Five-year changes in ovarian function restoration in premenopausal patients with breast cancer taking tamoxifen after chemotherapy: An ASTRRA study report
- Authors
- Kim, H.J.[Kim, H.J.]; Noh, W.C.[Noh, W.C.]; Nam, S.J.[Nam, S.J.]; Park, B.-W.[Park, B.-W.]; Lee, E.S.[Lee, E.S.]; Im, S.A.[Im, S.A.]; Jung, Y.S.[Jung, Y.S.]; Yoon, J.H.[Yoon, J.H.]; Kang, S.S.[Kang, S.S.]; Park, K.H.[Park, K.H.]; Lee, S.-J.[Lee, S.-J.]; Jeong, J.[Jeong, J.]; Lee, M.H.[Lee, M.H.]; Cho, S.H.[Cho, S.H.]; Kim, S.Y.[Kim, S.Y.]; Kim, H.-A.[Kim, H.-A.]; Han, S.-H.[Han, S.-H.]; Han, W.[Han, W.]; Hur, M.H.[Hur, M.H.]; Kim, S.[Kim, S.]; Ahn, S.H.[Ahn, S.H.]
- Issue Date
- Jul-2021
- Publisher
- Elsevier Ltd
- Keywords
- Chemotherapy; E2; FSH; Menstruation; Ovarian function; Tamoxifen
- Citation
- European Journal of Cancer, v.151, pp.190 - 200
- Indexed
- SCIE
SCOPUS
- Journal Title
- European Journal of Cancer
- Volume
- 151
- Start Page
- 190
- End Page
- 200
- URI
- https://scholarworks.bwise.kr/skku/handle/2021.sw.skku/91950
- DOI
- 10.1016/j.ejca.2021.03.017
- ISSN
- 0959-8049
- Abstract
- Background: Adding ovarian function suppression (OFS) after chemotherapy improves survival in young women with moderate- and high-risk breast cancer. Assessment of ovarian function restoration after chemotherapy becomes critical for subsequent endocrine treatment and addressing fertility issues. Patients and methods: In the adding OFS after chemotherapy trial, patients who resumed ovarian function up to 2 years after chemotherapy were randomised to receive either 5 years of tamoxifen or adding 2 years of OFS with tamoxifen. Ovarian function was evaluated from enrolment to randomisation, and patients who did not randomise because of amenorrhoea for 2 years received tamoxifen and were followed up for 5 years. Prospectively collected consecutive hormone levels (proportion of patients with premenopausal follicle-stimulating hormone [FSH] levels <30 mIU/mL and oestradiol [E2] levels ≥40 pg/mL) and history of menstruation were available for 1067 patients with breast cancer. Results: Over 5 years of tamoxifen treatment, 69% of patients resumed menstruation and 98% and 74% of patients satisfied predefined ovarian function restoration as per serum FSH and E2 levels, respectively. Menstruation was restored in 91% of patients younger than 35 years at baseline, but in only 33% of 45-year-old patients over 5 years. Among these patients, 41% experienced menstruation restoration within 2 years after chemotherapy and 28% slowly restored menstruation after 2–5 years. Younger age (<35 years) at baseline, anthracycline without taxanes and ≤90 days of chemotherapy were predictors of menstruation restoration. Conclusions: During 5 years of tamoxifen treatment after chemotherapy, two-thirds of the patients experienced menstruation restoration, especially patients younger than 35 years. Young age, Adriamycin without taxanes and short duration of chemotherapy appeared to have a positive effect on ovarian reserves in the long term. Trial registration: ClinicalTrials.gov identifier: NCT00912548. © 2021 Elsevier Ltd
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