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de Boer R, Hui R, Lim E, Yeo B, Zdenkowski N. Optimizing care for younger women with hormone receptor-positive, HER2-negative metastatic breast cancer. Asia Pac J Clin Oncol 2020; 16 Suppl 5:3-14. [PMID: 33137857 DOI: 10.1111/ajco.13461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 12/30/2022]
Abstract
Treatment strategies for hormone receptor-positive (HR+ ), human epidermal growth factor receptor 2-negative (HER2- ) metastatic breast cancer in young women (<40 years at diagnosis) have traditionally been extrapolated from data obtained from trials conducted either exclusively or predominantly in the postmenopausal setting. These young patients are usually treated with ovarian function suppression (OFS) + endocrine therapy (ET) ± targeted therapy, except if there is a concern about endocrine resistance or a need to gain rapid disease control due to the onset of visceral crisis. This review examines evidence that supports the use of a cyclin-dependent kinase 4/6 inhibitor, in combination with OFS and ET, when treating premenopausal or perimenopausal women with HR+ /HER2- metastatic breast cancer. This includes data from the MONALEESA-7 study (treating only premenopausal/perimenopausal women in the first-line setting), and the results of subgroup analyses from the PALOMA-3 and MONARCH-2 trials. We also consider a number of age-specific challenges that younger breast cancer patients can face, highlighting the importance of a multidisciplinary approach to ongoing care.
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Affiliation(s)
- Richard de Boer
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Epworth-Freemasons Private Hospital, Melbourne, Victoria, Australia
| | - Rina Hui
- University of Sydney, Camperdown, Sydney, New South Wales, Australia.,Westmead Hospital, Westmead, Sydney, New South Wales, Australia
| | - Elgene Lim
- St. Vincent's Clinical School, University of New South Wales, Darlinghurst, Sydney, New South Wales, Australia.,Garvan Institute of Medical Research, Darlinghurst, Sydney, New South Wales, Australia
| | - Belinda Yeo
- Austin Health, Heidelberg, Melbourne, Victoria, Australia.,Olivia Newton-John Cancer Research Institute, Heidelberg, Melbourne, Victoria, Australia
| | - Nicholas Zdenkowski
- University of Newcastle, Newcastle, New South Wales, Australia.,Lake Macquarie Private Hospital, Gateshead, New South Wales, Australia.,Breast Cancer Trials, Newcastle, New South Wales, Australia
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Lim EY, Lee SY, Shin HS, Lee J, Nam YD, Lee DO, Lee JY, Yeon SH, Son RH, Park CL, Heo YH, Kim YT. The Effect of Lactobacillus acidophilus YT1 (MENOLACTO) on Improving Menopausal Symptoms: A Randomized, Double-Blinded, Placebo-Controlled Clinical Trial. J Clin Med 2020; 9:E2173. [PMID: 32660010 PMCID: PMC7408745 DOI: 10.3390/jcm9072173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 12/18/2022] Open
Abstract
This study evaluated the efficacy of Lactobacillus acidophilus YT1 (MENOLACTO) for alleviating menopausal symptoms. This study was a multi-center, randomized, double-blinded, placebo-controlled clinical trial involving female subjects (ages: 40-60 years) with menopausal symptoms and a Kupperman index (KMI) score ≥ 20. Subjects were administered 1 × 108 CFU/day MENOLACTO or placebo, with the primary endpoint being total KMI score, and the effect of secondary endpoints on alleviating menopausal symptoms according to individual categories of the modified KMI, as well as a quality of life questionnaire (MENQOL questionnaire). After 12 weeks, total KMI scores decreased significantly, demonstrating improved menopausal symptoms relative to placebo along with improved modified KMI scores. Additionally, quality of life, according to the MENQOL questionnaire, significantly improved in all four symptoms-physical, psychosocial, vasomotor, and sexual symptoms. Moreover, we observed no significant difference between the two groups or significant changes in blood follicle-stimulating hormone and estradiol levels or endometrial thickness. These results demonstrated that MENOLACTO alleviated menopausal symptoms without notable side effects and improved quality of life, suggesting its efficacy as an alternative supplement to alleviate menopausal symptoms in women ineligible for hormonal therapy.
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Affiliation(s)
- Eun Yeong Lim
- Division of Food Functionality Research, Korea Food Research Institute, Wanju 55365, Korea; (E.Y.L.); (S.-Y.L.); (H.S.S.); (J.L.); (Y.-D.N.)
- Department of Food Biotechnology, Korea University of Science & Technology, Daejeon 34113, Korea
| | - So-Young Lee
- Division of Food Functionality Research, Korea Food Research Institute, Wanju 55365, Korea; (E.Y.L.); (S.-Y.L.); (H.S.S.); (J.L.); (Y.-D.N.)
- Department of Food Biotechnology, Korea University of Science & Technology, Daejeon 34113, Korea
| | - Hee Soon Shin
- Division of Food Functionality Research, Korea Food Research Institute, Wanju 55365, Korea; (E.Y.L.); (S.-Y.L.); (H.S.S.); (J.L.); (Y.-D.N.)
- Department of Food Biotechnology, Korea University of Science & Technology, Daejeon 34113, Korea
| | - Jaekwang Lee
- Division of Food Functionality Research, Korea Food Research Institute, Wanju 55365, Korea; (E.Y.L.); (S.-Y.L.); (H.S.S.); (J.L.); (Y.-D.N.)
| | - Young-Do Nam
- Division of Food Functionality Research, Korea Food Research Institute, Wanju 55365, Korea; (E.Y.L.); (S.-Y.L.); (H.S.S.); (J.L.); (Y.-D.N.)
- Department of Food Biotechnology, Korea University of Science & Technology, Daejeon 34113, Korea
| | - Dong Ock Lee
- Center for Gynecologic Cancer, National Cancer Center Korea, Goyang-si 10408, Korea;
| | - Ji Young Lee
- Department of Obstetrics and Gynecology, Konkuk University Hospital, Konkuk University School of Medicine, Seoul 05030, Korea;
| | - Sung Hum Yeon
- R&D Center, Huons Co., Ltd., Ansan 15588, Korea; (S.H.Y.); (R.H.S.); (C.L.P.)
| | - Rak Ho Son
- R&D Center, Huons Co., Ltd., Ansan 15588, Korea; (S.H.Y.); (R.H.S.); (C.L.P.)
| | - Chae Lee Park
- R&D Center, Huons Co., Ltd., Ansan 15588, Korea; (S.H.Y.); (R.H.S.); (C.L.P.)
| | - Yun Haeng Heo
- Clinical Operation Team, Huons Co., Ltd., Seongnam-si 13486, Korea;
| | - Yun Tai Kim
- Division of Food Functionality Research, Korea Food Research Institute, Wanju 55365, Korea; (E.Y.L.); (S.-Y.L.); (H.S.S.); (J.L.); (Y.-D.N.)
- Department of Food Biotechnology, Korea University of Science & Technology, Daejeon 34113, Korea
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Godínez-Chaparro B, Quiñonez-Bastidas GN, Rojas-Hernández IR, Austrich-Olivares AM, Mata-Bermudez A. Synergistic Interaction of a Gabapentin- Mangiferin Combination in Formalin-Induced Secondary Mechanical Allodynia and Hyperalgesia in Rats Is Mediated by Activation of NO-Cyclic GMP-ATP-Sensitive K + Channel Pathway. Drug Dev Res 2017; 78:390-402. [PMID: 28940250 DOI: 10.1002/ddr.21411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 09/01/2017] [Indexed: 11/07/2022]
Abstract
Preclinical Research Gabapentin is an anticonvulsant used to treat neuropathic pain. Mangiferin is an antioxidant that has antinociceptive and antiallodynic effects in inflammatory and neuropathic pain models. The purpose of this study was to determine the interaction between mangiferin and gabapentin in the development and maintenance of formalin-induced secondary allodynia and hyperalgesia in rats. Gabapentin, mangiferin, or their fixed-dose ratio combination were administrated peripherally. Isobolographic analyses was used to define the nature of the interaction of antiallodynic and/or antihyperalgesic effects of the two compounds. Theoretical ED50 values for the combination were 74.31 µg/paw and 95.20 µg/paw for pre- and post-treatment, respectively. These values were higher than the experimental ED50 values, 29.45 µg/paw and 37.73 µg/paw respectively, indicating a synergistic interaction in formalin-induced secondary allodynia and hyperalgesia. The antiallodynic and antihyperalgesic effect induced by the gabapentin/mangiferin combination was blocked by administration of L-NAME, the soluble guanylyl cyclase inhibitor, ODQ and glibenclamide. These data suggest that the gabapentin- mangiferin combination produces a synergistic interaction at the peripheral level. Moreover, the antiallodynic and hyperalgesic effect induced by the combination is mediated via the activation of an NO-cyclic GMP-ATP-sensitive K+ channel pathway. Drug Dev Res 78 : 390-402, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Beatriz Godínez-Chaparro
- Departamento de Sistemas Biológicos, División de Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana-Xochimilco, Calzada del Hueso 1100, Colonia Villa Quietud, Mexico, D.F, 04960, Mexico
| | - Geovanna Nallely Quiñonez-Bastidas
- Departamento de Sistemas Biológicos, División de Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana-Xochimilco, Calzada del Hueso 1100, Colonia Villa Quietud, Mexico, D.F, 04960, Mexico
| | - Isabel Rocío Rojas-Hernández
- Departamento de Sistemas Biológicos, División de Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana-Xochimilco, Calzada del Hueso 1100, Colonia Villa Quietud, Mexico, D.F, 04960, Mexico
| | - Amaya Montserrat Austrich-Olivares
- Departamento de Sistemas Biológicos, División de Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana-Xochimilco, Calzada del Hueso 1100, Colonia Villa Quietud, Mexico, D.F, 04960, Mexico
| | - Alfonso Mata-Bermudez
- Departamento de Sistemas Biológicos, División de Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana-Xochimilco, Calzada del Hueso 1100, Colonia Villa Quietud, Mexico, D.F, 04960, Mexico
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Ray JA, Kushnir MM, Meikle AW, Sindt JE, Strathmann FG. An exploratory study Evaluating the impact of opioid and non-opioid pain medications on serum/plasma free testosterone and free estradiol concentrations. Drug Test Anal 2017; 9:1555-1560. [DOI: 10.1002/dta.2174] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Julie A. Ray
- ARUP Institute for Clinical and Experimental Pathology; 500 Chipeta Way Salt Lake City UT 84108 USA
| | - Mark M. Kushnir
- ARUP Institute for Clinical and Experimental Pathology; 500 Chipeta Way Salt Lake City UT 84108 USA
| | - A. Wayne Meikle
- Department of Medicine; University of Utah; 30 N. 1900 E Salt Lake City UT 84132 USA
| | - Jill E. Sindt
- Department of Anesthesiology; University of Utah; 30 N. 1900 E Salt Lake City 84132 USA
| | - Frederick G. Strathmann
- ARUP Institute for Clinical and Experimental Pathology; 500 Chipeta Way Salt Lake City UT 84108 USA
- Department of Pathology; University of Utah; 15 N Medical Drive Salt Lake City UT 84112 USA
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Eden J. ENDOCRINE DILEMMA: Managing menopausal symptoms after breast cancer. Eur J Endocrinol 2016; 174:R71-7. [PMID: 26466611 DOI: 10.1530/eje-15-0814] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 10/14/2015] [Indexed: 11/08/2022]
Abstract
Managing the symptoms of menopause after a diagnosis of breast cancer offers some unique clinical challenges. For some women, vasomotor symptoms can be severe and debilitating, and hormone therapy is at least relatively contraindicated. Non-oestrogen therapies for hot flushes include SSRIs, clonidine, gabapentin and perhaps black cohosh extracts. Vulvovaginal atrophy can usually be alleviated by simple moisturizers, although some may need specialized physiotherapy such as vaginal dilators. In a small number, topical oestrogens may be the only treatment that works. The CO2 laser may be a novel, non-oestrogen therapy to alleviate this unpleasant symptom. Bone loss can be accelerated in some patients on AIs or those who had early menopause induced by chemotherapy.
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Affiliation(s)
- John Eden
- Barbara Gross Research UnitRoyal Hospital for Women and University of NSW, Locked bag 2000, Randwick, New South Wales 2031, Australia
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Abstract
INTRODUCTION Vasomotor symptoms (VMS) and the genitourinary syndrome of menopause (GSM) are recognized as the most frequent and bothersome symptoms associated with menopause. There are different treatments for both groups of symptoms, being necessary to individualize them. AREAS COVERED There are different therapies for VMS including hormonal treatments with estrogen, with and without progestins; the new alternative, tissue-selective estrogen complex (TSEC), tibolone, phytoestrogens and only progestins. Evidence also shows efficacy with selective serotonin reuptake inhibitors. Other nonhormonal alternatives exist as second-line treatments, all with not conclusive results. The GSM can be treated with nonhormonal treatments such as vaginal lubricants and moisturizers, other alternatives as vaginal laser needs to have more evidence. On the other hand, there is the possibility to use the hormonal treatments with systemic or local estrogen, which are the most effective treatment, the TSEC and the newest selective estrogen receptor modulator (SERM), ospemifene. Therapies with testosterone and dehydroepiandrosterone (DHEA) are still under study. The GSM can be treated with nonhormonal treatments such as vaginal lubricants and moisturizers, and other alternatives as vaginal laser need to have more evidence. On the other hand, there is the possibility to use the hormonal treatments with systemic or local estrogen, which are the most effective treatment, the TSEC and the newest SERM, ospemifene. Therapies with testosterone and DHEA are still under study. EXPERT OPINION The increasing numbers of therapies for menopausal symptoms open up new options, but we must individualize treatments. New possibilities arise in patients who did not have them and which can improve compliance and is also important to design strategies using combined or sequential treatments.
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Affiliation(s)
- Santiago Palacios
- a Institute Palacios of Women's Health , Madrid, Spain +34 9 15 78 05 17 ; +34 9 14 31 99 51 ;
| | - Andrea Mejias
- a Institute Palacios of Women's Health , Madrid, Spain +34 9 15 78 05 17 ; +34 9 14 31 99 51 ;
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Tella SH, Gallagher JC. Efficacy of desvenlafaxine succinate for menopausal hot flashes. Expert Opin Pharmacother 2014; 15:2407-18. [PMID: 25252697 DOI: 10.1517/14656566.2014.964641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The concern for the development of breast cancer, stroke, cardiovascular disease and deep venous thrombosis with the use of hormonal therapy has led to the development of alternative nonhormonal forms of therapy like desvenlafaxine for the management of hot flashes. AREAS COVERED This review is based upon a PubMed search and clinical trials. The pharmacokinetics and pharmacodynamics of desvenlafaxine are reviewed. This review outlines the effects of desvenlafaxine in management of severity and frequency of vasomotor symptoms, sleep quality and quality of life in postmenopausal women. The potential adverse effects of desvenlafaxine are summarized. EXPERT OPINION Based on the evidence from randomized clinical trials, desvenlafaxine is an alternate viable option for reducing the frequency and severity of hot flashes when other treatments fail. In clinical trials, it has been shown that desvenlafaxine reduced the frequency of hot flashes by 55 - 69%. In the trials so far it appears to have good safety and tolerability profile when the drug is initiated in titrating doses. The optimum dose is 100 mg/day and is to be started at 50 mg/day for 3 days and titrated to 100 mg/day. The most common adverse events reported were nausea, dry mouth, fatigue, constipation, diarrhea and somnolence.
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Affiliation(s)
- Sri Harsha Tella
- Creighton University School of Medicine, Department of Internal Medicine , 601 N 30th St, Suite 6718, Omaha, NE 68131 , USA +1 402 280 4518 ; +1 402 280 4517 ;
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