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

  • 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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