El efecto de los taxanos en la menstruación y de ovario reserva en mujeres con cáncer de mama

OBJECTIVE:

Taxanes are frequently used for the treatment of breast cancer but their impact on ovarian function is unknown. Our goal was to compare the impact of addition of taxanes to two otherwise identical chemotherapy protocols on menstruation and ovarian reserve.

DESIGN:

Prospective.

MATERIALS AND METHODS:

86 breast cancer patients with regular menstrual cycles prior to chemotherapy were evaluated. Patients either received Adriamycin/Cyclophosphamide/Taxane (ACT, n = 67) or Adriamycin/Cyclophosphamide (AC, n = 19) as adjuvant chemotherapy.

RESULTS:

Women who received ACT or AC were similar in age (34.8 ± 0.5 vs. 34.5 ± 1.3 years). The total dose of AC and the mean follow up after chemotherapy (2.67 ± 0.3 vs. 2.12 ± 0.7 years) were also similar for both groups. In the ACT group, a significantly larger proportion of patients experienced amenorrhea (45/67 vs. 8/19, P<0.05) and a lower number of patients showed no alteration in menstruation while receiving chemotherapy (16/67 vs. 9/19, P<0.05). The remaining patients had oligomenorrhea after chemothreapy but there was no significant difference between the two groups (6/67 vs. 2/19). A significantly higher number of patients failed to regain menstruation after ACT compared to AC (8/45 vs. 0/8, P<0.05). Of those who regained menstrual function, there was no difference in amenorrhea duration between ACT and AC groups (6.7 ± 2.0 vs. 7.4 ± 0.8 months). A trend towards significantly higher cycle day 2 FSH (21.2 ± 5.5 vs. 11.8 ± 2.1 mlU/ml) and E2 (73.5 ± 16.0 vs. 39.5 ± 15.2 pg/ml) levels was observed for those who received ACT vs. AC (P=0.07).

CONCLUSION:

The addition of taxanes was associated with higher rates of temporary and permanent amenorrhea. The observed trend for higher baseline FSH and E2 levels in women who received ACT indicates that taxanes may be detrimental to ovarian reserve.