Tamoxifen for the management of breast events induced by non-steroidal antiandrogens in patients with prostate cancer: a systematic review

Abstract

BackgroundTamoxifen has emerged as a potential management option for gynecomastia and breast pain due to non-steroidal antiandrogens, and it is considered an alternative to surgery or radiotherapy. The objective of this systematic review was to assess the benefits and harms of tamoxifen, in comparison to other treatment options, for either the prophylaxis or treatment of breast events induced by non-steroidal antiandrogens in prostate cancer patients.MethodsWe searched CENTRAL, MEDLINE, EMBASE, reference lists, the abstracts of three major conferences and three trial registers to identify ongoing randomized controlled trials (RCTs). Two authors independently screened the articles identified, assessed the trial quality and extracted data. The protocol was prospectively registered (CRD42011001320; http://www.crd.york.ac.uk/PROSPERO).ResultsFour studies were identified. Tamoxifen significantly reduced the risk of suffering from gynecomastia (risk ratio 9RR0 0.10, 95% CI 0.05 to 0.22) or breast pain (RR 0.06, 95% CI 0.02 to 0.17) at six months compared to untreated controls. Tamoxifen also showed a significant benefit for the prevention of gynecomastia (RR 0.22, 95% CI 0.08 to 0.58) and breast pain (RR 0.25, 95% CI 0.10 to 0.64) when compared to anastrozole after a median of 12 months. One study showed a significant benefit of tamoxifen for the prevention of gynecomastia (RR 0.24, 95% CI 0.09 to 0.65) and breast pain (RR 0.20, 95% CI 0.06 to 0.65) when compared with radiotherapy at six months. Radiotherapy increased the risk of suffering from nipple erythema and skin irritation, but there were no significant differences for any other adverse events (all P > 0.05).ConclusionsThe currently available evidence suggests good efficacy of tamoxifen for the prevention and treatment of breast events induced by non-steroidal antiandrogens. The impact of tamoxifen therapy on long-term adverse events, disease progression and survival remains unclear. Further large, well-designed RCTs, including long-term follow-ups, are warranted. Also, the optimal dose needs to be clarified.

Opposite effects of tamoxifen on metabolic syndrome‐induced bladder and prostate alterations: A role for GPR30/GPER?

“…This concept is in keeping also with the in vivo results of this study obtained in an animal model of MetS, where tamoxifen dosing did not counteract, but rather increased, the estrogen‐associated prostate inflammation. Tamoxifen has been used to limit breast pain and gynecomastia in prostate cancer patients treated with non‐steroidal antiandrogens . Only one study investigated the effect of tamoxifen effect over placebo on urinary symptoms in these patients and found that tamoxifen increased them , although without reaching statistical significance.…”

Combination of low-concentration of novel phytoestrogen (8,9)-furanyl-pterocarpan-3-ol from Pachyrhizus erosus attenuated tamoxifen-associated growth inhibition on breast cancer T47D cells

“…TAM has become the standard treatment for all stages of breast cancer in both pre-and post menopausal women [7] . The potential benefits of the use of TAM as a preventive has been widely studied and reported that TAM has ability to reduce the risk of breast cancer in approximately 50% of most women who have a high risk of breast cancer [6] . The result of TAM on inhibitory cell proliferation of T47D was support by previous studies.…”

“…Anti-estrogenic strategies have been remarkably efficacious for breast cancer treatment and prevention. Among these, tamoxifen (TAM) is the most widely prescribed SERM worldwide [5,6] . TAM is one of anti-estrogens that blocks activity of estrogens in most tissues that are sensitive to estrogens.…”

Evidenced‐based clinical practice guideline for prostate cancer (summary: Japanese Urological Association, 2016 edition)

“…Adverse events associated with hormone therapy: Adverse events, such as sexual dysfunction, hot flashes, fatigue, gynecomastia and mastalgia, have long been known. Tamoxifen is effective in treating gynecomastia and mastalgia, but it is not covered by insurance in Japan . Bisphosphonates and anti‐RANKL antibody are effective in the prevention of osteoporosis and fractures during hormone therapy, but they are not covered by insurance in Japan when used prophylactically.…”