Selection of appropriate biomarkers to monitor effectiveness of ovarian function suppression in pre-menopausal patients with ER+ breast cancer

Abstract

Use of gonadotropin-releasing hormone (GnRH) agonists has been widely adopted to provide reversible ovarian function suppression for pre-menopausal breast cancer patients who are also receiving aromatase inhibitor or tamoxifen therapy based on results of 25 randomized trials representing almost 15,000 women demonstrating a survival benefit with this approach. Past clinical trials designed to establish the efficacy of GnRH agonists have monitored testosterone in the prostate cancer setting and estradiol in the breast cancer setting. We explore the merits of various biomarkers including estradiol, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) and their utility for informing GnRH agonist treatment decisions in breast cancer. Estradiol remains our biomarker of choice in ensuring adequate ovarian function suppression with GnRH agonist therapy among pre-menopausal women with breast cancer. We recommend future trials to continue to focus on estradiol levels as the primary endpoint, as they have in the past.

De novo design of a nanoregulator for the dynamic restoration of ovarian tissue in cryopreservation and transplantation

“…The conventional biomarkers for assessing follicle function mainly include FSH and LH secreted by the pituitary gland, pigment content in follicular fluid, estradiol, follicle size and quantity, AMH, etc. FSH and LH hormones are two key hormones controlling follicle growth and development, assisting in reflecting the functional status of follicles [ 178 ]. The level of estradiol is often associated with follicle growth and development.…”