Becky
01-26-2006, 01:48 PM
Just found this - interesting in this came up during the chat topic on Hormonals. This article indicates that vaginal estrogen is not a good idea.
Oh well - I am not going to ask my onco about it now.
Best regards,
Becky
Vaginal Estrogen May Mix Poorly With Aromatase Inhibitors
By Jeff Minerd, MedPage Today Staff Writer
Reviewed by Robert Jasmer, MD; Assistant Professor of Medicine, University of California, San Francisco (http://www.medpagetoday.com/reviewer.cfm?reviewerid=55)
January 26, 2006
MedPage Today Action Points
Advise women taking aromatase inhibitors for breast cancer that this small study suggests that vaginal estrogen preparations should not be used to relieve symptoms of atrophic vaginitis.
Consider non-hormonal moisturizing gels or creams for this patient population instead.
Review
LONDON, Jan. 26 - Vaginal estrogen preparations for atrophic vaginitis may be contraindicated in women taking aromatase inhibitors as adjuvant therapy for breast cancer, according to a small study conducted here.
The preparations reverse the estrogen suppression achieved by aromatase inhibitors and cause estrogen levels to climb dangerously high, reported Ian Smith, M.D., of the Royal Marsden Foundation here, and colleagues, in a study published online today in the Annals of Oncology.
About 40% of postmenopausal women suffer from atrophic vaginitis, and the associated dryness, urinary incontinence, and pain during intercourse significantly reduce the quality of life for these patients, the researchers said.
One potential treatment, hormone therapy, is contraindicated in women taking aromatase inhibitors because it is known to interfere with the estrogen-suppressing effects of these breast cancer agents.
However, doctors sometimes offer vaginal estrogen preparations -- which come in the form of pills, rings, or creams -- to these women because of the belief the approach does not interfere with aromatase inhibitors, the authors said.
Their study included six women, ages 51 to 59, taking adjuvant aromatase inhibitor therapy for early breast cancer. All were prescribed Vagifem (estradiol vaginal tablets, 25 mcg) for 12 weeks, and their estrogen levels were monitored.
From baseline levels of less than 5 pmol/L, estrogen levels rose to a mean of 72 pmol/L at two weeks. By four weeks, this had decreased to a mean of about 35 pmol/L. However, only two women returned to baseline levels.
Furthermore, estrogen levels continued to rise in two other women, reaching 219 pmol/L in one and 137 pmol/L in the other at about 10 weeks.
In a seventh woman who used a vaginal cream preparation, the same overall pattern was observed-a marked spike in estrogen levels at two weeks that gradually tapered off but did not return to baseline.
Because of its low levels in these women, estrogen was measured using a sensitive radioimmunoassay developed by the researchers.
"Using this vaginal form of estrogen which, we found, increases systemic estradiol levels, will counteract aromatase inhibitor treatment," Dr. Smith said. "With long-term use, women may be risking the chance that their cancer may return, although this is probably not an issue if estrogen rises for only one to two months."
However, the efficacy of aromatase inhibitors depends on near total suppression of estrogen, the researchers noted.
"Our view is that the combination of aromatase inhibitors and Vagifem is contraindicated, apart from exceptional circumstances where regular monitoring of plasma estradiol with specialist assays is available," said co-author Anne Kendall, M.D., also of the Royal Marsden Foundation. "Other non-hormonal vaginal moisturizing gels or creams should be used in most cases."
Vagifem is manufactured by Novo Nordisk. The product's prescribing information states that it is contraindicated in women with known or suspected breast cancer.
Primary source: Annals of Oncology
Source reference:
Kendall A et al. Caution: vaginal estradiol appears to be contraindicated in postmenopausal women on adjuvant aromatase inhibitors. Annals of Oncology. Advanced online publication January 26, 2006.
Disclaimer (http://www.medpagetoday.com/disclaimer.cfm)
top (http://www.medpagetoday.com/HematologyOncology/BreastCancer/tb1/#top)
Oh well - I am not going to ask my onco about it now.
Best regards,
Becky
Vaginal Estrogen May Mix Poorly With Aromatase Inhibitors
By Jeff Minerd, MedPage Today Staff Writer
Reviewed by Robert Jasmer, MD; Assistant Professor of Medicine, University of California, San Francisco (http://www.medpagetoday.com/reviewer.cfm?reviewerid=55)
January 26, 2006
MedPage Today Action Points
Advise women taking aromatase inhibitors for breast cancer that this small study suggests that vaginal estrogen preparations should not be used to relieve symptoms of atrophic vaginitis.
Consider non-hormonal moisturizing gels or creams for this patient population instead.
Review
LONDON, Jan. 26 - Vaginal estrogen preparations for atrophic vaginitis may be contraindicated in women taking aromatase inhibitors as adjuvant therapy for breast cancer, according to a small study conducted here.
The preparations reverse the estrogen suppression achieved by aromatase inhibitors and cause estrogen levels to climb dangerously high, reported Ian Smith, M.D., of the Royal Marsden Foundation here, and colleagues, in a study published online today in the Annals of Oncology.
About 40% of postmenopausal women suffer from atrophic vaginitis, and the associated dryness, urinary incontinence, and pain during intercourse significantly reduce the quality of life for these patients, the researchers said.
One potential treatment, hormone therapy, is contraindicated in women taking aromatase inhibitors because it is known to interfere with the estrogen-suppressing effects of these breast cancer agents.
However, doctors sometimes offer vaginal estrogen preparations -- which come in the form of pills, rings, or creams -- to these women because of the belief the approach does not interfere with aromatase inhibitors, the authors said.
Their study included six women, ages 51 to 59, taking adjuvant aromatase inhibitor therapy for early breast cancer. All were prescribed Vagifem (estradiol vaginal tablets, 25 mcg) for 12 weeks, and their estrogen levels were monitored.
From baseline levels of less than 5 pmol/L, estrogen levels rose to a mean of 72 pmol/L at two weeks. By four weeks, this had decreased to a mean of about 35 pmol/L. However, only two women returned to baseline levels.
Furthermore, estrogen levels continued to rise in two other women, reaching 219 pmol/L in one and 137 pmol/L in the other at about 10 weeks.
In a seventh woman who used a vaginal cream preparation, the same overall pattern was observed-a marked spike in estrogen levels at two weeks that gradually tapered off but did not return to baseline.
Because of its low levels in these women, estrogen was measured using a sensitive radioimmunoassay developed by the researchers.
"Using this vaginal form of estrogen which, we found, increases systemic estradiol levels, will counteract aromatase inhibitor treatment," Dr. Smith said. "With long-term use, women may be risking the chance that their cancer may return, although this is probably not an issue if estrogen rises for only one to two months."
However, the efficacy of aromatase inhibitors depends on near total suppression of estrogen, the researchers noted.
"Our view is that the combination of aromatase inhibitors and Vagifem is contraindicated, apart from exceptional circumstances where regular monitoring of plasma estradiol with specialist assays is available," said co-author Anne Kendall, M.D., also of the Royal Marsden Foundation. "Other non-hormonal vaginal moisturizing gels or creams should be used in most cases."
Vagifem is manufactured by Novo Nordisk. The product's prescribing information states that it is contraindicated in women with known or suspected breast cancer.
Primary source: Annals of Oncology
Source reference:
Kendall A et al. Caution: vaginal estradiol appears to be contraindicated in postmenopausal women on adjuvant aromatase inhibitors. Annals of Oncology. Advanced online publication January 26, 2006.
Disclaimer (http://www.medpagetoday.com/disclaimer.cfm)
top (http://www.medpagetoday.com/HematologyOncology/BreastCancer/tb1/#top)