Effect of Adjuvant Chemotherapy on the Circulating Levels of Pituitary Hormones in Postmenopausal Breast Cancer Patients

Abstract

The effect of adjuvant chemotherapy on the circulating levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH) and prolactin (PRL) has been investigated in postmenopausal breast cancer patients. In the patients who received adjuvant CMF-chemotherapy, there was a significant decrease in the circulating FSH, LH and PRL levels compared to healthy age-matched controls. A positive correlation was found between this decline in the FSH, LH and PRL values and the regression of tumor size following chemotherapy regimen. 14 There is no direct evidence that hormones themselves can convert a normal cell into a malignant cell but it is generally agreed that a complex interplay of hormonal and other factors results in a proliferative effect. 5Mammary tissue is the target for a number of hormones, including gonadotropins and sex steroids, which makes it relevant to understand the relationship of hormonal changes associated with the development and/or treatment of breast carcinoma. Conflicting data have appeared in the literature regarding the circulating levels of pituitary gonadotropins (LH, FSH) and prolactin (PRL) in breast cancer patients.5-7 Experimental mammary cancer has been shown to be dependent on PRL. 2,[8][9] In some cases, hypophysectomy leads to remission of metastatic breast cancer, possibly due to reduction in mammotrophic action ascribed to several anterior pituitary hormones. Adjuvant chemotherapy or chemotherapy coupled with endocrine therapy has been used effectively to control carcinoma of the breast. But this approach has some difficulties in postmenopausal patients due to their endocrine status. The role of these therapies in postmenopausal breast cancer patients appears to be palliative rather than curative and results in an increase in disease-free intervals. 10In this report, the effect of adjuvant chemotherapy on the circulating levels of pituitary hormones (FSH, LH and PRL) has been investigated in postmenopausal breast cancer patients using sensitive radioimmunoassay methods. Material and MethodsOne hundred and eight postmenopausal women were included in this study. Their informed consent was obtained and they were divided into two groups. Fifty-six women (control group) were without any endocrinological disorder, were healthy and were postmenopausal for over a year (ages between 46 and 65 years). The second group (therapy group) consisted of 52 postmenopausal women with advanced stage breast cancer who were between the ages of 47 and 68 years. This group was receiving adjuvant chemotherapy with cyclophosphamide, methotrexate and 5 -fluorouracil (CMF-therapy).Other risk factors, e.g., family history, parity, and any hormonal drugs used in the past, were also recorded. Patients were examined monthly and blood picture, liver studies, brain scan and mammography were performed for disease progression (micrometastases).Blood sampling was carried out in both the control and therapy groups, overlapping with the drug regimen to therapy group subjects between 9 a.m. and 10 a.m. on days 1, 8, ...