Informing hot flash treatment decisions for breast cancer survivors: a systematic review of randomized trials comparing active interventions

Johns, Claire; Seav, Susan M.; Dominick, Sally A.; Gorman, Jessica R.; Li, Hongying; Natarajan, Loki; Mao, Jun J.; Su, Han

doi:10.1007/s10549-016-3765-4

Cited by 62 publications

(50 citation statements)

References 60 publications

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“…21,23,24,54–59 Phytoestrogens, botanicals, and dietary supplements can also be used (category 2B for all); however, data are mixed or limited on the effectiveness and safety of these particular treatments in the general menopausal population and in cancer survivors. 22,60–67 Vitamin E has been thought to have marginal improvement in vasomotor symptoms in both general menopause and patients with breast cancer, but data are limited and have shown mixed results.…”

Section: Menopausementioning

confidence: 99%

Survivorship, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology

Denlinger¹,

Sanft²,

Baker³

et al. 2017

J Natl Compr Canc Netw

106

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Many cancer survivors experience menopausal symptoms, including female survivors taking aromatase inhibitors or with a history of oophorectomy or chemotherapy, and male survivors who received or are receiving androgen-ablative therapies. Sexual dysfunction is also common in cancer survivors. Sexual dysfunction and menopause-related symptoms can increase distress and have a significant negative impact on quality of life. This portion of the NCCN Guidelines for Survivorship provide recommendations for screening, evaluation, and treatment of sexual dysfunction and menopausal symptoms to help healthcare professionals who work with survivors of adult-onset cancer in the posttreatment period.

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Section: Menopausementioning

confidence: 99%

Survivorship, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology

Denlinger¹,

Sanft²,

Baker³

et al. 2017

J Natl Compr Canc Netw

106

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“…Those taking tamoxifen as endocrine therapy or high-risk women taking tamoxifen to reduce their breast cancer risk 62 should avoid the SSRIs fluoxetine and paroxetine since these impair conversion of tamoxifen to its active metabolite, potentially diminishing its efficacy. 34 A randomised trial comparing the SNRI venlafaxine (extended release, 75 mg/day) with 0.5 mg/day oral 17β oestradiol found that both treatments were associated with a statistically significant reduction in the frequency of vasomotor symptoms of around 50% after eight weeks of use. 63 Oestradiol improved menopause-related quality of life (as measured by the MENQOL 64 ) more than venlafaxine.…”

Section: Serotonin Selective Reuptake Inhibitors and Serotonin And Nomentioning

confidence: 99%

“…Desvenlafaxine 100 mg/day is the active metabolite of venlafaxine and reduces vasomotor symptoms for up to 12 months. 34 Desvenlafaxine is not available in the UK.…”

Section: Serotonin Selective Reuptake Inhibitors and Serotonin And Nomentioning

confidence: 99%

“…A systematic review of 13 randomised controlled trials including 1714 women found that gabapentin (300 mg three times per day) reduced the severity and frequency of vasomotor symptoms in breast cancer survivors (table 1⇓). 34 Up to 900 mg/day gabapentin is generally well tolerated, but side effects are dose related and may include somnolence, dizziness, and fatigue. 35 36 A randomised controlled trial in 163 breast cancer survivors found that pregabalin (75 mg twice daily) significantly reduced the frequency and severity of vasomotor symptoms (table 1⇓).…”

Section: Gabapentin and Pregabalinmentioning

confidence: 99%

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Non-hormonal treatments for menopausal symptoms

Hickey

Szabo

Hunter

2017

BMJ

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“…5 Second, antidepressants are often co-prescribed with tamoxifen for extended periods, 6 in part because depression often coexists with breast cancer and in part to offset vasomotor symptoms induced by tamoxifen. 7 Third, and in contrast with most drug interactions, the consequences are delayed by years and manifest simply as treatment failure, undermining causal attribution at the patient level.…”

mentioning

confidence: 99%

Revisiting the drug interaction between tamoxifen and SSRI antidepressants

Juurlink

2016

BMJ

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Few topics in therapeutics are more vexing than drug interactions. They number in the thousands, involve confusing terminology, and are rarely supported by evidence stronger than case reports and volunteer studies.1 It's not surprising, therefore, that experts disagree on which interactions are serious and which ones are not.2 And yet their importance is undeniable because they can cause serious morbidity or even death, despite epitomizing, in theory at least, avoidable drug related harm.Over the past decade, few drug interactions have been as controversial as those involving tamoxifen and selective serotonin reuptake inhibitor (SSRI) antidepressants, 3 explored yet again by Donneyong and colleagues in a linked study (doi:10.1136/bmj.i5014). 4 On its surface, the issue seems straightforward: as a prodrug, tamoxifen requires conversion to active metabolites, the most important of which is endoxifen. This process is influenced by cytochrome-P450 isoenzyme 2D6 (CYP2D6), an enzyme characterized by marked variability from person to person. Some SSRIs but not others inhibit CYP2D6, conceivably attenuating or even abolishing the benefits of tamoxifen.The importance of this potential interaction is amplified by three factors. First, tamoxifen is a monumental treatment, conferring dramatic reductions in breast cancer recurrence and associated mortality.5 Second, antidepressants are often co-prescribed with tamoxifen for extended periods, 6 in part because depression often coexists with breast cancer and in part to offset vasomotor symptoms induced by tamoxifen.7 Third, and in contrast with most drug interactions, the consequences are delayed by years and manifest simply as treatment failure, undermining causal attribution at the patient level.Why does the interaction between tamoxifen and SSRIs remain controversial? One reason is that tamoxifen's pharmacokinetic fate involves processes other than CYP2D6.8 Another is that studies of the relation between CYP2D6 activity and outcomes in women receiving tamoxifen yield remarkably inconsistent results.9 Finally, with some exceptions, 10 11 observational studies show little evidence that use of antidepressants is associated with adverse outcomes in women receiving tamoxifen. 12-14Donneyong and colleagues used data from five US health insurance databases to study women already being treated with an SSRI at the outset of treatment with tamoxifen or who received an SSRI later during its course. 4 Over a median follow-up of about two years, they found no difference in overall mortality among women receiving SSRIs that inhibit CYP2D6 (paroxetine and fluoxetine) relative to SSRIs that do not (citalopram, escitalopram, fluvoxamine and sertraline).These findings are unsurprising, if for no other reason than follow-up was too brief for any differential survival to show up.5 Studying total mortality rather than cancer specific outcomes further diminished the investigators' ability to discern signal from noise. Consequently, this study does little to disprove a meaningful interaction bet...

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Informing hot flash treatment decisions for breast cancer survivors: a systematic review of randomized trials comparing active interventions

Cited by 62 publications

References 60 publications

Survivorship, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology

Survivorship, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology

Non-hormonal treatments for menopausal symptoms

Revisiting the drug interaction between tamoxifen and SSRI antidepressants

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