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Adjuvant Aromatase Inhibitors for Early Breast Cancer After Chemotherapy-Induced Amenorrhoea: Caution and Suggested Guidelines

Ian E. Smith, Mitch Dowsett, Yoon-Sim Yap, Geraldine Walsh, Per E. Lønning, Richard J. Santen, Daniel Hayes

From the Royal Marsden Hospital Institute of Cancer Research, London, United Kingdom; Section of Oncology, Department of Medicine, Haukeland University Hospital, Bergen, Norway; University of Virginia Health Sciences Center, Charlottesville, VA; and the University of Michigan Comprehensive Cancer Center, Ann Arbor, MI

Address reprint requests to Ian Smith, MD, Breast Unit, the Royal Marsden Hospital, Fulham Rd, London, SW3 6JJ United Kingdom; e-mail: ian.smith{at}rmh.nhs.uk

PURPOSE: Aromatase inhibitors (AIs) are now established as adjuvant therapy for early hormone receptor–positive breast cancer in postmenopausal women. Their use is sometimes extended to younger women after chemotherapy-induced amenorrhoea; we have audited this in one institution's breast unit, and we propose guidelines for use in such circumstances.

PATIENTS AND METHODS: The use of aromatase inhibitors as adjuvant therapy in younger women age 40 with hormone receptor–positive early breast cancer and chemotherapy-induced amenorrhea has been audited clinically and biochemically.

RESULTS: A total of 45 such women were identified in the audit, with a median age of 47 years (range, 39 to 52 years). Twelve women (27%) showed a return of ovarian function (10 renewed menses, one pregnancy, one biochemically premenopausal) after starting an AI. Median age at restart of ovarian function was 44 years (range, 40 to 50 years).

CONCLUSION: AIs may promote recovery of ovarian function in some women with chemotherapy-induced amenorrhea and should be used with caution. Biochemical monitoring of ovarian function requires highly sensitive immunoassays. Guidelines for the selection and delivery of adjuvant endocrine therapy in such patients are proposed.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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