Findings from the RxPONDER trial, whereby adjuvant chemotherapy followed by endocrine therapy compared with endocrine therapy alone has shown that "women with low pretreatment serum anti-Mullerian hormone (AMH) were unlikely to benefit from chemotherapy, even if younger than 50 years." In addition, AMH, a known measure of ovarian reserve, found that "usage of ovarian function suppression was low in premenopausal participants, with only 6% and 19% in the chemotherapy followed by endocrine therapy and endocrine therapy arms" respectively, thus the unmet need to determine benefit from adjuvant chemotherapy in order to avoid overtreatment especially in younger women.
Click here to read more about this study.
Sources mentioned:
Kalinsky K, Barlow WE, Pathak HB, et al. Ovarian reserve as a measure of adjuvant chemotherapy benefit in hormone receptor positive (HR-positive), HER2-negative, node-positive breast cancer in SWOG S1007 (RxPONDER) . Annals of Oncology; Published online 24 July 2026. DOI: 10.1016/j.annonc.2026.05.697
Valenza C, Partridge AH. Measurement of ovarian reserve to tailor systemic therapy decisions: future potential or ready for primetime? Annals of Oncology; Published online 8 July 2026. DOI: 10.1016/j.annonc.2026.07.002
This is a useful reminder that chronological age and self-reported menopause status are blunt tools when judging adjuvant chemotherapy benefit. A direct marker of ovarian reserve could help separate patients who still gain from treatment from those mainly exposed to toxicity. It is the sort of nuanced treatment-selection question that often comes up in onc brothers discussions, where the real issue is not doing more, but doing what still helps.
ReplyDeleteAMH as a pretreatment measure of ovarian reserve is such an elegant answer to a question that has frustrated oncologists for years — biology over self-reporting, always. The finding that low-AMH women are unlikely to benefit from chemotherapy, even under 50, could genuinely reshape who gets chemo in HR-positive, HER2-negative disease. The real win here is avoiding overtreatment for younger women who already face enough; that is exactly the kind of precision care this blog highlights so well.
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