How to Treat Hot Flashed in Women with Breast Cancer Treated with Endocrine Therapy?

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • The Arimidex, Tamoxifen, Alone or in Combination trial (ATAC):
    • Found hot flashes are a frequent side effect of anti-estrogen therapy:
      • However:
        • Anastrozole was associated with significantly fewer hot flashes than tamoxifen:
          • 34% vs 40%:
            • p<0.0001
    • Because of their negative influence on overall quality of life:
      • Hot flashes:
        • May decrease medication compliance
    • Hot flashes may be decreased or alleviated:
      • With non-hormonal therapies:
        • A recent systematic review of 13 randomized controlled trials compared possible non-hormonal agents for hot flash treatments:
          • Hot flash reduction was equivalent regardless of patient use of tamoxifen or aromatase inhibitor
        • Citalopram 10 mg, 20 mg, and 30 mg daily:
          • Had comparable outcomes
        • Venlafaxine 75 mg daily:
          • Improved hot flashes and alleviated hot flash symptoms:
            • Faster than clonidine
        • Gabapentin 900 mg daily was more effective than 300 mg
        • Paroxetine 10 mg daily had fewer side effects than 20 mg
        • Interestingly:
          • Acupuncture had similar efficacy to venlafaxine and gabapentin and:
            • Was suggested to have longer durability with fewer side effects
        • Vitamin E has been found to have modest effectiveness:
          • At best in small clinical trials

REFERENCES

  1. Baum M, Budzar AU, Cuzick J, et al. Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early breast cancer: first results of the ATAC randomised trial. Lancet. 2002;359(9324):2131-2139.
  2. Johns C, Seav SM, Dominick SA, et al. Informing hot flash treatment decisions for breast cancer survivors: a systematic review of randomized trials comparing active interventions. Breast Cancer Res Treat. 2016;156(3):415-426.
  3. Bordeleau L, Pritchard K, Goodwin P, Loprinzi C. Therapeutic options for the management of hot flashes in breast cancer survivors: an evidence-based review. Clin Ther. 2007;29(2):230-241.
  4. Loprinzi CL, Wolf SL, Barton DL, Laack NN. Symptom management in premenopausal patients with breast cancer. Lancet Oncol. 2008;9(10):993-1001.

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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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