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Five-year changes in ovarian function restoration in premenopausal patients with breast cancer taking tamoxifen after chemotherapy: An ASTRRA study report

 Hee J Kim  ;  Woo C Noh  ;  Seok J Nam  ;  Byeong-Woo Park  ;  Eun S Lee  ;  Seock A Im  ;  Yong S Jung  ;  Jung H Yoon  ;  Sung S Kang  ;  Kyong H Park  ;  Soo-Jung Lee  ;  Joon Jeong  ;  Min H Lee  ;  Se H Cho  ;  Sung Y Kim  ;  Hyun-Ah Kim  ;  Se-Hwan Han  ;  Wonshik Han  ;  Min H Hur  ;  Seonok Kim  ;  Sei H Ahn 
 EUROPEAN JOURNAL OF CANCER, Vol.151 : 190-200, 2021-07 
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Chemotherapy ; E2 ; FSH ; Menstruation ; Ovarian function ; Tamoxifen
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.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Park, Byeong Woo(박병우) ORCID logo https://orcid.org/0000-0003-1353-2607
Jeong, Joon(정준) ORCID logo https://orcid.org/0000-0003-0397-0005
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