1
|
Ruddy KJ, Schaid DJ, Partridge AH, Larson NB, Batzler A, Häberle L, Dittrich R, Widschwendter P, Fink V, Bauer E, Schwitulla J, Rübner M, Ekici AB, Aivazova-Fuchs V, Stewart EA, Beckmann MW, Ginsburg E, Wang L, Weinshilboum RM, Couch FJ, Janni W, Rack B, Vachon C, Fasching PA. Genetic predictors of chemotherapy-related amenorrhea in women with breast cancer. Fertil Steril 2019; 112:731-739.e1. [PMID: 31371054 DOI: 10.1016/j.fertnstert.2019.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/10/2019] [Accepted: 05/16/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To study how genetics may play a role in determining risk of chemotherapy-related amenorrhea (CRA) in young women with breast cancer. DESIGN Genome-wide association study. SETTING Not applicable. PATIENT(S) Premenopausal women ≤45 years of age enrolled in one of these three trials were included if they had at least one menstrual case report form after chemotherapy ended and if they were of European ancestry. Forms during and up to 3 months after receipt of GnRH agonist were excluded. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The association of single-nucleotide polymorphisms with post-chemotherapy menstruation adjusted for trial and arm, age, tamoxifen use, and nodal status. RESULT(S) The median age of the 1,168 women was 41 years (range 19-45). Among these, 457 (39%) never resumed menses after chemotherapy. Older age, tamoxifen use, and node-negative disease were associated with increased risk of CRA. Adjusting for these, rs147451859, in an intron of PPCDC (phosphopantothenoylcysteine decarboxylase), and rs17587029, located 5' upstream of RPS20P11 (ribosomal protein S20 pseudogene 11), were associated with post-chemotherapy menstruation. CONCLUSION(S) Genetic variation may contribute to risk of CRA. Better prediction of who will experience CRA may inform reproductive and treatment decision making in young women with cancer.
Collapse
Affiliation(s)
| | - Daniel J Schaid
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Ann H Partridge
- Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Nicholas B Larson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Anthony Batzler
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Ralf Dittrich
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Peter Widschwendter
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Visnja Fink
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Emanuel Bauer
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Judith Schwitulla
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias Rübner
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Arif B Ekici
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | | | - Elizabeth A Stewart
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Elizabeth Ginsburg
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Liewei Wang
- Department of Pharmacology, Mayo Clinic, Rochester, Minnesota
| | | | - Fergus J Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Celine Vachon
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| |
Collapse
|
3
|
Han W, Youn HJ. Clinical Studies Investigating the Use of Leuprorelin in Breast Cancer Patients from Asia. Asian Pac J Cancer Prev 2019; 20:1475-1479. [PMID: 31127911 PMCID: PMC6857887 DOI: 10.31557/apjcp.2019.20.5.1475] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Leuprorelin is a synthetic analogue of naturally occurring gonadotropin-releasing hormone. It is currently approved in the United States, Europe and Asia and has indications in advanced prostate cancer, endometriosis, breast cancer and precocious puberty. This review examined clinical trials of leuprorelin in women with breast cancer in Asia.
Collapse
Affiliation(s)
- Wonshik Han
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Cancer Hospital, Republic of Korea.
| | - Hyun Jo Youn
- Department of Surgery, Research Institute of Clinical Medicine, Chonbuk National University and Biomedical Research Institute, Chonbuk National University Hospital, Republic of Korea
| |
Collapse
|
4
|
Hildebrandt T, Oversohl N, Dittrich R, Lotz L, Beckmann MW, Lux MP. Can a University Reproductive Medicine Centre Be Financed Under the Pre-Existing General Conditions in Germany? Geburtshilfe Frauenheilkd 2019; 79:63-71. [PMID: 30686835 PMCID: PMC6336462 DOI: 10.1055/a-0749-9103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/16/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022] Open
Abstract
Background Reduced resources for financing healthcare services are available to the German health system. For this reason, demographic development represents one of the greatest challenges for the German health system. Reproductive medicine can offer potential solutions and counteract the ageing of the population through an increase in the birth rate. Most reproductive medical treatments take place in private centres. For the development of new, innovative therapeutic approaches, continuing education and scientific advancement, university centres are essential. Materials and Methods Using multistage contribution margin accounting, IVF and ICSI treatments at the University Fertility Centre Franken (UFF) were investigated in 2012. The cost situation from the perspective of the patient couple and the statutory payer were contrasted with the cost and revenue situation of the service provider as a university reproductive medicine centre. Results The costs for the patient couple for an IVF treatment cycle were 538.71 € and for an ICSI cycle, 700.07 €. For the payer, the costs, including the university flat rate (194.80 €) to be paid, amount to 733.51 € for an IVF cycle and 894.87 € for an ICSI cycle. The payments of the patient couple and the payer were added and this yielded total costs of 1272.22 € and 1594.94 €. The University Fertility Centre Franken, as a part of the Department of Gynaecology of the Erlangen University Hospital, incurred costs of 1364.47 € for an IVF treatment cycle and 1423.48 € for an ICSI treatment cycle. In addition, the OB/GYN clinic had to pay the university hospital a flat general expense rate of 14.9% of the income. There was thus a loss for the department of gynaecology of 281.81 € for an IVF cycle and 66.19 € for an ICSI cycle. Discussion From the perspective of a university reproductive medicine centre, IVF and ICSI treatments currently cannot be performed in a cost-covering manner. At the same time, a reproductive medicine treatment cycle represents a significant financial burden on the patient couple due to only partial cost coverage by most statutory health insurance funds. This therefore demonstrates a need for action in health policy to revise and, in the interest of the patient couples, reproductive medicine centres and, not least of all, in the interest of society, to improve existing cost absorption policies and thus also benefit from this as a society over the long term.
Collapse
Affiliation(s)
- Thomas Hildebrandt
- Erlangen University Hospital, Department of Gynecology and Obstetrics, CCC Erlangen EMN, Friedrich Alexander University, Erlangen, Germany
| | - Nicola Oversohl
- Erlangen University Hospital, Department of Gynecology and Obstetrics, CCC Erlangen EMN, Friedrich Alexander University, Erlangen, Germany
| | - Ralf Dittrich
- Erlangen University Hospital, Department of Gynecology and Obstetrics, CCC Erlangen EMN, Friedrich Alexander University, Erlangen, Germany
| | - Laura Lotz
- Erlangen University Hospital, Department of Gynecology and Obstetrics, CCC Erlangen EMN, Friedrich Alexander University, Erlangen, Germany
| | - Matthias W Beckmann
- Erlangen University Hospital, Department of Gynecology and Obstetrics, CCC Erlangen EMN, Friedrich Alexander University, Erlangen, Germany
| | - Michael P Lux
- Erlangen University Hospital, Department of Gynecology and Obstetrics, CCC Erlangen EMN, Friedrich Alexander University, Erlangen, Germany
| |
Collapse
|