A highly-sensitive anti-Müllerian hormone assay improves analysis of ovarian function following chemotherapy for early breast cancer

• Published in: European journal of cancer (1990) 2014-09, Vol.50 (14), p.2367-2374
• Main Authors: Chai, Joyce, Howie, A. Forbes, Cameron, David A, Anderson, Richard A
• Format: Article
• Language: English
• Subjects: AMH; Anti-Mullerian Hormone - analysis; Biological and medical sciences; Biomarkers, Tumor - analysis; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - physiopathology; Chemotherapy; Cohort Studies; Female; Hematology, Oncology and Palliative Medicine; Humans; Medical sciences; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Ovarian function; Ovarian Function Tests - methods; Ovarian reserve; Ovary - physiopathology; Pharmacology. Drug treatments; Prospective Studies; Sensitivity and Specificity; Tumors
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2014.06.011

Abstract Aim Anti-Müllerian hormone (AMH) shows promise as a biomarker of the ovarian reserve but current assays are insufficiently sensitive to allow assessment of this post-chemotherapy in most women. We have assessed a new highly sensitive AMH assay (Ansh picoAMH) in the evaluation of ovarian activity in women with very low ovarian reserve after chemotherapy. Methods A prospective cohort and an independent validation cohort of premenopausal women with early breast cancer (eBC) were recruited at the time of diagnosis (combined n = 98), and ovarian reserve markers 2–5 years later following chemotherapy were assessed in relation to menstrual activity. Results The picoAMH assay had a limit of detection of 7.5 pg/ml. AMH clearly distinguished women with ongoing menses from those with amenorrhoea at 2 years after diagnosis (mean 522 ± 169 versus 8.9 ± 1.3 pg/ml, P < 0.0001) with high predictive value for continuing menses or amenorrhoea for the subsequent 3 years. AMH was detectable in more women than using a previous assay ( P = 0.004). Other markers of the ovarian reserve (follicle-stimulating hormone (FSH), inhibin B) were also of discriminatory value but to lesser extents. This finding was validated in a second, independent cohort of women treated for eBC. Conclusion The 10-fold increased assay sensitivity showed very clear distinction between groups based on ovarian activity with excellent prediction of future menses or amenorrhoea. This will improve assessment of post-chemotherapy ovarian function in women and may aid treatment decisions.