The rates of chemotherapy-induced amenorrhea in patients treated with adjuvant doxorubicin and cyclophosphamide followed by a taxane

Yee Lu Tham, Krystal Sexton, Heidi Weiss, Richard M Elledge, Lois C. Friedman, Rita Kramer

Research output: Contribution to journalArticle

112 Citations (Scopus)

Abstract

OBJECTIVE: Adjuvant chemotherapy in premenopausal women with breast cancer may induce amenorrhea, which can affect fertility, choice of hormonal therapy, and increase the risk of late toxicity. The incidence of chemotherapy-induced amenorrhea (CIA) resulting from doxorubicin and cyclophosphamide (AC) followed by a taxane (T) is poorly characterized. METHODS: We retrospectively surveyed women who were premenopausal and less than age 50 at initiation of chemotherapy to determine the rates of CIA in women receiving AC followed by T compared with AC alone. RESULTS: One hundred ninety-one eligible women completed the survey. The rate of CIA in women who received AC followed by T was 64% (95% confidence interval [CI] = 55-72%) compared with 55% (95% CI = 43-66%) in AC alone. As expected, CIA rates were higher in older than younger women (82% vs. 55%, P = 0.004). Multivariate logistic regression analysis revealed that age >40 was associated with a 4.6-fold increased risk of CIA (95% CI = 1.7-12.1, P = 0.002). It also revealed that receiving T after AC was associated with an odds ratio of 1.9 for CIA as compared with receiving AC alone (95% CI = 1.0-3.5, P = 0.05). Despite ≥6 months of amenorrhea, many women ≤40 resumed menses (40%). CIA was more likely to be irreversible in those >40. The addition of taxanes did not alter the rate of reversibility for the group as a whole (P = 0.36). CONCLUSIONS: Older age and the addition of taxane to AC increased the risk of CIA and the amenorrhea was more likely to be irreversible for women >40. Women ≤40 often resume menstruation even after 6 months of amenorrhea, and the addition of T does not play a role. Subsequent resumption of menstrual function must be considered when initiating appropriate hormonal therapy.

Original languageEnglish (US)
Pages (from-to)126-132
Number of pages7
JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
Volume30
Issue number2
DOIs
StatePublished - Apr 2007
Externally publishedYes

Fingerprint

Amenorrhea
Doxorubicin
Cyclophosphamide
Drug Therapy
Confidence Intervals
Menstruation
taxane
Taxoids
Adjuvant Chemotherapy
Fertility
Logistic Models
Odds Ratio
Regression Analysis
Breast Neoplasms

Keywords

  • Amenorrhea
  • Breast cancer
  • Chemotherapy
  • Reversibility
  • Taxane

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

The rates of chemotherapy-induced amenorrhea in patients treated with adjuvant doxorubicin and cyclophosphamide followed by a taxane. / Tham, Yee Lu; Sexton, Krystal; Weiss, Heidi; Elledge, Richard M; Friedman, Lois C.; Kramer, Rita.

In: American Journal of Clinical Oncology: Cancer Clinical Trials, Vol. 30, No. 2, 04.2007, p. 126-132.

Research output: Contribution to journalArticle

Tham, Yee Lu ; Sexton, Krystal ; Weiss, Heidi ; Elledge, Richard M ; Friedman, Lois C. ; Kramer, Rita. / The rates of chemotherapy-induced amenorrhea in patients treated with adjuvant doxorubicin and cyclophosphamide followed by a taxane. In: American Journal of Clinical Oncology: Cancer Clinical Trials. 2007 ; Vol. 30, No. 2. pp. 126-132.
@article{81223b4bc6024ba0a9bdcff4d9b8e483,
title = "The rates of chemotherapy-induced amenorrhea in patients treated with adjuvant doxorubicin and cyclophosphamide followed by a taxane",
abstract = "OBJECTIVE: Adjuvant chemotherapy in premenopausal women with breast cancer may induce amenorrhea, which can affect fertility, choice of hormonal therapy, and increase the risk of late toxicity. The incidence of chemotherapy-induced amenorrhea (CIA) resulting from doxorubicin and cyclophosphamide (AC) followed by a taxane (T) is poorly characterized. METHODS: We retrospectively surveyed women who were premenopausal and less than age 50 at initiation of chemotherapy to determine the rates of CIA in women receiving AC followed by T compared with AC alone. RESULTS: One hundred ninety-one eligible women completed the survey. The rate of CIA in women who received AC followed by T was 64{\%} (95{\%} confidence interval [CI] = 55-72{\%}) compared with 55{\%} (95{\%} CI = 43-66{\%}) in AC alone. As expected, CIA rates were higher in older than younger women (82{\%} vs. 55{\%}, P = 0.004). Multivariate logistic regression analysis revealed that age >40 was associated with a 4.6-fold increased risk of CIA (95{\%} CI = 1.7-12.1, P = 0.002). It also revealed that receiving T after AC was associated with an odds ratio of 1.9 for CIA as compared with receiving AC alone (95{\%} CI = 1.0-3.5, P = 0.05). Despite ≥6 months of amenorrhea, many women ≤40 resumed menses (40{\%}). CIA was more likely to be irreversible in those >40. The addition of taxanes did not alter the rate of reversibility for the group as a whole (P = 0.36). CONCLUSIONS: Older age and the addition of taxane to AC increased the risk of CIA and the amenorrhea was more likely to be irreversible for women >40. Women ≤40 often resume menstruation even after 6 months of amenorrhea, and the addition of T does not play a role. Subsequent resumption of menstrual function must be considered when initiating appropriate hormonal therapy.",
keywords = "Amenorrhea, Breast cancer, Chemotherapy, Reversibility, Taxane",
author = "Tham, {Yee Lu} and Krystal Sexton and Heidi Weiss and Elledge, {Richard M} and Friedman, {Lois C.} and Rita Kramer",
year = "2007",
month = "4",
doi = "10.1097/01.coc.0000251398.57630.4f",
language = "English (US)",
volume = "30",
pages = "126--132",
journal = "American Journal of Clinical Oncology",
issn = "0277-3732",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - The rates of chemotherapy-induced amenorrhea in patients treated with adjuvant doxorubicin and cyclophosphamide followed by a taxane

AU - Tham, Yee Lu

AU - Sexton, Krystal

AU - Weiss, Heidi

AU - Elledge, Richard M

AU - Friedman, Lois C.

AU - Kramer, Rita

PY - 2007/4

Y1 - 2007/4

N2 - OBJECTIVE: Adjuvant chemotherapy in premenopausal women with breast cancer may induce amenorrhea, which can affect fertility, choice of hormonal therapy, and increase the risk of late toxicity. The incidence of chemotherapy-induced amenorrhea (CIA) resulting from doxorubicin and cyclophosphamide (AC) followed by a taxane (T) is poorly characterized. METHODS: We retrospectively surveyed women who were premenopausal and less than age 50 at initiation of chemotherapy to determine the rates of CIA in women receiving AC followed by T compared with AC alone. RESULTS: One hundred ninety-one eligible women completed the survey. The rate of CIA in women who received AC followed by T was 64% (95% confidence interval [CI] = 55-72%) compared with 55% (95% CI = 43-66%) in AC alone. As expected, CIA rates were higher in older than younger women (82% vs. 55%, P = 0.004). Multivariate logistic regression analysis revealed that age >40 was associated with a 4.6-fold increased risk of CIA (95% CI = 1.7-12.1, P = 0.002). It also revealed that receiving T after AC was associated with an odds ratio of 1.9 for CIA as compared with receiving AC alone (95% CI = 1.0-3.5, P = 0.05). Despite ≥6 months of amenorrhea, many women ≤40 resumed menses (40%). CIA was more likely to be irreversible in those >40. The addition of taxanes did not alter the rate of reversibility for the group as a whole (P = 0.36). CONCLUSIONS: Older age and the addition of taxane to AC increased the risk of CIA and the amenorrhea was more likely to be irreversible for women >40. Women ≤40 often resume menstruation even after 6 months of amenorrhea, and the addition of T does not play a role. Subsequent resumption of menstrual function must be considered when initiating appropriate hormonal therapy.

AB - OBJECTIVE: Adjuvant chemotherapy in premenopausal women with breast cancer may induce amenorrhea, which can affect fertility, choice of hormonal therapy, and increase the risk of late toxicity. The incidence of chemotherapy-induced amenorrhea (CIA) resulting from doxorubicin and cyclophosphamide (AC) followed by a taxane (T) is poorly characterized. METHODS: We retrospectively surveyed women who were premenopausal and less than age 50 at initiation of chemotherapy to determine the rates of CIA in women receiving AC followed by T compared with AC alone. RESULTS: One hundred ninety-one eligible women completed the survey. The rate of CIA in women who received AC followed by T was 64% (95% confidence interval [CI] = 55-72%) compared with 55% (95% CI = 43-66%) in AC alone. As expected, CIA rates were higher in older than younger women (82% vs. 55%, P = 0.004). Multivariate logistic regression analysis revealed that age >40 was associated with a 4.6-fold increased risk of CIA (95% CI = 1.7-12.1, P = 0.002). It also revealed that receiving T after AC was associated with an odds ratio of 1.9 for CIA as compared with receiving AC alone (95% CI = 1.0-3.5, P = 0.05). Despite ≥6 months of amenorrhea, many women ≤40 resumed menses (40%). CIA was more likely to be irreversible in those >40. The addition of taxanes did not alter the rate of reversibility for the group as a whole (P = 0.36). CONCLUSIONS: Older age and the addition of taxane to AC increased the risk of CIA and the amenorrhea was more likely to be irreversible for women >40. Women ≤40 often resume menstruation even after 6 months of amenorrhea, and the addition of T does not play a role. Subsequent resumption of menstrual function must be considered when initiating appropriate hormonal therapy.

KW - Amenorrhea

KW - Breast cancer

KW - Chemotherapy

KW - Reversibility

KW - Taxane

UR - http://www.scopus.com/inward/record.url?scp=34147175631&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34147175631&partnerID=8YFLogxK

U2 - 10.1097/01.coc.0000251398.57630.4f

DO - 10.1097/01.coc.0000251398.57630.4f

M3 - Article

C2 - 17414460

AN - SCOPUS:34147175631

VL - 30

SP - 126

EP - 132

JO - American Journal of Clinical Oncology

JF - American Journal of Clinical Oncology

SN - 0277-3732

IS - 2

ER -