In these 151, median age at diagnosis was 41 years (range = 24–49), and median time from last chemotherapy dose to survey completion was 62.5 months (range = 2–138). Of 273 women who consented, 258 completed the web survey, and 151 had analyzable menstrual data.
#HAZEL 4 YOU PROSTSTE SKIN#
Exclusion criteria included receipt of multiple regimens or no chemotherapy receipt of ovarian suppression medication (GnRH agonist) surgical menopause or other cause of amenorrhea before or at the same time as diagnosis incomplete menstrual data diagnosis with a cancer other than breast cancer, nonmelanoma skin cancer, or carcinoma in situ of the cervix report of an unknown regimen and no date available for last chemotherapy dose without an LMP within a month before survey completion. Receipt of trastuzumab and/or pertuzumab was ignored when defining the last chemotherapy dose because prior research has not found that these are gonadotoxic.
When available, medical record data regarding type of chemotherapy received were used. Date of patient-reported LMP was compared with date of final chemotherapy dose (according to medical record, if available, or patient-report, if unavailable) to determine if the LMP occurred before or after the last chemotherapy dose. Medical record abstraction was performed by a single physician. After return of both, they were asked to complete a web-based survey that inquired about the receipt, type, and dates of chemotherapy and antiestrogen medication, as well as the date of their last menstrual period (LMP). Respondents were mailed a paper consent form and an authorization form to access their medical records. In our retrospective cohort study, women diagnosed with breast cancer when they were aged younger than 50 years, and within the past 10 years, were recruited through a Dr Susan Love Research Foundation Army of Woman e-mail request. However, menopausal status was evaluated less than half a year after completion of docetaxel/carboplatin in that study, which may not have allowed adequate time for menstrual recovery.
Lambertini and colleagues evaluated rates of CRA in patients with HER-2 positive cancers and found that three-quarters of young women who received TCH experienced amenorrhea, corresponding to a higher risk than anthracycline-based regimens (adjusted OR 2.24, 95% CI = 1.18 to 4.27) ( 7). However, little is known about rates of CRA following a TCH regimen. Ĭommon regimens for the treatment of human epidermal growth factor receptor 2 (HER2)–positive disease include doxorubicin/cyclophosphamide followed by paclitaxel and trastuzumab (ACT-H) and docetaxel/carboplatin/trastuzumab (TCH). Although several studies have demonstrated that rates of amenorrhea are not significantly different with the addition of taxanes or trastuzumab to anthracycline-based regimens ( 5, 6), others have suggested that there may be an increased likelihood of amenorrhea with the addition of a taxane ( 7, 8). Older age and higher doses of alkylating agents are associated with increased incidence of CRA ( 4). This study suggests that carboplatin/taxane causes less CRA than cyclophosphamide-based regimens.Ĭhemotherapy-related amenorrhea (CRA) is a well-established toxicity associated with many breast cancer treatment regimens ( 1), and it has potential implications for quality of life, fertility, medical morbidity, and prognosis in young breast cancer survivors ( 2, 3).
Last menstrual period was before the last chemotherapy dose in 51% of the 86 participants who received anthracycline/cyclophosphamide/taxane, in 42% of the 43 who received only taxane/cyclophosphamide, and in 13% of the 15 who received carboplatin/taxane. In this study, accrued in collaboration with Army of Women, menstrual data were analyzed for 151 breast cancer survivors (median age = 41 years at diagnosis, and median time between last chemotherapy and survey = 62.5 months). For patients with human epidermal growth factor receptor 2–positive disease, anthracycline- and cyclophosphamide-sparing regimens (eg, carboplatin/taxane) are common (in combination with human epidermal growth factor receptor 2–directed therapy). However, the incidence of CRA after regimens that do not include either an anthracycline or a cyclophosphamide is poorly studied. Young women who have not begun or completed their desired childbearing at the time of diagnosis with breast cancer often wish to understand and minimize their risk of chemotherapy-related amenorrhea (CRA).
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