Abstract P5-21-08: One-tenth of patients younger than 40 years develop a permanent chemotherapy-induced ovarian function failure after receiving adjuvant anthracycline-based chemotherapy with or without taxanes
Authors: Tjan-Heijnen Vivianne C , Vriens Ingeborg J , Beijers Ashley J , Aarts Maureen J , de Boer Maaike , Royen Joyce H , van Golde Ron J 
Published: May 2015

Background

To assess the incidence and predictors of (permanent) chemotherapy-induced ovarian function failure (COFF) in premenopausal women with hormone receptor positive breast cancer treated with adjuvant chemotherapy.

Patients and methods

In our university hospital, patients with COFF and hormone-receptor positive breast cancer are monitored for ovarian function recovery by 3-monthly FSH and estradiol blood levels (serum estradiol is measured by direct immunoassay). In this present study, we collected data from the medical records of all premenopausal women with hormone-receptor positive breast cancer treated with anthracycline-based chemotherapy, with or without the addition of taxanes, who were diagnosed in the years 2005-2012. To meet the definition of COFF, the amenorrhea and ovarian function suppression had to last ≥24 weeks since the last menstruation before or during chemotherapy. Patients with hormone-receptor negative breast cancer were excluded.

Results

We identified 135 eligible women. Initial oral hormonal therapy consisted of tamoxifen (n= 116) or aromatase inhibitors (AI, n=16, of whom 1 patient younger than 40 years). Median follow-up of the included patients was 25 months (range 3-69 months). The majority of women was older than 40 years (80%). Permanent or temporary COFF was present in 95.6% of patients; that is, in 97.2% of patients of ≥ 40 years versus in 88.8% of patients &lt; 40 years of age, which was not different between age-groups. However, permanent COFF was significantly more often present in women ≥ 40 years (75%) as compared with 11.1% of women &lt; 40 years ( P &lt; 0.03). Patients who developed a permanent COFF had a mean age of 47.4 (SD 3.9) years, whereas patients who developed a temporary COFF had a mean age of 38.0 (SD 6.5).

In 57% of the patients, premenopausal hormone levels were the first evidence of ovarian function recovery. The second-last FSH and estradiol values of patients who had an ovarian function recovery were still clearly in postmenopausal range (Figures will be shown at the meeting).

Conclusion

COFF is seen in 89% of patients &lt; 40 years, but in the majority it was reversible. This is reassuring for those with a childwish. As in a significant proportion of patients FSH and estradiol values are the first sign of ovarian function recovery, close monitoring of ovarian function is required if ovarian function suppression is considered an additional effective hormonal treatment, and with respect to indication of non-hormonal contraceptive devices. We would not recommend AI as single hormonal treatment in young patients with COFF.

Citation Format: Vivianne C Tjan-Heijnen, Ingeborg J Vriens, Ashley J Beijers, Maureen J Aarts, Maaike de Boer, Joyce H Royen, Ron J van Golde. One-tenth of patients younger than 40 years develop a permanent chemotherapy-induced ovarian function failure after receiving adjuvant anthracycline-based chemotherapy with or without taxanes [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-21-08.