate marker in this regard.…”

Oncotype DX Recurrence Score in premenopausal women

“…There are data demonstrating that the absence of anti-mullerian hormone (AMH) is a reliable predictive indicator for loss of ovarian function in premenopausal women after chemotherapy. 58 Future studies can consider the use of AMH along with traditionally accepted criteria using FSH or menstrual history to diagnosis and predict premature ovarian insufficiency.…”

Breast cancer treatment and ovarian function

“…AFC on the third day of the menstrual cycle also appears to be a reliable marker of ovarian follicle pool (Lutchman Singh et al 2007). Of these markers, AMH seems to be the earliest and most reliable indicator of ovarian aging and reduction in post-chemotherapy ovarian reserve and in predicting the return of menses after chemotherapy for breast cancer (Anderson et al 2006;Chai et al 2014;Anderson et al 2022).…”