Adverse effects of non-hormonalpharmacologicalinterventions in breast cancer survivors, suffering from hot flashes: A systematic review and meta-analysis.

Jill Brook Hervik,Trine Stub

doi:10.1007/s10549-016-4002-x

Abstract

PurposeTo access frequency and severity of adverse effects (AE) of non-hormonal drugs (NHD) for hot flashes in breast cancer survivors compared to controls and analyze adverse-effect risk by reviewing published randomized trials.MethodsCochrane Central Register for Controlled Trials, Embase, Medline, PsycINFO and PubMed databases were searched. Trials were included where participants were survivors of breast cancer suffering from hot flashes, treatment included self-administered venlafaxine, gabapentin or clonidine, and AE were reported. AE frequency and severity were graded. A meta-analysis of ten trials with sub-group analyses was conducted.ResultsForty-nine studies were identified, and 12 were included. A total of 1467 participants experienced 772 adverse effects, 81 % (n = 627) in the treatment group and 19 % (n = 145) in the control group. Sixty-seven percent of AE was graded as mild and 33 % as moderate. The frequency of AE for NHD was overall significant compared to placebo. Sub-group analysis indicated that AE frequency and severity increased at higher doses of venlafaxine and gabapentin compared to placebo.ConclusionThe odds for experiencing AE was significantly higher in patients randomized to high-dose NHD than those randomized to controls, including placebo, low-dose medication and acupuncture. These therapies should be considered as a potential treatment alternative.

Highlights

Breast cancer is the second most common cancer in the world and the most frequent cancer among women. 1.67 million new cases were diagnosed in 2012 [1].Treatment of breast cancer includes surgery, chemotherapy, radiation and endocrine therapy
Purpose To access frequency and severity of adverse effects (AE) of non-hormonal drugs (NHD) for hot flashes in breast cancer survivors compared to controls and analyze adverse-effect risk by reviewing published randomized trials
The odds for experiencing AE was significantly higher in patients randomized to high-dose NHD

Summary

Introduction

Breast cancer is the second most common cancer in the world and the most frequent cancer among women. Treatment of breast cancer includes surgery, chemotherapy, radiation and endocrine therapy. Fifty percent of women diagnosed with breast cancer have a tumour that is oestrogen receptor positive, and they are offered hormone-suppression treatment lasting for at least five years [2]. Tamoxifen is an oestrogen receptor modulator which blocks the effect of oestrogen in breast tissue. It is indicated for use in premenopausal women and, as an initial treatment, in post-menopausal women. Aromatase inhibitors are recommended only for post-menopausal women, in whom the main source of oestrogen comes from the conversion of testosterone to estradiol, facilitated by the aromatase enzyme

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