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. 2022 Feb;17(1):10-15.
doi: 10.1159/000514445. Epub 2021 Mar 4.

Is Anti-Müllerian Hormone a Marker of Ovarian Reserve in Young Breast Cancer Patients Receiving a GnRH Analog during Chemotherapy?

Rosalba Torrisi  1 , Vera Basilico  2 , Laura Giordano  1 , Michele Caruso  3 , Antonino Musolino  4 , Marta Noemi Monari  5 , Carlo Carnaghi  2   3 , Armando Santoro  1   6
Affiliations

Is Anti-Müllerian Hormone a Marker of Ovarian Reserve in Young Breast Cancer Patients Receiving a GnRH Analog during Chemotherapy?

Rosalba Torrisi et al. Breast Care (Basel). 2022 Feb.

Abstract

Introduction: Anti-Müllerian hormone (AMH) is the most reliable biomarker of ovarian reserve; however, its role in predicting ovarian recovery after chemotherapy is unclear. Administration of a GnRH analog (GnRHa) during chemotherapy significantly reduces the ovarian failure rate and increases the pregnancy rate. The available data on the behavior of AMH during concurrent administration of chemotherapy and GnRHa are inconsistent. We investigated whether concurrent administration of triptorelin and adjuvant chemotherapy might reduce the expected drop of AMH.

Methods: Eligible patients were premenopausal women aged <40 years, with a diagnosis of early breast cancer, and candidates to 4-8 cycles of adjuvant chemotherapy. Triptorelin (3.75 mg i.m.) was started before chemotherapy and administered every 4 weeks thereafter. The principal endpoint was the proportion of patients with an AMH percent change ≤50% between 12 months after chemotherapy and basal levels. The secondary endpoint was the proportion of patients achieving postchemotherapy AMH levels above the threshold of 0.2 ng/mL.

Results: Fifty patients were enrolled, 31 of whom had blood samples available at baseline and 1 year after the end of chemotherapy. AMH decreased to nearly undetectable levels after chemotherapy and recovered after 12 months, but they did not exceed 1 tenth of the pretreatment levels. As for the secondary endpoint, 15 of the 31 patients recovered AMH levels above the threshold.

Conclusions: This study did not reach its principal endpoint; however, the rate of 48% of patients who recovered AMH above threshold levels favorably compared with those in studies without concurrent GnRHa, supporting a better recovery of AMH with triptorelin.

Keywords: Anti-Müllerian hormone; Chemotherapy; GnRh analog; Ovarian function protection.

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Conflict of interest statement

R.T.: participation on the advisory board of and recipient of speaker fees from MSD, Pfizer, Lilly, and the Istituto Gentili. A.M.: advisory boards of Roche, Novartis, Pfizer, Lilly, Macrogenics, and Eisai. A.S.: participation on the advisory board of and recipient of speaker fees from Sandoz, Servier, EISAI, Roche, Novartis, Gilead, Pfizer, and BMS.

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