1
|
Sheng RY, Yan Y, Linh Dang H. Acupuncture for hot flashes: A literature review of randomized controlled trials conducted in the last 10 years. WORLD JOURNAL OF TRADITIONAL CHINESE MEDICINE 2021. [DOI: 10.4103/wjtcm.wjtcm_27_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
2
|
Pan Y, Meister R, Löwe B, Kaptchuk TJ, Buhling KJ, Nestoriuc Y. Open-label placebos for menopausal hot flushes: a randomized controlled trial. Sci Rep 2020; 10:20090. [PMID: 33208855 PMCID: PMC7674475 DOI: 10.1038/s41598-020-77255-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 11/06/2020] [Indexed: 12/14/2022] Open
Abstract
This study investigated the efficacy of an open-label placebo (OLP) treatment for menopausal hot flushes. Women with at least five moderate or severe hot flushes per day were allocated to receive four weeks of OLP for twice a day or no-treatment. Intention-to-treat analyses included n = 100 women. In comparison to no-treatment, OLP reduced the log-transformed hot flush composite score (frequency × intensity) (mean difference in change: − 0.32, 95% CI [− 0.43; − 0.21], p < 0.001, Cohen’s d = 0.86), hot flush frequency (− 1.12 [− 1.81; − 0.43], p = 0.02, Cohen’s d = 0.51), and improved overall menopause-related quality of life (− 2.53 [− 4.17; − 0.89], p = 0.02, Cohen’s d = 0.49). Twelve (24%) (vs. three [6%]) patients had 50% lesser hot flushes. Problem rating of hot flushes and subdomains of quality of life did not improve. After four weeks, the OLP group was further divided via randomization to continue or discontinue the treatment. Benefits were maintained at week 8 (log-transformed score: − 0.04 [− 0.06; 0.14], p = 0.45). There was no difference between taking placebos for 8 or 4 weeks (log-transformed score: 0.04 [− 0.17; 0.25], p = 0.73). Results indicate that open-label placebos may be an effective, safe alternative for menopausal hot flushes.
Collapse
Affiliation(s)
- Yiqi Pan
- Department of Clinical Psychology, Helmut-Schmidt-University/University of the Federal Armed Forces, Hamburg, Germany. .,Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Ramona Meister
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Ted J Kaptchuk
- Program in Placebo Studies and the Therapeutic Encounter (PiPS), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Kai J Buhling
- Department of Gynecological Endocrinology, Clinic of Gynecology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Yvonne Nestoriuc
- Department of Clinical Psychology, Helmut-Schmidt-University/University of the Federal Armed Forces, Hamburg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
3
|
Wilhelms DB, Dock H, Brito HO, Pettersson E, Stojakovic A, Zajdel J, Engblom D, Theodorsson E, Hammar ML, Spetz Holm ACE. CGRP Is Critical for Hot Flushes in Ovariectomized Mice. Front Pharmacol 2019; 9:1452. [PMID: 30662401 PMCID: PMC6328451 DOI: 10.3389/fphar.2018.01452] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 11/26/2018] [Indexed: 11/13/2022] Open
Abstract
Hot flushes are common and troublesome symptoms of menopause. The neuropeptide calcitonin gene-related peptide (CGRP) is increased in plasma during hot flushes but it has not been clear if CGRP is causally involved in the mechanism underpinning the flushes. Here, we examined the effect of interventions with CGRP in a mouse model of hot flushes based on flush-like temperature increases triggered by forced physical activity in ovariectomized mice. Compared to normal mice, ovariectomized mice reacted with an exaggerated, flush-like, temperature increase after physical exercise. This increase was completely blocked by the non-peptide CGRP-antagonist MK-8825 (-0.41 degrees Celsius, 95% CI: -0,83 to 0,012, p < 0.0001) at a dose that had no obvious effects on locomotor activity (50 mg/kg). Further, the flush-like temperature increases were strongly attenuated in ovariectomized mice lacking αCGRP due to a genetic modification. Collectively, our findings suggest that CGRP is an important mediator of experimentally induced hot flushes and they identify CGRP antagonists as promising treatment candidates for women and possibly also men with hot flushes.
Collapse
Affiliation(s)
- Daniel B. Wilhelms
- Division of Drug Research, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Department of Emergency Medicine, Local Health Care Services in Central Östergötland, Linköping, Sweden
| | - Hua Dock
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Haissa O. Brito
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Emma Pettersson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Andrea Stojakovic
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Joanna Zajdel
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - David Engblom
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Elvar Theodorsson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Mats L. Hammar
- Division of Childrens and Womens Health, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Gynaecology and Obstetrics in Linköping, Center of Paediatrics and Gynaecology and Obstetrics, Linköping, Sweden
| | - Anna-Clara E. Spetz Holm
- Division of Childrens and Womens Health, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Gynaecology and Obstetrics in Linköping, Center of Paediatrics and Gynaecology and Obstetrics, Linköping, Sweden
| |
Collapse
|
4
|
Koo S, Ahn Y, Lim JY, Cho J, Park HY. Obesity associates with vasomotor symptoms in postmenopause but with physical symptoms in perimenopause: a cross-sectional study. BMC Womens Health 2017; 17:126. [PMID: 29216853 PMCID: PMC5721621 DOI: 10.1186/s12905-017-0487-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 11/29/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Middle-aged women experience various menopausal symptoms during the menopause. These symptoms can affect their quality of life and health. Several epidemiological studies reported that obesity associates with menopausal symptoms. The aim of this cross-sectional study was to examine the associations between obesity and multiple menopausal symptoms at different stages of menopause in middle-aged Korean women. METHODS The study population included women aged 44-56 years who visited a tertiary referral hospital for medical check-ups between November 2012 and March 2013 and were free from serious illness, could comprehend a questionnaire. The Menopause-Specific Quality of Life (MENQOL) questionnaire was used to assess the prevalence of menopausal symptoms. Overweight and obesity were defined as body mass index (BMI) of 23-24.9 and ≥25 kg/m2, respectively. RESULTS Of the 2204 middle-aged women, 929 met the eligibility criteria. Of these, 533 (57.4%) and 396 (42.6%) were in perimenopause and postmenopause, respectively. In perimenopause, obese women were significantly more likely to have moderate/severe physical symptoms (MENQOL domain score ≥ 5) than normal or overweight women. In postmenopause, obese women were significantly more likely to have moderate/severe vasomotor symptoms. Multiple linear regression with adjustment for confounders showed that relative to normal weight, obesity in perimenopause and postmenopause associated independently with physical symptoms (beta coefficient = 0.35; P = 0.023) and vasomotor symptoms (beta coefficient = 0.68; P = 0.003), respectively. Overweight did not associate with menopausal symptoms. BMI did not associate significantly with psychosocial or sexual symptoms at either stage of menopause. CONCLUSIONS Obese women had more frequent menopausal symptoms than normal or overweight women but the associated menopausal symptom differed depending on the menopausal stage. Further studies are required to confirm this result and identify the underlying mechanisms.
Collapse
Affiliation(s)
- Seul Koo
- Division of Cardiovascular Diseases, Center for Biomedical Sciences, Korea National Institute of Health, 187 Osongsaengmyeng 2-Ro, Osong-eup, Heungdeok-gu, Cheongju-si, Chungcheongbuk-Do 28160 Republic of Korea
| | - Younjhin Ahn
- Division of Rare Diseases, Center for Biomedical Sciences, Korea National Institute of Health, 187 Osongsaengmyeng 2-Ro, Osong-eup, Heungdeok-gu, Cheongju-si, Chungcheongbuk-Do 28160 Republic of Korea
| | - Joong-Yeon Lim
- Division of Cardiovascular Diseases, Center for Biomedical Sciences, Korea National Institute of Health, 187 Osongsaengmyeng 2-Ro, Osong-eup, Heungdeok-gu, Cheongju-si, Chungcheongbuk-Do 28160 Republic of Korea
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Departments of Epidemiology and Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Hyun-Young Park
- Division of Cardiovascular Diseases, Center for Biomedical Sciences, Korea National Institute of Health, 187 Osongsaengmyeng 2-Ro, Osong-eup, Heungdeok-gu, Cheongju-si, Chungcheongbuk-Do 28160 Republic of Korea
| |
Collapse
|
5
|
Lesi G, Razzini G, Musti MA, Stivanello E, Petrucci C, Benedetti B, Rondini E, Ligabue MB, Scaltriti L, Botti A, Artioli F, Mancuso P, Cardini F, Pandolfi P. Acupuncture As an Integrative Approach for the Treatment of Hot Flashes in Women With Breast Cancer: A Prospective Multicenter Randomized Controlled Trial (AcCliMaT). J Clin Oncol 2016; 34:1795-802. [PMID: 27022113 DOI: 10.1200/jco.2015.63.2893] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the effectiveness of acupuncture for the management of hot flashes in women with breast cancer. PATIENTS AND METHODS We conducted a pragmatic, randomized controlled trial comparing acupuncture plus enhanced self-care versus enhanced self-care alone. A total of 190 women with breast cancer were randomly assigned. Random assignment was performed with stratification for hormonal therapy; the allocation ratio was 1:1. Both groups received a booklet with information about climacteric syndrome and its management to be followed for at least 12 weeks. In addition, the acupuncture group received 10 traditional acupuncture treatment sessions involving needling of predefined acupoints. The primary outcome was hot flash score at the end of treatment (week 12), calculated as the frequency multiplied by the average severity of hot flashes. The secondary outcomes were climacteric symptoms and quality of life, measured by the Greene Climacteric and Menopause Quality of Life scales. Health outcomes were measured for up to 6 months after treatment. Expectation and satisfaction of treatment effect and safety were also evaluated. We used intention-to-treat analyses. RESULTS Of the participants, 105 were randomly assigned to enhanced self-care and 85 to acupuncture plus enhanced self-care. Acupuncture plus enhanced self-care was associated with a significantly lower hot flash score than enhanced self-care at the end of treatment (P < .001) and at 3- and 6-month post-treatment follow-up visits (P = .0028 and .001, respectively). Acupuncture was also associated with fewer climacteric symptoms and higher quality of life in the vasomotor, physical, and psychosocial dimensions (P < .05). CONCLUSION Acupuncture in association with enhanced self-care is an effective integrative intervention for managing hot flashes and improving quality of life in women with breast cancer.
Collapse
Affiliation(s)
- Grazia Lesi
- Grazia Lesi, Muriel Assunta Musti, Elisa Stivanello, Chiara Petrucci, Pamela Mancuso, and Paolo Pandolfi, Bologna Local Health Authority; Francesco Cardini, Health and Social Agency of Emilia-Romagna Region, Bologna; Giorgia Razzini, Benedetta Benedetti, and Fabrizio Artioli, Civil Hospital, Carpi; Ermanno Rondini, Istituti di Ricovero e Cura a Carattere Scientifico-Arcispedale S. Maria Nuova di Reggio Emilia, Reggio Emilia; Maria Bernadette Ligabue, Civil Hospital, Coreggio; Laura Scaltriti, Civil Hospital, Guastalla; and Alberto Botti, Hospital of Piacenza, Piacenza, Italy
| | - Giorgia Razzini
- Grazia Lesi, Muriel Assunta Musti, Elisa Stivanello, Chiara Petrucci, Pamela Mancuso, and Paolo Pandolfi, Bologna Local Health Authority; Francesco Cardini, Health and Social Agency of Emilia-Romagna Region, Bologna; Giorgia Razzini, Benedetta Benedetti, and Fabrizio Artioli, Civil Hospital, Carpi; Ermanno Rondini, Istituti di Ricovero e Cura a Carattere Scientifico-Arcispedale S. Maria Nuova di Reggio Emilia, Reggio Emilia; Maria Bernadette Ligabue, Civil Hospital, Coreggio; Laura Scaltriti, Civil Hospital, Guastalla; and Alberto Botti, Hospital of Piacenza, Piacenza, Italy.
| | - Muriel Assunta Musti
- Grazia Lesi, Muriel Assunta Musti, Elisa Stivanello, Chiara Petrucci, Pamela Mancuso, and Paolo Pandolfi, Bologna Local Health Authority; Francesco Cardini, Health and Social Agency of Emilia-Romagna Region, Bologna; Giorgia Razzini, Benedetta Benedetti, and Fabrizio Artioli, Civil Hospital, Carpi; Ermanno Rondini, Istituti di Ricovero e Cura a Carattere Scientifico-Arcispedale S. Maria Nuova di Reggio Emilia, Reggio Emilia; Maria Bernadette Ligabue, Civil Hospital, Coreggio; Laura Scaltriti, Civil Hospital, Guastalla; and Alberto Botti, Hospital of Piacenza, Piacenza, Italy
| | - Elisa Stivanello
- Grazia Lesi, Muriel Assunta Musti, Elisa Stivanello, Chiara Petrucci, Pamela Mancuso, and Paolo Pandolfi, Bologna Local Health Authority; Francesco Cardini, Health and Social Agency of Emilia-Romagna Region, Bologna; Giorgia Razzini, Benedetta Benedetti, and Fabrizio Artioli, Civil Hospital, Carpi; Ermanno Rondini, Istituti di Ricovero e Cura a Carattere Scientifico-Arcispedale S. Maria Nuova di Reggio Emilia, Reggio Emilia; Maria Bernadette Ligabue, Civil Hospital, Coreggio; Laura Scaltriti, Civil Hospital, Guastalla; and Alberto Botti, Hospital of Piacenza, Piacenza, Italy
| | - Chiara Petrucci
- Grazia Lesi, Muriel Assunta Musti, Elisa Stivanello, Chiara Petrucci, Pamela Mancuso, and Paolo Pandolfi, Bologna Local Health Authority; Francesco Cardini, Health and Social Agency of Emilia-Romagna Region, Bologna; Giorgia Razzini, Benedetta Benedetti, and Fabrizio Artioli, Civil Hospital, Carpi; Ermanno Rondini, Istituti di Ricovero e Cura a Carattere Scientifico-Arcispedale S. Maria Nuova di Reggio Emilia, Reggio Emilia; Maria Bernadette Ligabue, Civil Hospital, Coreggio; Laura Scaltriti, Civil Hospital, Guastalla; and Alberto Botti, Hospital of Piacenza, Piacenza, Italy
| | - Benedetta Benedetti
- Grazia Lesi, Muriel Assunta Musti, Elisa Stivanello, Chiara Petrucci, Pamela Mancuso, and Paolo Pandolfi, Bologna Local Health Authority; Francesco Cardini, Health and Social Agency of Emilia-Romagna Region, Bologna; Giorgia Razzini, Benedetta Benedetti, and Fabrizio Artioli, Civil Hospital, Carpi; Ermanno Rondini, Istituti di Ricovero e Cura a Carattere Scientifico-Arcispedale S. Maria Nuova di Reggio Emilia, Reggio Emilia; Maria Bernadette Ligabue, Civil Hospital, Coreggio; Laura Scaltriti, Civil Hospital, Guastalla; and Alberto Botti, Hospital of Piacenza, Piacenza, Italy
| | - Ermanno Rondini
- Grazia Lesi, Muriel Assunta Musti, Elisa Stivanello, Chiara Petrucci, Pamela Mancuso, and Paolo Pandolfi, Bologna Local Health Authority; Francesco Cardini, Health and Social Agency of Emilia-Romagna Region, Bologna; Giorgia Razzini, Benedetta Benedetti, and Fabrizio Artioli, Civil Hospital, Carpi; Ermanno Rondini, Istituti di Ricovero e Cura a Carattere Scientifico-Arcispedale S. Maria Nuova di Reggio Emilia, Reggio Emilia; Maria Bernadette Ligabue, Civil Hospital, Coreggio; Laura Scaltriti, Civil Hospital, Guastalla; and Alberto Botti, Hospital of Piacenza, Piacenza, Italy
| | - Maria Bernadette Ligabue
- Grazia Lesi, Muriel Assunta Musti, Elisa Stivanello, Chiara Petrucci, Pamela Mancuso, and Paolo Pandolfi, Bologna Local Health Authority; Francesco Cardini, Health and Social Agency of Emilia-Romagna Region, Bologna; Giorgia Razzini, Benedetta Benedetti, and Fabrizio Artioli, Civil Hospital, Carpi; Ermanno Rondini, Istituti di Ricovero e Cura a Carattere Scientifico-Arcispedale S. Maria Nuova di Reggio Emilia, Reggio Emilia; Maria Bernadette Ligabue, Civil Hospital, Coreggio; Laura Scaltriti, Civil Hospital, Guastalla; and Alberto Botti, Hospital of Piacenza, Piacenza, Italy
| | - Laura Scaltriti
- Grazia Lesi, Muriel Assunta Musti, Elisa Stivanello, Chiara Petrucci, Pamela Mancuso, and Paolo Pandolfi, Bologna Local Health Authority; Francesco Cardini, Health and Social Agency of Emilia-Romagna Region, Bologna; Giorgia Razzini, Benedetta Benedetti, and Fabrizio Artioli, Civil Hospital, Carpi; Ermanno Rondini, Istituti di Ricovero e Cura a Carattere Scientifico-Arcispedale S. Maria Nuova di Reggio Emilia, Reggio Emilia; Maria Bernadette Ligabue, Civil Hospital, Coreggio; Laura Scaltriti, Civil Hospital, Guastalla; and Alberto Botti, Hospital of Piacenza, Piacenza, Italy
| | - Alberto Botti
- Grazia Lesi, Muriel Assunta Musti, Elisa Stivanello, Chiara Petrucci, Pamela Mancuso, and Paolo Pandolfi, Bologna Local Health Authority; Francesco Cardini, Health and Social Agency of Emilia-Romagna Region, Bologna; Giorgia Razzini, Benedetta Benedetti, and Fabrizio Artioli, Civil Hospital, Carpi; Ermanno Rondini, Istituti di Ricovero e Cura a Carattere Scientifico-Arcispedale S. Maria Nuova di Reggio Emilia, Reggio Emilia; Maria Bernadette Ligabue, Civil Hospital, Coreggio; Laura Scaltriti, Civil Hospital, Guastalla; and Alberto Botti, Hospital of Piacenza, Piacenza, Italy
| | - Fabrizio Artioli
- Grazia Lesi, Muriel Assunta Musti, Elisa Stivanello, Chiara Petrucci, Pamela Mancuso, and Paolo Pandolfi, Bologna Local Health Authority; Francesco Cardini, Health and Social Agency of Emilia-Romagna Region, Bologna; Giorgia Razzini, Benedetta Benedetti, and Fabrizio Artioli, Civil Hospital, Carpi; Ermanno Rondini, Istituti di Ricovero e Cura a Carattere Scientifico-Arcispedale S. Maria Nuova di Reggio Emilia, Reggio Emilia; Maria Bernadette Ligabue, Civil Hospital, Coreggio; Laura Scaltriti, Civil Hospital, Guastalla; and Alberto Botti, Hospital of Piacenza, Piacenza, Italy
| | - Pamela Mancuso
- Grazia Lesi, Muriel Assunta Musti, Elisa Stivanello, Chiara Petrucci, Pamela Mancuso, and Paolo Pandolfi, Bologna Local Health Authority; Francesco Cardini, Health and Social Agency of Emilia-Romagna Region, Bologna; Giorgia Razzini, Benedetta Benedetti, and Fabrizio Artioli, Civil Hospital, Carpi; Ermanno Rondini, Istituti di Ricovero e Cura a Carattere Scientifico-Arcispedale S. Maria Nuova di Reggio Emilia, Reggio Emilia; Maria Bernadette Ligabue, Civil Hospital, Coreggio; Laura Scaltriti, Civil Hospital, Guastalla; and Alberto Botti, Hospital of Piacenza, Piacenza, Italy
| | - Francesco Cardini
- Grazia Lesi, Muriel Assunta Musti, Elisa Stivanello, Chiara Petrucci, Pamela Mancuso, and Paolo Pandolfi, Bologna Local Health Authority; Francesco Cardini, Health and Social Agency of Emilia-Romagna Region, Bologna; Giorgia Razzini, Benedetta Benedetti, and Fabrizio Artioli, Civil Hospital, Carpi; Ermanno Rondini, Istituti di Ricovero e Cura a Carattere Scientifico-Arcispedale S. Maria Nuova di Reggio Emilia, Reggio Emilia; Maria Bernadette Ligabue, Civil Hospital, Coreggio; Laura Scaltriti, Civil Hospital, Guastalla; and Alberto Botti, Hospital of Piacenza, Piacenza, Italy
| | - Paolo Pandolfi
- Grazia Lesi, Muriel Assunta Musti, Elisa Stivanello, Chiara Petrucci, Pamela Mancuso, and Paolo Pandolfi, Bologna Local Health Authority; Francesco Cardini, Health and Social Agency of Emilia-Romagna Region, Bologna; Giorgia Razzini, Benedetta Benedetti, and Fabrizio Artioli, Civil Hospital, Carpi; Ermanno Rondini, Istituti di Ricovero e Cura a Carattere Scientifico-Arcispedale S. Maria Nuova di Reggio Emilia, Reggio Emilia; Maria Bernadette Ligabue, Civil Hospital, Coreggio; Laura Scaltriti, Civil Hospital, Guastalla; and Alberto Botti, Hospital of Piacenza, Piacenza, Italy
| |
Collapse
|
6
|
Mao JJ, Bowman MA, Xie SX, Bruner D, DeMichele A, Farrar JT. Electroacupuncture Versus Gabapentin for Hot Flashes Among Breast Cancer Survivors: A Randomized Placebo-Controlled Trial. J Clin Oncol 2015; 33:3615-20. [PMID: 26304905 DOI: 10.1200/jco.2015.60.9412] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Hot flashes are a common and debilitating symptom among survivors of breast cancer. This study aimed at evaluating the effects of electroacupuncture (EA) versus gabapentin (GP) for hot flashes among survivors of breast cancer, with a specific focus on the placebo and nocebo effects. PATIENTS AND METHODS We conducted a randomized controlled trial involving 120 survivors of breast cancer experiencing bothersome hot flashes twice per day or greater. Participants were randomly assigned to receive 8 weeks of EA or GP once per day with validated placebo controls (sham acupuncture [SA] or placebo pills [PPs]). The primary end point was change in the hot flash composite score (HFCS) between SA and PP at week 8, with secondary end points including group comparisons and additional evaluation at week 24 for durability of treatment effects. RESULTS By week 8, SA produced significantly greater reduction in HFCS than did PP (-2.39; 95% CI, -4.60 to -0.17). Among all treatment groups, the mean reduction in HFCS was greatest in the EA group, followed by SA, GP, and PP (-7.4 v -5.9 v -5.2 v -3.4; P = < .001). The pill groups had more treatment-related adverse events than did the acupuncture groups: GP (39.3%), PP (20.0%), EA (16.7%), and SA (3.1%), with P = .005. By week 24, HFCS reduction was greatest in the EA group, followed by SA, PP, and GP (-8.5 v -6.1 v -4.6 v -2.8; P = .002). CONCLUSION Acupuncture produced larger placebo and smaller nocebo effects than did pills for the treatment of hot flashes. EA may be more effective than GP, with fewer adverse effects for managing hot flashes among breast cancer survivors; however, these preliminary findings need to be confirmed in larger randomized controlled trials with long-term follow-up.
Collapse
Affiliation(s)
- Jun J Mao
- Jun J. Mao, Sharon X. Xie, Angela DeMichele, and John T. Farrar, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Marjorie A. Bowman, Wright State University Boonshoft School of Medicine, Dayton, OH; and Deborah Bruner, Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA.
| | - Marjorie A Bowman
- Jun J. Mao, Sharon X. Xie, Angela DeMichele, and John T. Farrar, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Marjorie A. Bowman, Wright State University Boonshoft School of Medicine, Dayton, OH; and Deborah Bruner, Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | - Sharon X Xie
- Jun J. Mao, Sharon X. Xie, Angela DeMichele, and John T. Farrar, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Marjorie A. Bowman, Wright State University Boonshoft School of Medicine, Dayton, OH; and Deborah Bruner, Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | - Deborah Bruner
- Jun J. Mao, Sharon X. Xie, Angela DeMichele, and John T. Farrar, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Marjorie A. Bowman, Wright State University Boonshoft School of Medicine, Dayton, OH; and Deborah Bruner, Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | - Angela DeMichele
- Jun J. Mao, Sharon X. Xie, Angela DeMichele, and John T. Farrar, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Marjorie A. Bowman, Wright State University Boonshoft School of Medicine, Dayton, OH; and Deborah Bruner, Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | - John T Farrar
- Jun J. Mao, Sharon X. Xie, Angela DeMichele, and John T. Farrar, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Marjorie A. Bowman, Wright State University Boonshoft School of Medicine, Dayton, OH; and Deborah Bruner, Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| |
Collapse
|
7
|
Wang W, Bai W, Cui G, Jin B, Wang K, Jia J, Da Y, Qin L. Effects of estradiol valerate and remifemin on norepinephrine signaling in the brain of ovariectomized rats. Neuroendocrinology 2015; 101:120-32. [PMID: 25613345 DOI: 10.1159/000375162] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 01/12/2015] [Indexed: 11/19/2022]
Abstract
AIMS We investigated the norepinephrine pathway changes from the locus coeruleus (LC) to the preoptic area of the hypothalamus (POAH) in the brain of ovariectomized rats under low estrogen levels and explored the therapeutic effects of estradiol valerate (E2) and Remifemin (ICR) on these changes. METHODS 40 female Sprague-Dawley rats were randomly divided into the following groups: surgery with vehicle (SHAM), ovariectomy surgery with vehicle (OVX), ovariectomy with E2 treatment (OVX + E2), and ovariectomy with Remifemin (OVX + ICR). After 4 weeks of treatment, we observed the changes by immunohistochemistry. RESULTS (1) The average optical density of DBH-ir fibers and the number of α1-adrenoreceptor- and estrogen receptor (ER)α-positive neurons in the main nuclei of POAH were all reduced in OVX rats compared with the SHAM group. The above changes were normalized in all nuclei of the POAH in the E2 group, while they were normalized in some nuclei in the ICR group. Coexpression of ERα and α1-adrenoreceptor was observed in the POAH. (2) The number of DBH- and ERα-positive neurons in the LC decreased in the OVX group compared with the SHAM group and increased after treatment with E2 and ICR. Coexpression of ERα and DBH was observed in the LC. CONCLUSION Low estrogen (OVX) altered norepinephrine synthesis in the LC, the projection of norepinephrine fibers and α1-adrenoreceptor expression in the POAH. Both E2 and ICR normalized the norepinephrine pathway, but E2 achieved greater effects than ICR. ICR had different effects in different nuclei in the POAH and its therapeutic effect was better in the LC.
Collapse
Affiliation(s)
- Wenjuan Wang
- Anatomy and Embryology Department, Peking University Health Science Center, Beijing, PR China
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Zelnak AB. Special considerations in early-stage breast cancer patients and survivors. Obstet Gynecol Clin North Am 2013; 40:573-82. [PMID: 24021258 DOI: 10.1016/j.ogc.2013.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Long-term outcomes for early-stage breast cancer have continued to improve, and more patients are becoming long-term survivors. In addition to patients' concern about risk of developing recurrent disease, they are also concerned about potential toxicities of treatment. Current guidelines for long-term follow-up are reviewed. Potential toxicities of tamoxifen and aromatase inhibitors are reviewed. Management of menopausal symptoms, cancer-related fatigue, and cognitive function is discussed.
Collapse
Affiliation(s)
- Amelia B Zelnak
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, 1365 Clifton Road Northeast, Atlanta, GA 30322, USA.
| |
Collapse
|
9
|
Yadav M, Volkar J. Potential role of gabapentin and extended-release gabapentin in the management of menopausal hot flashes. Int J Gen Med 2013; 6:657-64. [PMID: 23950657 PMCID: PMC3742343 DOI: 10.2147/ijgm.s45880] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
About 80% of postmenopausal women experience vasomotor symptoms, such as hot flashes and night sweats – symptoms that are associated with sleep disruption and can lead to fatigue and mood changes. Moreover, hot flashes can be embarrassing for women, causing difficulties at work and in their social lives. Many therapies have been advocated for relief of vasomotor symptoms, but only hormone therapy has been US Food and Drug Administration approved. However, after the Women’s Health Initiative Study suggested that there was a correlation between hormone therapy and increased risk for breast cancer and cardiovascular events, many women stopped taking hormone therapy, and many do not want to initiate it. Hormone therapy is also contraindicated in certain women, such as those with a history of hormone-stimulated cancer like breast and uterine cancer. Gabapentin (Neurontin) has shown efficacy in relieving vasomotor symptoms and is used as off-label for this indication. A new extended-release formulation of gabapentin has also shown efficacy in treating hot flashes and improving sleep quality with possibly fewer side effects than regular gabapentin.
Collapse
Affiliation(s)
- Manisha Yadav
- Center for Specialized women's Health, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | |
Collapse
|
10
|
Allameh Z, Rouholamin S, Valaie S. Comparison of Gabapentin with Estrogen for treatment of hot flashes in post-menopausal women. J Res Pharm Pract 2013; 2:64-9. [PMID: 24991606 PMCID: PMC4076904 DOI: 10.4103/2279-042x.117392] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Various non-hormonal agents have been used for the treatment of hot flashes in women with menopause. Some studies have reported that gabapentin appears to be an effective and well-tolerated treatment modality. The aim of this study was to evaluate whether the treatment with gabapentin is effective in reducing hot flash frequency and severity and also to compare gabapentin 100 mg/day, 300 mg/day and conjugated estrogen in this regards. METHODS In this comparative clinical trial, 100 post-menopausal women attending outpatient clinics of Isfahan University hospitals were included from April 2008 to February 2009. Participants randomly received gabapentin 300 mg/day, gabapentin 100 mg/day, or conjugated estrogen 0.625 mg/day for 12 weeks. Frequency and severity of hot flashes and adverse effects were compared among the three groups. FINDINGS From all, 16 participants dropped out. There were no significant differences among the groups before intervention in terms of age, body mass index and baseline hot flash frequency and severity. Hot flash diaries were used to record the frequency and severity of hot flashes. After the treatment period, there was a significant decrease in both severity and frequency of hot flashes in all three groups. Post-hoc analyses showed that the frequency and severity of hot flashes were significantly lower in those who received gabapentin 300 mg/day or estrogen 0.625 mg/day compared to those who received gabapentin 100 mg/day. There was not statistically significant difference between those who received gabapentin 300 mg/day and those who received estrogen. Very few adverse effects, mostly gastrointestinal discomfort were observed in both gabapentin groups (8%). CONCLUSION Gabapentin 300 mg/day could be useful to relieve hot flashes in women for whom hormone therapy is not suitable or when hot flashes do not respond to other therapies. Further researches are needed to determine the efficacy of gabapentin use for longer periods or at higher doses.
Collapse
Affiliation(s)
- Zahra Allameh
- Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Safoura Rouholamin
- Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sonia Valaie
- Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
11
|
|
12
|
Acupuncture as treatment of hot flashes and the possible role of calcitonin gene-related Peptide. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2011; 2012:579321. [PMID: 22110545 PMCID: PMC3205728 DOI: 10.1155/2012/579321] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Accepted: 08/29/2011] [Indexed: 11/18/2022]
Abstract
The mechanisms behind hot flashes in menopausal women are not fully understood. The flashes in women are probably preceded by and actually initiated by a sudden downward shift in the set point for the core body temperature in the thermoregulatory center that is affected by sex steroids, β-endorphins, and other central neurotransmitters. Treatments that influence these factors may be expected to reduce hot flashes. Since therapy with sex steroids for hot flashes has appeared to cause a number of side effects and risks and women with hot flashes and breast cancer as well as men with prostate cancer and hot flashes are prevented from sex steroid therapy there is a great need for alternative therapies. Acupuncture affecting the opioid system has been suggested as an alternative treatment option for hot flashes in menopausal women and castrated men. The heat loss during hot flashes may be mediated by the potent vasodilator and sweat gland activator calcitonin gene-related peptide (CGRP) the concentration of which increases in plasma during flashes in menopausal women and, according to one study, in castrated men with flushes. There is also evidence for connections between the opioid system and the release of CGRP. In this paper we discuss acupuncture as a treatment alternative for hot flashes and the role of CGRP in this context.
Collapse
|
13
|
Bordeleau L, Pritchard KI, Loprinzi CL, Ennis M, Jugovic O, Warr D, Haq R, Goodwin PJ. Multicenter, Randomized, Cross-Over Clinical Trial of Venlafaxine Versus Gabapentin for the Management of Hot Flashes in Breast Cancer Survivors. J Clin Oncol 2010; 28:5147-52. [PMID: 21060031 DOI: 10.1200/jco.2010.29.9230] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Nonhormonal pharmacologic interventions are recommended for the treatment of hot flashes in breast cancer survivors. Antidepressants and gabapentin have been shown to be both effective and well tolerated; however, it is not clear which is preferred. Patients and Methods This was a group-sequential, open-label, randomized, cross-over trial of 4 weeks of venlafaxine (37.5 mg daily for 7 days followed by 75 mg daily for 21 days) versus gabapentin (300 mg once per day for 3 days, then 300 mg twice per day for 3 days, then 300 mg three times per day for 22 days), with patient preference as the primary outcome. Postmenopausal women with at least 14 bothersome hot flashes per week for the prior month were eligible. A 2-week baseline period and a 2-week tapering/washout time was used before the first and second treatment periods, respectively. Diaries were used to measure hot flashes and potential toxicities throughout the study. Participants completed a preference questionnaire at the end of the study. A predefined Pocock stopping rule was applied. Patient preference and hot flash and toxicity outcomes were compared between treatments. Results Sixty-six patients were randomly assigned, 56 of whom provided a preference (eight dropped out and two had no preference); 18 (32%) preferred gabapentin and 38 (68%) preferred venlafaxine (P = .01). Both agents reduced hot flash scores to a similar extent (66% reduction). Venlafaxine was associated with increased nausea, appetite loss, constipation, and reduced negative mood changes compared with gabapentin, whereas gabapentin was associated with increased dizziness and appetite compared with venlafaxine (all P < .05). Conclusion Breast cancer survivors prefer venlafaxine over gabapentin for treating hot flashes.
Collapse
Affiliation(s)
- Louise Bordeleau
- From the Marvelle Koffler Breast Centre and Samuel Lunenfeld Research Institute at Mount Sinai Hospital; University of Toronto; Sunnybrook Odette Cancer Centre; Princess Margaret Hospital; and St. Michael's Hospital, Toronto; Applied Statistician, Markham, Ontario, Canada; and Mayo Clinic, Rochester, MN
| | - Kathleen I. Pritchard
- From the Marvelle Koffler Breast Centre and Samuel Lunenfeld Research Institute at Mount Sinai Hospital; University of Toronto; Sunnybrook Odette Cancer Centre; Princess Margaret Hospital; and St. Michael's Hospital, Toronto; Applied Statistician, Markham, Ontario, Canada; and Mayo Clinic, Rochester, MN
| | - Charles L. Loprinzi
- From the Marvelle Koffler Breast Centre and Samuel Lunenfeld Research Institute at Mount Sinai Hospital; University of Toronto; Sunnybrook Odette Cancer Centre; Princess Margaret Hospital; and St. Michael's Hospital, Toronto; Applied Statistician, Markham, Ontario, Canada; and Mayo Clinic, Rochester, MN
| | - Marguerite Ennis
- From the Marvelle Koffler Breast Centre and Samuel Lunenfeld Research Institute at Mount Sinai Hospital; University of Toronto; Sunnybrook Odette Cancer Centre; Princess Margaret Hospital; and St. Michael's Hospital, Toronto; Applied Statistician, Markham, Ontario, Canada; and Mayo Clinic, Rochester, MN
| | - Olivera Jugovic
- From the Marvelle Koffler Breast Centre and Samuel Lunenfeld Research Institute at Mount Sinai Hospital; University of Toronto; Sunnybrook Odette Cancer Centre; Princess Margaret Hospital; and St. Michael's Hospital, Toronto; Applied Statistician, Markham, Ontario, Canada; and Mayo Clinic, Rochester, MN
| | - David Warr
- From the Marvelle Koffler Breast Centre and Samuel Lunenfeld Research Institute at Mount Sinai Hospital; University of Toronto; Sunnybrook Odette Cancer Centre; Princess Margaret Hospital; and St. Michael's Hospital, Toronto; Applied Statistician, Markham, Ontario, Canada; and Mayo Clinic, Rochester, MN
| | - Rashida Haq
- From the Marvelle Koffler Breast Centre and Samuel Lunenfeld Research Institute at Mount Sinai Hospital; University of Toronto; Sunnybrook Odette Cancer Centre; Princess Margaret Hospital; and St. Michael's Hospital, Toronto; Applied Statistician, Markham, Ontario, Canada; and Mayo Clinic, Rochester, MN
| | - Pamela J. Goodwin
- From the Marvelle Koffler Breast Centre and Samuel Lunenfeld Research Institute at Mount Sinai Hospital; University of Toronto; Sunnybrook Odette Cancer Centre; Princess Margaret Hospital; and St. Michael's Hospital, Toronto; Applied Statistician, Markham, Ontario, Canada; and Mayo Clinic, Rochester, MN
| |
Collapse
|
14
|
Smetana GW, Sillman JS. Update in new medications for primary care. J Gen Intern Med 2010; 25:261-9. [PMID: 20012703 PMCID: PMC2839334 DOI: 10.1007/s11606-009-1209-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Revised: 11/05/2009] [Accepted: 11/09/2009] [Indexed: 11/30/2022]
Affiliation(s)
- Gerald W Smetana
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Shapiro 621D, 330 Brookline Ave, Boston, MA, USA.
| | | |
Collapse
|
15
|
Carretti N, Florio P, Reis FM, Comai S, Bertazzo A, Petraglia F. Reduction of serum serotonin precursors after veralipride treatment for postmenopausal hot flushes. Climacteric 2010; 13:141-6. [PMID: 20082603 DOI: 10.3109/13697130903219208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- N Carretti
- Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy
| | | | | | | | | | | |
Collapse
|
16
|
Kim SH, Lee MR, Lee KC, Lee JH, Kwon HC, Kim DC, Lee KW, Cho SH. Use of Antidepressants in Patients with Breast Cancer Taking Tamoxifen. J Breast Cancer 2010. [DOI: 10.4048/jbc.2010.13.4.325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Seong Hwan Kim
- Department of Psychiatry, Dong-A University College of Medicine, Busan, Korea
| | - Mi-Ri Lee
- Department of Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Keun-Cheol Lee
- Department of Plastic and Reconstructive Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Jin-Hwa Lee
- Department of Radiology, Dong-A University College of Medicine, Busan, Korea
| | - Hyuk-Chan Kwon
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Dae-Cheol Kim
- Department of Pathology, Dong-A University College of Medicine, Busan, Korea
| | - Kyeong Woo Lee
- Department of Rehabilitation Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Se-Heon Cho
- Department of Surgery, Dong-A University College of Medicine, Busan, Korea
| |
Collapse
|
17
|
Women's health, breast health: a review of the gynecologic effects of breast cancer. Obstet Gynecol Surv 2009; 64:469-80; quiz 499. [PMID: 19545455 DOI: 10.1097/ogx.0b013e3181a713f1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Breast cancer is very common and seen in both premenopausal and postmenopausal women. Research into prevention, better screening, and more effective treatments is occurring continually, and changes are translated into clinical practice relatively quickly. It is important for women's health care providers to have an understanding of breast cancer treatments and the gynecologic side effects. For premenopausal women interested in fertility, options should be discussed prior to chemotherapy. Issues pertaining to pregnancy after breast cancer should be discussed in a multidisciplinary fashion, involving the obstetrician/gynecologist, breast surgeon, and oncologist. Ovarian suppression is often used as part of breast cancer treatment in premenopausal women with hormone positive disease, and menopausal symptoms may be severe. Hormonal therapies including tamoxifen and the aromatase inhibitors are used in the treatment of hormone positive breast cancers. Each of these drugs has a variety of gynecologic implications. Understanding the options for treatment for menopausal complaints in breast cancer patients is important for women's health providers. Although most breast cancers are sporadic, a small percentage will be due to mutations in the BRCA genes. It is important for women's health providers to take an appropriate family history and refer to genetic counselors for possible testing when hereditary cancer is suspected. This review focuses on the various women's health issues pertaining to breast cancer and treatment.
Collapse
|
18
|
Abstract
BACKGROUND Vasomotor symptoms are the most common complaints for which menopausal women seek medical care. Eighty per cent of all menopausal women will have hot flushes and night sweats, and of these 9% will have severe symptoms impacting their quality of life. Ideally, treatment should target the group most severely afflicted, and options for treatment should be tailored to each woman, since, for most women, vasomotor symptoms spontaneously resolve in 3 - 5 years. Recommendation at this time is for the shortest duration of therapy, which means that episodic review of therapy is indicated. OBJECTIVE To review the latest literature investigating therapies for vasomotor symptoms and to discuss their effectiveness with emphasis on placebo-controlled, randomized clinical trials. METHODS A literature search in PubMed for 'vasomotor symptoms', 'menopause symptoms', 'hot flushes', 'hot flashes' and 'night sweats' from 2003 to the present was performed. CONCLUSIONS Estrogen remains the gold standard for treating vasomotor symptoms. As investigations into the physiology of hot flushes continue, centrally active drugs (selective serotonin or norepinephrine-serotonin reuptake inhibitors and gabapentin) have increased in use. The benefit from dietary herbal supplements is still inconclusive; however, recent studies have shown some mild response to soy and black cohosh.
Collapse
Affiliation(s)
- Wen Shen
- Johns Hopkins University School of Medicine, Division of Gynecology, 600 North Wolfe Street, Phipps 249, Baltimore, MD 21287, USA .
| | | |
Collapse
|
19
|
Rae JM, Sikora MJ, Henry NL, Li L, Kim S, Oesterreich S, Skaar TC, Nguyen AT, Desta Z, Storniolo AM, Flockhart DA, Hayes DF, Stearns V. Cytochrome P450 2D6 activity predicts discontinuation of tamoxifen therapy in breast cancer patients. THE PHARMACOGENOMICS JOURNAL 2009; 9:258-64. [PMID: 19421167 DOI: 10.1038/tpj.2009.14] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The selective estrogen receptor modulator tamoxifen is routinely used for treatment and prevention of estrogen-receptor-positive breast cancer. Studies of tamoxifen adherence suggest that over half of patients discontinue treatment before the recommended 5 years. We hypothesized that polymorphisms in CYP2D6, the enzyme responsible for tamoxifen activation, predict for tamoxifen discontinuation. Tamoxifen-treated women (n=297) were genotyped for CYP2D6 variants and assigned a 'score' based on predicted allele activities from 0 (no activity) to 2 (high activity). Correlation between CYP2D6 score and discontinuation rates at 4 months was tested. We observed a strong nonlinear correlation between higher CYP2D6 score and increased rates of discontinuation (r(2)=0.935, P=0.018). These data suggest that presence of active CYP2D6 alleles may predict for higher likelihood of tamoxifen discontinuation. Therefore, patients who may be most likely to benefit from tamoxifen may paradoxically be most likely to discontinue treatment prematurely.
Collapse
Affiliation(s)
- J M Rae
- Breast Oncology Program, Department of Internal Medicine, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI 48109-0612, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Pharmacogenetics and breast cancer endocrine therapy: CYP2D6 as a predictive factor for tamoxifen metabolism and drug response? Expert Rev Mol Med 2008; 10:e34. [PMID: 19019258 DOI: 10.1017/s1462399408000896] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The identification of genetic polymorphisms that influence the efficacy and safety of therapies for breast cancer may allow future treatments to be individualised based not only on tumour characteristics but also on host genetics. Genetic factors that affect the metabolism, efficacy and safety of tamoxifen, one of the most common drugs used for the treatment and prevention of breast cancer, have received particular attention. Cytochrome P450 2D6 (CYP2D6) is crucial in the metabolism of tamoxifen to its active metabolite endoxifen. Women with genetic variants of CYP2D6 or who take drugs that inhibit the enzyme have low endoxifen plasma concentrations and may show reduced benefits to tamoxifen treatment. CYP2D6 polymorphisms and variants in other candidate genes may also influence secondary benefits and side effects of tamoxifen. Here, we summarise data suggesting that CYP2D6 status may be an important predictor of the benefits of tamoxifen to an individual; in addition, we briefly discuss the role of variants in other candidate genes. Whether CYP2D6 status should be determined prior to initiating tamoxifen therapy is currently under debate and may be appropriate only for select women who are candidates for tamoxifen alone but for whom alternative standard options are available.
Collapse
|
21
|
Henry NL, Stearns V, Flockhart DA, Hayes DF, Riba M. Drug interactions and pharmacogenomics in the treatment of breast cancer and depression. Am J Psychiatry 2008; 165:1251-5. [PMID: 18829880 PMCID: PMC2742969 DOI: 10.1176/appi.ajp.2008.08040482] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
MESH Headings
- Adrenergic Uptake Inhibitors/adverse effects
- Adrenergic Uptake Inhibitors/pharmacokinetics
- Adrenergic Uptake Inhibitors/therapeutic use
- Antidepressive Agents/adverse effects
- Antidepressive Agents/pharmacokinetics
- Antidepressive Agents/therapeutic use
- Antineoplastic Agents, Hormonal/adverse effects
- Antineoplastic Agents, Hormonal/pharmacokinetics
- Antineoplastic Agents, Hormonal/therapeutic use
- Biotransformation/genetics
- Breast Neoplasms/blood
- Breast Neoplasms/drug therapy
- Breast Neoplasms/psychology
- Carcinoma, Ductal, Breast/blood
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/psychology
- Cyclohexanols/adverse effects
- Cyclohexanols/pharmacokinetics
- Cyclohexanols/therapeutic use
- Cytochrome P-450 CYP2D6/genetics
- Cytochrome P-450 CYP2D6 Inhibitors
- Delayed-Action Preparations
- Depressive Disorder, Major/blood
- Depressive Disorder, Major/drug therapy
- Drug Interactions/genetics
- Drug Therapy, Combination
- Female
- Genotype
- Hot Flashes/blood
- Hot Flashes/chemically induced
- Hot Flashes/drug therapy
- Hot Flashes/psychology
- Humans
- Middle Aged
- Pharmacogenetics
- Selective Serotonin Reuptake Inhibitors/adverse effects
- Selective Serotonin Reuptake Inhibitors/pharmacokinetics
- Selective Serotonin Reuptake Inhibitors/therapeutic use
- Tamoxifen/adverse effects
- Tamoxifen/analogs & derivatives
- Tamoxifen/blood
- Tamoxifen/pharmacokinetics
- Tamoxifen/therapeutic use
- Treatment Outcome
- Venlafaxine Hydrochloride
Collapse
Affiliation(s)
- N Lynn Henry
- Breast Oncology Program, University of Michigan Comprehensive Cancer Center, 300 North Ingalls St., Bldg. 3A04, Ann Arbor, MI 48109-5419, USA.
| | | | | | | | | |
Collapse
|
22
|
Hickey M, Saunders C, Partridge A, Santoro N, Joffe H, Stearns V. Practical clinical guidelines for assessing and managing menopausal symptoms after breast cancer. Ann Oncol 2008; 19:1669-80. [PMID: 18522932 DOI: 10.1093/annonc/mdn353] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The purpose of this study was to provide practical, evidence-based guidelines for evaluating and treating common menopausal symptoms following breast cancer. METHODS Literature review of the causes, assessment and management of menopausal symptoms in breast cancer patients. RESULTS A number of nonhormonal treatments are effective in treating hot flashes. Whether pharmacological treatment is given will depend on the severity of symptoms and on patient wishes. For severe and frequent hot flashes, the best data support the use of venlafaxine, paroxetine and gabapentin in women with breast cancer. Side-effects are relatively common with all these agents. For vaginal dryness, topical estrogen treatment is the most effective but the safety of estrogens following breast cancer is not established. There are limited data on effective treatments for sexual dysfunction during menopause. CONCLUSION Menopausal symptoms after breast cancer should be evaluated and managed as warranted using a systematic approach and may benefit from multidisciplinary input.
Collapse
Affiliation(s)
- M Hickey
- School of Women's and Infants Health, King Edward Memorial Hospital, University of Western Australia, Perth, Western Australia.
| | | | | | | | | | | |
Collapse
|