A blood test measuring anti-Müllerian hormone (AMH) may help identify premenopausal women with hormone receptor–positive, HER2-negative breast cancer who are unlikely to benefit from adjuvant chemotherapy, potentially allowing some patients to avoid unnecessary treatment.
The findings, published in Annals of Oncology, come from an analysis of the phase 3 RxPONDER trial, which previously established that postmenopausal women with 1 to 3 positive lymph nodes and a 21-gene recurrence score of 25 or lower can generally receive endocrine therapy without chemotherapy. Premenopausal women, however, showed an overall benefit from chemotherapy, creating uncertainty over whether all younger patients require it.
Researchers investigated whether blood markers of ovarian reserve could provide a more biologically precise way to distinguish patients who benefit. Pretreatment serum samples from 1556 women younger than 55 years were tested for AMH, inhibin B, and several other reproductive hormones.
AMH emerged as the strongest predictor. Women with AMH concentrations below 10 pg/mL, indicating low ovarian reserve, did not gain a measurable benefit from adding chemotherapy to endocrine therapy. By contrast, women with AMH concentrations of 10 pg/mL or higher had improved invasive disease-free survival with chemotherapy. Inhibin B showed a similar predictive pattern, whereas estradiol, progesterone, luteinizing hormone, and follicle-stimulating hormone did not.
Importantly, low AMH identified some women classified as premenopausal who did not benefit from chemotherapy. Among premenopausal participants younger than 55 years, approximately 21 percent had AMH below the 10-pg/mL threshold. The researchers concluded that ovarian reserve was more informative for predicting chemotherapy benefit than age or reported menopausal status.
The findings point toward a potential new diagnostic role for AMH beyond fertility assessment. However, implementation would require sufficiently sensitive laboratory methods: the clinically informative threshold was below the reliable measurement range of several existing commercial AMH assays. The authors therefore called for laboratories to optimize assay performance at very low concentrations and for the findings to be validated in additional clinical trials before AMH is routinely used to guide breast cancer treatment decisions.
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