- •Estrone might be a better marker then estradiol to detect ovarian reactivation.
- •Breast cancer patients aged 36 to 56 years need to be monitored closely during adjuvant treatment with aromatase inhibitors
Background and Purpose
Ovarian function recovery (OFR) during adjuvant use of an aromatase inhibitor (AI) negatively impacts breast cancer outcome. We measured serum FSH and estrogen levels in consecutive AI-users with an uncertain menopausal status during follow-up and report associated risk factors of OFR
A retrospective cross sectional observational monocentric study including breast cancer patients in follow-up using an adjuvant AI, age 36 to 56 years, with at least one serum estradiol (E2) and estrone (E1) measurement between 2013 and 2020. Estrogens were quantified using a sensitive liquid chromatography-tandem mass spectrometry method (LC-MS/MS). Women on LHRH agonist were included while those with a bilateral oophorectomy or ovarian irradiation were not. We aimed to identify risk factors of OFR considering age, body mass index (BMI), previous chemotherapy and duration of AI use. Univariable analysis was used to evaluate risk factors of OFR.
E2/E1 levels were assessed in 207 patients with a median age of 50 years (range 36-56). 17 of 159 on AI (10.7%) and 3 of 48 on AI + LHRH (6.3%) had OFR. Seven out of 17 patients (41,2%) with OFR in the AI only group and 2 out of 3 patients (66,7%) in the AI+LHRH agonist group were in amenorrhea. Age <50 y and adjuvant chemotherapy were statistically significantly different between the OFR group and the group with postmenopausal estrogen levels.
Breast cancer patients aged 36 to56 years need to be monitored closely during adjuvant treatment with aromatase inhibitors: to confirm menopausal status, to evaluate compliance and to ensure ovarian activity remains adequately suppressed. Estrone might be a better marker then estradiol to detect ovarian reactivation.
Abbreviation:OFR (Ovarian function recovery), OFS (Ovarian function suppression), LHRH (luteinizing hormone-releasing hormone), TES (total estrogen suppression), LC-MS/MS (liquid chromatography-tandem mass spectrometry), CIA (chemotherapy induced amenorrhea), LLOQ (lower limit of quantification)
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Published online: September 27, 2022
Accepted: September 24, 2022
Received in revised form: March 30, 2022
Received: November 21, 2021
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