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

Eur J Cancer. 2014 Sep;50(14):2367-74. doi: 10.1016/j.ejca.2014.06.011. Epub 2014 Jul 11.

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.

Keywords: AMH; Breast cancer; Chemotherapy; Ovarian function; Ovarian reserve.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Mullerian Hormone / analysis*
  • Biomarkers, Tumor / analysis
  • Breast Neoplasms / drug therapy*
  • Breast Neoplasms / physiopathology*
  • Cohort Studies
  • Female
  • Humans
  • Ovarian Function Tests / methods*
  • Ovary / physiopathology*
  • Prospective Studies
  • Sensitivity and Specificity

Substances

  • Biomarkers, Tumor
  • Anti-Mullerian Hormone