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Breast Cancer Research and Treatment
Published in: Breast Cancer Research and Treatment 1/2021

01-01-2021 | Fertility | Clinical trial

Impact of adjuvant chemotherapy or tamoxifen-alone on the ovarian reserve of young women with breast cancer

Authors: Shari B. Goldfarb, Volkan Turan, Giuliano Bedoschi, Enes Taylan, Nadia Abdo, Tessa Cigler, Heejung Bang, Sujita Patil, Maura N. Dickler, Kutluk H. Oktay

Published in: Breast Cancer Research and Treatment | Issue 1/2021

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Abstract

Purpose

To determine the longitudinal impact of adjuvant chemotherapy and tamoxifen-only treatments on the reproductive potential of women with breast cancer by using a sensitive ovarian reserve marker anti-Mullerian hormone (AMH) as a surrogate.

Methods

One-hundred-and-forty-two women with a primary diagnosis of breast cancer were prospectively followed with serum AMH assessments before the initiation, and 12, 18 and 24 months after the completion of adjuvant chemotherapy or the start of tamoxifen-only treatment. The chemotherapy regimens were classified into Anthracycline-Cyclophosphamide-based (AC-based) and Cyclophosphamide-Methotrexate + 5-Fluorouracil (CMF). Longitudinal data were analyzed by mixed effects model for treatment effects over time, adjusting for baseline age and BMI.

Results

Both chemotherapy regimens resulted in significant decline in ovarian reserve compared to the tamoxifen-only treatment (p < 0.0001 either regimen vs. tamoxifen for overall trend). AMH levels sharply declined at 12 months but did not show a significant recovery from 12 to 18 and 18 to 24 months after the completion of AC-based or CMF regimens. The degree of decline did not differ between the two chemotherapy groups (p = 0.53). In contrast, tamoxifen-only treatment did not significantly alter the age-adjusted serum AMH levels over the 24-month follow up. Likewise, the use of adjuvant tamoxifen following AC-based regimens did not affect AMH recovery.

Conclusions

Both AC-based regimens and CMF significantly compromise ovarian reserve, without a recovery beyond 12 months post-chemotherapy. In contrast, tamoxifen-only treatment does not seem to alter ovarian reserve. These data indicate that the commonly used chemotherapy regimens but not the hormonal therapy compromise future reproductive potential.
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Metadata
Title
Impact of adjuvant chemotherapy or tamoxifen-alone on the ovarian reserve of young women with breast cancer
Authors
Shari B. Goldfarb
Volkan Turan
Giuliano Bedoschi
Enes Taylan
Nadia Abdo
Tessa Cigler
Heejung Bang
Sujita Patil
Maura N. Dickler
Kutluk H. Oktay
Publication date
01-01-2021
Publisher
Springer US
Published in
Breast Cancer Research and Treatment / Issue 1/2021
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-020-05933-7

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