Management of hot flashes in women with breast cancer receiving ovarian function suppression

e12510 Background: Among premenopausal women with breast cancer (BC), adherence to endocrine therapy (ET) has often been reported suboptimal due to age-related adverse effects, lack of understandable information and inadequate social support. The current increased use of ovarian function suppression (OFS) may lead to even lower adherence rates in this group due to its high adverse effects profile. This study aims to assess the extent to which premenopausal patients comply with ET and to identify factors that hinder optimal adherence in Mexico. Methods: Women aged ≤50 years with primary stage I-III hormone receptor-positive BC receiving adjuvant ET for ≥1year were invited to fill a survey regarding their attitude towards ET and self-reported adherence. Fisher’s exact test was used to explore associations between categorical variables. This study was funded by AstraZeneca Mexico. Results: From Sep 2019 to Jan 2020, 127 patients with a median age of 45 years (range: 25-50) were included. Most had at least high school education (64%) and were unemployed (61%). ET distribution was: 69% tamoxifen (TMX) alone; 2% TMX switch to aromatase inhibitor (AI); 29% OFS plus TMX/AI. All patients recognized ET as a necessary part of their treatment and 97% believed it reduced their recurrence risk, yet 14% considered they had not received enough information about ET. Adverse effects were reported by 98%, predominantly hot flashes (82%), arthralgias (59%) and fatigue (58%). A statistically significant higher proportion of patients treated with a switch strategy or OFS experienced hot flashes, headache, insomnia, decreased libido and dyspareunia than those with TMX alone. Only 59% claimed their physician had taken measures to reduce these symptoms. Overall, 93% reported complete ET adherence. Nonetheless, 22% of them subsequently acknowledged missing 1-6 doses in the last month, the most common reasons being forgetfulness (78%), adverse effects (27%) and unwillingness to take the medication (11%). Unemployed patients were more likely to report daily compliance than students/employees (79% vs 60%; p = 0.02). No significant differences in adherence were found according to other factors, including type of ET. Conclusions: Premenopausal Mexican women self-report remarkably high rates of ET adherence. However, a considerable proportion misses ≥1 doses/month, with forgetfulness as the most common cause particularly in students/employees. Interventions aimed at reminding this group to take their ET and managing adverse effects could be crucial to improve adherence and, consequently, disease outcomes.

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Challenges in Treating Premenopausal Women with Endocrine-Sensitive Breast Cancer

American Society of Clinical Oncology Educational Book ◽

10.1200/edbk_159069 ◽

2016 ◽

pp. 23-32 ◽

Cited By ~ 7

Author(s):

Hatem A. Azim ◽

Nancy E. Davidson ◽

Kathryn J. Ruddy

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Side Effects ◽

Sexual Dysfunction ◽

Aromatase Inhibitor ◽

Endocrine Therapy ◽

Ovarian Function ◽

Hot Flashes ◽

Premenopausal Women ◽

Ovarian Function Suppression

For the hundreds of thousands of premenopausal women who are diagnosed annually with endocrine-sensitive breast cancer, treatment strategies are complex. For many, chemotherapy may not be necessary, and endocrine therapy decision making is paramount. Options for adjuvant endocrine regimens include tamoxifen for 5 years, tamoxifen for 10 years, ovarian function suppression (OFS) plus tamoxifen for 5 years, and OFS plus an aromatase inhibitor for 5 years. There are modest differences in efficacy between these regimens, with a benefit from OFS most obvious among patients with higher-risk disease; therefore, choosing which should be used for a given patient requires consideration of expected toxicities and patient preferences. An aromatase inhibitor cannot be safely prescribed without OFS in this setting. Additional research is needed to determine whether genomic tests such as Prosigna and Endopredict can help with decision making about optimal duration of endocrine therapy for premenopausal patients. Endocrine therapy side effects can include hot flashes, sexual dysfunction, osteoporosis, and infertility, all of which may impair quality of life and can encourage nonadherence with treatment. Ovarian function suppression worsens menopausal side effects. Hot flashes tend to be worse with tamoxifen/OFS, whereas sexual dysfunction and osteoporosis tend to be worse with aromatase inhibitors/OFS. Pregnancy is safe after endocrine therapy, and some survivors can conceive naturally. Still, embryo or oocyte cryopreservation should be considered at the time of diagnosis for patients with endocrine-sensitive disease who desire future childbearing, particularly if they will undergo chemotherapy.

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Is Estradiol Monitoring Necessary in Women Receiving Ovarian Suppression for Breast Cancer?

Journal of Clinical Oncology ◽

10.1200/jco.2015.65.3493 ◽

2016 ◽

Vol 34 (14) ◽

pp. 1573-1579 ◽

Cited By ~ 14

Author(s):

Antroula Papakonstantinou ◽

Theodoros Foukakis ◽

Kenny A. Rodriguez-Wallberg ◽

Jonas Bergh

Keyword(s):

Breast Cancer ◽

Ovarian Function ◽

Relevant Literature ◽

Hot Flashes ◽

Metastatic Carcinoma ◽

Axillary Node ◽

Receptor Expression ◽

Sensitive Assay ◽

Ki 67 ◽

Ovarian Function Suppression

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors’ suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 36-year-old premenopausal woman had been diagnosed with stage III breast cancer. After an initial biopsy confirmed breast cancer, she underwent mastectomy and axillary node dissection for a left-sided breast cancer, measuring 7 cm. The tumor had lobular histology and was considered grade 2 of 3. Metastatic carcinoma was identified in 10 of 13 axillary nodes. Immunohistochemical studies showed that the tumor was strongly positive for estrogen and progesterone receptor expression and had a Ki-67 score of 15% (> 20% is considered high according to a Swedish quality control study and the St Gallen Expert Consensus). 1 , 2 There was no amplification of the HER2/neu gene. Staging scans were negative for metastatic disease. In the adjuvant setting, she received three cycles of anthracycline-cyclophosphamide combination chemotherapy followed by three cycles of taxane chemotherapy and then locoregional radiotherapy. After completion of chemotherapy, she developed amenorrhea. As adjuvant endocrine therapy, she began monthly goserelin administration to achieve ovarian function suppression (OFS), in combination with the aromatase inhibitor (AI) exemestane. She experienced menopausal symptoms including hot flashes, vaginal dryness, and sexual dysfunction. After two monthly treatments with goserelin and exemestane, a sensitive assay for serum estradiol was checked and returned at 16 pg/mL (61 pmol/L); postmenopausal range for sensitive assay is less than 15 pg/mL (< 50 pmol/L). The patient has now been referred to our unit to discuss further management.

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103P Long-term results and bone-protective effect of everolimus added to letrozole and ovarian function suppression for premenopausal women with hormone receptor-positive, HER2-negative metastatic breast cancer: An updated analysis of the LEO study

Annals of Oncology ◽

10.1016/j.annonc.2021.03.117 ◽

2021 ◽

Vol 32 ◽

pp. S67

Author(s):

H. Jeong ◽

J.H. Jeong ◽

J.E. Kim ◽

J-H. Ahn ◽

K.H. Jung ◽

...

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Protective Effect ◽

Ovarian Function ◽

Metastatic Breast ◽

Premenopausal Women ◽

Long Term Results ◽

Ovarian Function Suppression ◽

Hormone Receptor Positive

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The Modern Landscape of Endocrine Therapy for Premenopausal Women with Breast Cancer

Breast Care ◽

10.1159/000439462 ◽

2015 ◽

Vol 10 (5) ◽

pp. 312-315 ◽

Cited By ~ 8

Author(s):

Lorenzo Rossi ◽

Olivia Pagani

Keyword(s):

Breast Cancer ◽

Endocrine Therapy ◽

Ovarian Function ◽

Treatment Options ◽

Endocrine Resistance ◽

Premenopausal Women ◽

New Drugs ◽

Fine Tuning ◽

Individual Risk ◽

Ovarian Function Suppression

The optimal endocrine therapy for premenopausal women with early and advanced breast cancer still remains an important and controversial issue. For over 30 years, tamoxifen has been the gold standard in the adjuvant setting. New therapeutic options, such as the addition of ovarian function suppression to oral endocrine therapy (either tamoxifen or aromatase inhibitors), can improve outcomes over tamoxifen alone in well-selected patients. Treatment duration has also been revisited, and extended therapy is becoming a new standard of care, especially in high-risk patients. Endocrine therapy for advanced disease still represents a challenge and a research priority. New drugs and combinations able to overcome endocrine resistance are at the horizon, and their role in premenopausal women should be better elucidated. Side effects and quality of life (including family planning considerations) play an important role in treatment selection and in the patients' treatment adherence and should always be discussed before start of treatment. The paper will specifically focus on how to integrate all new treatment options in the current armamentarium of endocrine therapy of premenopausal women, with the aim of best fine-tuning treatment selections according to the individual risk/benefit evaluation.

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