Interview
with Neil Love, MD from Breast Cancer Update for Medical Oncologists,
Program 4 2000
Play
Audio Below:
Dr.
Loprinzi: For people who, if they have severe hot flashes and
they really want something to help them and it’s a non-estrogen
preparation to help them, then going to a progestational agent,
megestrol acetate, will give you about an 80% reduction in those
hot flashes. It is very satisfying. Another newer thing we have
been utilizing recently is using the medroxy-progesterone acetate
depo preparation intra-muscular shot, one shot every two weeks for
three doses, and we see a 90% or so reduction in hot flashes, which
even after stopping those three doses, in many women, will lasts
for months and hot flashes won’t come back. In some they do
come back.
Dr.
Love: I’m sure every time you present the progestin data somebody
jumps up in the audience and says, "But what about the breast cancer
effect?"
Dr.
Loprinzi: Yes, and that’s the next thing. It is true that with
using progesterones in breast cancer there are not any good data
to suggest that it’s anymore or less safe than using estrogen.
And the main advantage of it, in practice, is that its name is not
estrogen, probably. So I think that that is a very fair statement.
Now, having said that, there are no good data to demonstrate that
it is detrimental. You can go to some test tube or some animal situation
and say, "Well, in here it might do this to perturb this and that
sort of thing," but on the other hand it is a therapy we utilize
for treatment of metastatic breast cancer. So there are no good
data there.
Dr.
Love: You can say the same thing about HRT.
Dr.
Loprinzi: Yes, that’s where I’m coming to. You can say
the same thing about hormone replacement therapy. And there are
data, you know, where people are starting to look at that. And the
pendulum, as to whether to utilize hormone replacement therapy,
in this country I believe, is swinging a bit from one extreme to
the other.
Biopsy
confirmed benign breast disease, postmenopausal use of exogenous
female hormones, and breast carcinoma risk. Byrne,
C.; Connolly, J. L.; Colditz, G. A., and Schnitt, S. J.. Cancer.
89(10):2046-2052, 2000 Nov 15.
Postmenopausal
estrogens - Opposed, unopposed, or none of the above Willett, W. C.; Colditz, G., and Stampfer, M. (Reprint available
from: Willett WC Harvard Univ, Sch Publ Hlth, Dept Nutr 667 Huntington
Ave Boston, MA 02115 USA).. Jama: Journal of the American Medical
Association. 283(4):534-535, 2000 Jan 26. No abstract
Re:
Effect of hormone replacement therapy on breast cancer risk: Estrogen
versus estrogen plus progestin Archer, D. F.; Bush, T., and Nachtigall, L. E. (Reprint available
from: Nachtigall LE NYU, Sch Med, Dept Obstet & Gynecol 251
E 33rd St New York, NY 10016 USA).. Journal of the National Cancer
Institute. 92(23):1950-1951, 2000 Dec 6. No abstract
Estrogen
deficiency: In search of symptom control and sexuality. Loprinzi,
C. L. and Barton, D. Journal of the National Cancer Institute. 92(13):1028-1029,
2000 Jul 5. No abstract
