Between December 2015 and June 2017, 101
breast cancer patients of age ≤ 45 years with stages I to III had been enrolled. The patients were assigned without interference to receive either (neo)
adjuvant chemotherapy with
goserelin (
goserelin group) or without
goserelin (
chemotherapy group) as their own selection. AMH and menstrual status were evaluated before, during and 0.5 year, 1 year after
chemotherapy. Primary end point was the incidence of low AMH value (<0.4 μg/L) at the end of 1 year. Secondary end point was the incidence of
amenorrhea (the absence of menses in the preceding 12 months after assignment).
RESULTS: In the study, 51 patients chose to join the
chemotherapy group, while the other 50 patients selected
goserelin to preserve their ovarian reserve function. More unmarried or childless,
hormone receptors negative,receiving
breast conservation therapy patients with earlier stage selected
goserelin before
chemotherapy. The incidence of low AMH value was significantly higher in
chemotherapy group than in
goserelin group (74.5% vs. 38.0%, P<0.001) in 1 year after
chemotherapy. The incidence of
amenorrhea was consistent with AMH (56.9% vs. 24.0%, P=0.001). And more patients' menstruation (78.9% vs. 54.5%) and AMH value (71.0% vs. 53.8%) recovered in
goserelin group within 6 months after
chemotherapy. In subgroup analysis, AMH and menstruation seemingly recovered more in
goserelin group independent of age,
chemotherapy regimen and use of
tamoxifen. Especially, AMH value of 36.4% (8/22) patients in
chemotherapy group and 18.4% (7/38) patients in
goserelin group still maintained low level (<0.4 μg /L) although their menstruation had recovered 1 year after
chemotherapy. In addition, 41 patients (20 patients in
chemotherapy group, 21 patients in
goserelin group) could be evaluated for the dynamic change of AMH and menstrual status during
chemotherapy. The mean level of AMH in
chemotherapy group declined rapidly to very low level before the 3rd cycle, while 70% of the patients kept presence of menstruation. At the same time, the mean level of AMH in
goserelin group was still above 0.4 μg /L, but all of the patients had menopause.
CONCLUSION: Our study has offered evidence that
Goserelin with
chemotherapy could protect against ovarian reserve failure for young
breast cancer patients, now that more patients' AMH value recovered earlier who had selected co-treatment. AMH may be a more precise marker than menstrual status to clinically evaluate ovarian reserve function pre-, during and post-
chemotherapy.