AMH Test Helps Predict Adjuvant Chemotherapy Benefit in Premenopausal Breast Cancer

Hormone receptor-positive, human epidermal growth factor receptor 2-negative (HR+/HER2-) breast cancer can present a difficult treatment decision in premenopausal patients with low recurrence scores. Determining which women younger than 55 truly benefit from adding chemotherapy to endocrine therapy remains a persistent clinical challenge. Objective measures of ovarian function have been proposed to refine treatment selection, but their predictive value has remained unclear. New findings demonstrate that anti-Müllerian hormone (AMH) may help identify which patients are most likely to benefit from chemotherapy plus endocrine therapy in this setting.

Investigators at the Winship Cancer Institute at Emory University assessed whether hormones associated with ovarian reserve could predict the relative benefit of chemotherapy plus endocrine therapy (CET) versus endocrine therapy (ET) alone in women younger than 55 with hormone receptor-positive, HER2-negative breast cancer and a recurrence score (RS) of 25 or lower. Pretreatment serum levels of estradiol, progesterone, follicle-stimulating hormone, luteinizing hormone, anti-Müllerian hormone (AMH), and inhibin B were evaluated.

AMH, a marker of ovarian reserve, was assessed using a 10 pg/mL threshold representing normal ovarian reserve. Researchers observed a significant interaction between AMH status and treatment for invasive disease-free survival (IDFS). Among the 64% of women with AMH levels of 10 pg/mL or higher, IDFS favored CET over ET alone. In contrast, CET provided no apparent benefit among the 36% with AMH levels below 10 pg/mL. A similar pattern was observed for distant relapse-free survival.

The analysis included 1,556 participants younger than 55. Baseline levels of estradiol, progesterone, luteinizing hormone, and follicle-stimulating hormone did not predict benefit from CET. Ultrasensitive inhibin B, measured in the pg/mL range, was also found to predict chemotherapy benefit.

The findings come from patients with hormone receptor-positive, HER2-negative, node-positive breast cancer enrolled in SWOG S1007 (RxPONDER). The study, titled “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),” was published online July 24, 2026, in Annals of Oncology.

“These results move us closer to precision medicine. Rather than making treatment decisions based solely on age, we may soon be able to use objective biological measurements of menopausal status to identify who truly needs chemotherapy and who does not,” said Dr. Kevin Kalinsky, from the Winship Cancer Institute at Emory University.

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Winship Cancer Institute at Emory University