Chemotherapy as part of lung cancer treatment was associated with early-onset menopause in younger women, researchers reported.

In an analysis of premenopausal women who were diagnosed with lung cancer before the age of 50, 64% of women who received chemotherapy said they began menopause during the year post-diagnosis, according to Elizabeth Cathcart-Rake, MD, of the Mayo Clinic in Rochester, Minnesota, and colleagues.

This was in contrast to the 15% of patients who didn’t undergo any systemic therapy within a year of diagnosis who self-reported early menopause, the researchers wrote in Menopause.

“While prior studies suggest that alkylating agents are responsible for much of the ovarian toxicity experienced by young women with certain cancers, it is clear from these findings and others that nonalkylating agents can also damage ovarian function,” explained Cathcart-Rake’s group.

The study population consisted of 182 premenopausal women with average age of 43 at lung cancer diagnosis; just under half had received systemic chemotherapy in the year after diagnosis.

Most of the women who underwent chemotherapy in the study received platinum chemotherapy agents, including cisplatin and carboplatin. Around two-thirds of these women also received taxane agents including paclitaxel and docetaxel, a third of women received antimetabolite agents (pemetrexed and gemcitabine [Gemzar]), and 29% received a topoisomerase inhibitor, such as etoposide or topotecan. Few women in the study received other chemotherapy agents, such as epothilone or vinorelbine (Navelbine).

Also, 26 patients received targeted therapies, including epidermal growth factor receptor, vascular endothelial growth factor, CD20, anaplastic lymphoma kinase, and human epidermal growth factor inhibitors. The authors’ analysis only included three of these patients, which was a study limitation. Among these three women, two remained perimenopausal throughout the follow-up period, while one patient reported being postmenopausal 2 years after her diagnosis.

“Among women who received chemotherapy, those who were older at diagnosis reported becoming postmenopausal after fewer years than women who were younger at diagnosis,” the authors noted.

In addition to self-reporting of cancer therapies and menopausal status, other study limitations included the small sample size, which didn’t allow the authors to separately assess the women ages <45. Because of this, the group wrote “conversions from pre to postmenopausal status may concordantly be explained by variables such as time to follow-up, age, and smoking status.”

In a statement, JoAnn Pinkerton, MD, executive director of The North American Menopause Society, praised the study for drawing attention to this relationship, noting that “although more definitive research is needed, premenopausal women who need chemotherapy for lung cancer appear to have a similar risk of amenorrhea, early menopause, and loss of fertility as premenopausal women receiving chemotherapy for breast cancer and lymphoma.”

Pinkerton added that premenopausal women with lung cancer must be educated by their healthcare providers regarding the potential risks of chemotherapy-related amenorrhea, menopause issues — hot flashes, vaginal dryness, and bone loss — and the potential loss of fertility before treatment with chemotherapy is initiated.

last updated 08.30.2018

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