Long-term antimüllerian hormone patterns differ by cancer treatment exposures in young breast cancer survivors

Zhou, Beth; Kwan, Brian; Desai, Milli; Nalawade, Vinit; Ruddy, Kathryn J.; Nathan, Paul C.; Henk, Henry J.; Murphy, James D.; Whitcomb, Brian W.; Su, H. Irene

doi:10.1016/j.fertnstert.2022.01.016

Cited by 12 publications

(10 citation statements)

References 58 publications

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“…Next, detailing which specific cancer treatments, beyond broad categories of chemotherapy, radiation and surgery, are related to which maternal comorbidity is needed to prioritise research and clinical screening and surveillance. Future studies that leverage claims data to measure more detailed exposures may be feasible and valid 54–56 …”

Section: Discussionmentioning

confidence: 99%

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Maternal comorbidity and adverse perinatal outcomes in survivors of adolescent and young adult cancer: A cohort study

Desai

Zhou

Nalawade

et al. 2023

BJOG

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Objective To evaluate risks of preterm birth (PTB) and severe maternal morbidity (SMM) in female survivors of adolescent and young adult cancer and assess maternal comorbidity as a potential mechanism. To determine whether associations differ by use of assisted reproductive technology (ART). Design Retrospective cohort. Setting Commercially insured females in the USA. Sample Females with live births from 2000–2019 within a de‐identified US administrative health claims data set. Methods Log‐binomial regression models estimated relative risks of PTB and SMM by cancer status and tested for effect modification. Causal mediation analysis evaluated the proportions explained by maternal comorbidity. Main Outcome Measures PTB and SMM. Results Among 46 064 cancer survivors, 2440 singleton births, 214 multiple births and 2590 linked newborns occurred after cancer diagnosis. In singleton births, the incidence of PTB was 14.8% in cancer survivors versus 12.4% in females without cancer (aRR 1.19, 95% CI 1.06–1.34); the incidence of SMM was 3.9% in cancer survivors versus 2.4% in females without cancer (aRR 1.44, 95% CI 1.13–1.83). Cancer survivors had more maternal comorbidities before and during pregnancy; 26% of the association between cancer and PTB and 30% of the association between cancer and SMM was mediated by maternal comorbidities. Tests for effect modification of cancer status on perinatal outcomes by ART were non‐significant. Conclusions Preterm birth and SMM risks were modestly increased after cancer. Significant proportions of elevated risks may result from increased comorbidities. ART did not significantly modify the association between adolescent and young adult cancer and adverse perinatal outcomes. The prevention and treatment of comorbidities provides an opportunity to improve perinatal outcomes among cancer survivors.

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Section: Discussionmentioning

confidence: 99%

“…Future studies that leverage claims data to measure more detailed exposures may be feasible and valid. [54][55][56]…”

Section: Discussionmentioning

confidence: 99%

Maternal comorbidity and adverse perinatal outcomes in survivors of adolescent and young adult cancer: A cohort study

Desai

Zhou

Nalawade

et al. 2023

BJOG

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“…27,30,31 Increased POI and decreased ovarian reserve have also been observed after platinum exposure in AYA cancer survivors. 25,32 More than 30 Gy radiation to the hypothalamus significantly increases risk of hypothalamic hypogonadism resulting in infertility from anovulation. 30 For the majority of additional chemotherapy and targeted therapy agents including immunotherapy, quality of evidence is less robust or absent.…”

Section: National Comprehensive Cancer Network 12mentioning

confidence: 99%

“…Some female CAYA survivors will have a residual but narrower window of ovarian function after cancer treatment. 28,32,38 Posttreatment FP via oocyte or embryo cryopreservation may be considered in those at risk of POI or infertility and never underwent FP before cancer treatment; survivors who underwent FP but may have insufficient cryopreserved materials for a reasonable chance at achieving their goal family size; and survivors who wish to defer childbearing and are thus at risk of age-related fertility decline.…”

Section: Post-treatment Considerations Femalesmentioning

confidence: 99%

“…On alkylating chemotherapy, cut points in cyclophosphamide equivalent dose range from 4000 to 12,000 mg/m 2 , stratified by pubertal status 27,30,31 . Increased POI and decreased ovarian reserve have also been observed after platinum exposure in AYA cancer survivors 25,32 . More than 30 Gy radiation to the hypothalamus significantly increases risk of hypothalamic hypogonadism resulting in infertility from anovulation 30 .…”

Section: Infertility Risk Varies By Treatment and Age: Risk Stratific...mentioning

confidence: 99%

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Fertility preservation before and after cancer treatment in children, adolescents, and young adults

Yang,

Strohl,

2023

Cancer

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Fertility is a top concern for many survivors of cancer diagnosed as children, adolescents and young adults (CAYA). Fertility preservation (FP) treatments are effective, evidence‐based interventions to support their family building goals. Fertility discussions are a part of quality oncology care throughout the cancer care continuum. For nearly 2 decades, clinical guidelines recommend counseling patients about the possibility of infertility promptly at diagnosis and offering FP options and referrals as indicated. Multiple guidelines now recommend post‐treatment counseling. Infertility risks differ by cancer treatments and age, rendering risk stratification a central part of FP care. To support FP decision‐making, online tools for female risk estimation are available. At diagnosis, females can engage in mature oocyte/embryo cryopreservation, ovarian tissue cryopreservation, ovarian suppression with GnRH agonists, in vitro oocyte maturation, and/or conservative management for gynecologic cancers. Post‐treatment, several populations may consider undergoing oocyte/embryo cryopreservation. Male survivors’ standard of care FP treatments center on sperm cryopreservation before cancer treatment and do not have the same post‐treatment indication for additional gamete cryopreservation. In practice, FP care requires systemized processes to routinely screen for FP needs, bridge oncology referrals to fertility, offer timely fertility consultations and access to FP treatments, and support financial navigation. Sixteen US states passed laws requiring health insurers to provide insurance benefits for FP treatments, but variation among the laws and downstream implementation are barriers to accessing FP treatments. To preserve the reproductive futures of CAYA survivors, research is needed to improve risk stratification, FP options, and delivery of FP care.

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Long-term effect of chemotherapy after ovarian decortication on the ovarian function in women surviving cancer

Ortiz,

Peña,

Hidalgo

et al. 2023

J Assist Reprod Genet

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Purpose Ovarian decortication may affect ovarian function. We investigated the status of ovarian reserve after ovarian decortication plus chemotherapy at a stage of presumed stabilized recovery in women surviving cancer. Methods We searched our database for cancer survivors subjected to ovarian decortication and chemotherapy at least 3 years previously. Ovarian function was explored for levels of anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), and estradiol (E2), and menstrual pattern. Results Forty women (mean age 29.6 (SD, 6.1) years) were assessed at a mean of 4.7 (1.5) years after surgery. The predecortication levels of AMH and FSH changed at post-treatment from 2.2 (1.4) to 0.5 (1.3) ng/mL for AMH (p < 0.001) and from 4.7 (2.1) to 16.7 (21. 6) IU/L for FSH (p < 0.001). Amenorrhea consistent with primary ovarian insufficiency (POI) was diagnosed in 11 women, and normal ovarian reserve (AMH ≥ 1.0 ng/mL) was found in 4 of the 21 women who recovered regular cycles. Logistic regression confirmed AMH as an independent predictor of diminished ovarian reserve (OR = 0.24, 95% CI: 0.04-0.63, p = 0.025) and POI (OR = 0.11, 95% CI: 0.01–0.52, p = 0.027), and age was predictive of POI (OR = 1.36, 95% CI: 1.08–1.96, p = 0.035) and of irregular menstrual cycle (OR = 1.20, 95% CI: 1.03–1.46, p = 0.034). Conclusion Ovarian decortication plus chemotherapy had a deleterious effect when assessed at a stage of stabilized ovarian recovery, but whether ovarian decortication had a specific impact cannot be revealed from our data.

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Long-term antimüllerian hormone patterns differ by cancer treatment exposures in young breast cancer survivors

Cited by 12 publications

References 58 publications

Maternal comorbidity and adverse perinatal outcomes in survivors of adolescent and young adult cancer: A cohort study

Maternal comorbidity and adverse perinatal outcomes in survivors of adolescent and young adult cancer: A cohort study

Fertility preservation before and after cancer treatment in children, adolescents, and young adults

Long-term effect of chemotherapy after ovarian decortication on the ovarian function in women surviving cancer

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