Vitamin E, hot flashes and Tamoxifen

[1rarebird]

While getting my weekly infusion of Herceptin this morning, I mentioned to my nurse that I have been sleeping poorly since starting Tamoxifen 6 weeks ago and my hot flashes keep waking me. She said that many people with this problem take Vitamin E supplements and often find some relief. She recommended taking 400 IU doses twice a day.

I double checked via the Internet and basically found several sources that confirmed my nurse's recommendations. However, when I checked for possible adverse interactions of Vitamin E and Tamoxifen, I found an abstract of a paper listed in the November 2006 Annals of Surgical Oncology which warned of a possible decease in Tamoxifen efficacy with the concurrent administration of Vitamin E (see http://www.springerlink.com/content/x7m3qt7lx1173n51/ ) The researchers conducted experiments in vitro and in mice models using humanized breast cancer cells.

I don't know if the dosing in the experiments was equivalent to typical Tamoxifen therapy and likely vitamin E supplementation by breast cancer patients. I am wondering if this same sort research has been conducted by others and what the recommendations are. Although I would like to sleep better, I certainly don't want to jeopardize whatever benefit I may be getting from the Tamoxifen.

bird

[PinkGirl]

Hi Bird
I don't know anything about Vit. E but I do know that everything my
onc. gave me "permission" to try for hot flashes did not work.

I have a small fan beside my bed ... aimed right at my head ... this
is what has worked the best for me.

[Jean]

Hi 1Rarebird,
When selecting a vit. e supplement, you should choose one which contains other tocopherols and tocotrienols, not just aplpha- tocopherol. Commercial alpha- tocopherol acctate supplement fail to reduce the incidence of breast cancer and help with hot flashes.
It is the tocotrienols one of the 8 members of the Vit. E family which have demonstrated the most siginigicant
potential. Check with the health store you purchase your Vit. E....Also you should be taking your vit. e with a meal for best absorption.

Try to eat foods rich in Vit.E which is your best source.
Chickpeas, corn,Nuts, Wheat germ, which all offer a good combination of tocopherols plus tocotrienols. The natural form is always best.

While Vit. E is believed to prevent certain cancers you should also be careful not to over dose on vit. e

http://www.sciencedaily.com/releases/2008/02/080229075222.htm

[Rich66]

More recent (2009) support for avoiding Vitamin E with TAM:

J Surg Res. (http://javascript%3Cb%3E%3C/b%3E:AL_get%28this,%20%27jour%27,%20%27J%20Surg%20 Res.%27%29;) 2009 May 1;153(1):143-7. Epub 2008 Apr 22.
Vitamin E increases biomarkers of estrogen stimulation when taken with tamoxifen.

Peralta EA (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Peralta%20EA%22%5BAuthor%5D), Brewer AT (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Brewer%20AT%22%5BAuthor%5D), Louis S (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Louis%20S%22%5BAuthor%5D), Dunnington GL (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Dunnington%20GL%22%5BAuthor%5D).
Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL 62794-9638, USA. eperalta@siumed.edu
Abstract

BACKGROUND: Vitamin E (alpha-tocopherol acetate, AT) diminishes the antiproliferative effect of tamoxifen on breast cancer cells in vitro. METHODS: A prospective study of seven women taking tamoxifen for adjuvant therapy of breast cancer. Four who were already taking AT supplements had random core biopsies of the normal breast and again 30 days after discontinuing AT. Three who were not on AT had biopsies before and after adding AT 400 mg for 30 days. Biopsies were stained for estrogen receptor (ER) and the mitogen-activated protein kinase p-ERK. Tissue extracts were assayed for p-ERK by enzyme-linked immunosorbent assay. Serum levels of alpha-tocopherol and tamoxifen were measured. RESULTS: Five out of seven patients had lower tamoxifen levels while taking AT, four of these went to subtherapeutic levels. Biopsies showed 23% of ductal cells were ER positive when patients were off AT and 70% on AT (P = 0.02). P-ERK staining was 21% off AT and 82% on AT. Five of seven patients had significantly higher tissue p-ERK when on AT. CONCLUSIONS: Biomarkers of estrogen-stimulation (ER, progesterone receptor, and p-ERK) were higher in breast biopsies of women taking vitamin E supplements while taking tamoxifen. Findings suggest that vitamin E supplements may interfere with the therapeutic effects of tamoxifen.

PMID: 18468636 [PubMed - indexed for MEDLINE]


More on Tamoxifen HERE (http://her2support.org/vbulletin/showthread.php?t=41711)

[1rarebird]

Thank you, Rich, for locating this research synopsis. E.A. Perlata at Southern Illinois School of Medicine was also involved in the 2006 study done with mice. I am glad to see he and his cohorts follow up with this 2009 study using brave women willing to undergo the unpleasantness of core biopsy to test his earlier hypothesis. I suspect there may be a call for more exhaustive tests to be preformed, but I have seen enough now to disregard my nurse's recommendation and I will not be taking the vitamin E while I am still on Tamoxifen.
Thanks again--
bird

[v-ness]

i got my chemopause hot flashes completely under control, and they were bad, by using 900 mgs of neurontin. then i started tamoxifen and the resulting extra hot flashes from that over-rode the neurontin's power to curb them. the other night i slept with an ice pack under my neck it was so bad. i guess i will try a higher dose of neurontin and, if that doesn't work, give up. hoping exercise might help, which i am doing much more frequently now that radiation is over. v

[naturalhealth]

I typically have found that many people I know of have greater success using natural supplements to help with side effects than some of the prescribed medications. Vitamin E (http://www.seacoastvitamins.com/supplement/now-foods-vitamin-e-400-iu-mixed-tocopherols-250-softgels-8929)is a safe, natural supplement without really any side effects. It's also very difficult to overdose on it, so you can usually feel very safe taking a little more than the recommended dosage if necessary. There are very few drug interactions, and I've never read anything about Tamoxifen being a problem. However, if you're concerned about it, I would definitely talk to your doctor about it. But if he/she approves it even after your concerns, then definitely give it a try.

[sassy]

Like v-ness, I have used neurontin for hot flashes. Started on a fairly high dose, then tapered down as I got the flashes better under control. It does NOT make them go away entirely, but did help significantly.

[1rarebird]

http://www.surgjournal.com/article/S0039-6060%2806%2900392-8/abstract

The reason I decided forego vitamin E for my HFs.
bird

Volume 140 (http://www.surgjournal.com/issues?Vol=140), Issue 4 (http://www.surgjournal.com/issues/contents?issue_key=S0039-6060%2806%29X0588-3), Pages 607-615 (October 2006)
http://www.surgjournal.com/webfiles/images/transparent.gif
















Effect of vitamin E on tamoxifen-treated breast cancer cells

Presented at the 63rd Annual Meeting of the Central Surgical Association, Louisville, Kentucky, March 9-11, 2006.
Elizabeth A. Peralta (http://www.surgjournal.com/article/S0039-6060%2806%2900392-8/abstract#), MDhttp://www.surgjournal.com/webfiles/images/icon_authorInfo.gif (http://www.surgjournal.com/article/S0039-6060%2806%2900392-8/abstract#cor1)http://www.surgjournal.com/webfiles/images/icon_emailAuthor.gif (eperalta@siumed.edu), Melita L. Viegas (http://www.surgjournal.com/article/S0039-6060%2806%2900392-8/abstract#), MD, Somaja Louis (http://www.surgjournal.com/article/S0039-6060%2806%2900392-8/abstract#), MS, Deborah L. Engle (http://www.surgjournal.com/article/S0039-6060%2806%2900392-8/abstract#), MS, Gary L. Dunnington (http://www.surgjournal.com/article/S0039-6060%2806%2900392-8/abstract#), MDReceived 10 February 2006; accepted 10 July 2006. published online 04 September 2006.
Background

Induction of apoptosis by tamoxifen has been postulated to involve oxidative stress. Tamoxifen (TAM) may act on estrogen receptors (ER) located in the plasma membrane. Our hypothesis that supplemental antioxidant vitamin E (α-tocopherol) acts at the plasma membrane to alter the effectiveness of tamoxifen was tested in ER-positive breast cancer cell lines, MCF-7 and T47D.

Methods

Cells were treated in vitro with 20-μM TAM alone and in combination with 10-μM α-tocopherol (AT). Estrogen growth signals were quantified by immunohistochemical staining for the mitogen-activated protein kinase p-ERK. Rapid changes in intracellular calcium were detected in TAM-treated MCF-7 and T-47D cells by fluorescence microscopy of cells loaded with the calcium-sensitive dye Fluo 4AM. Apoptosis was assayed by flow cytometry.

Results

Proliferating cells in normal medium exhibited strong p-ERK staining. Addition of TAM abolished p-ERK staining and caused cell rounding and death. The addition of AT led to the restoration of cell proliferation and p-ERK expression even in the presence of high-dose TAM. Intracellular calcium rapidly increased in MCF-7 and T47D cells upon exposure to TAM, followed by an increase in caspase activation and eventual apoptosis. The increase in intracellular calcium was abolished by the addition of 10μM AT to TAM, and pan-caspase staining decreased at 5 hours from 72% to 41%.

Conclusions

These studies suggest that supplemental vitamin E decreases the inhibitory effect of TAM on the proliferation of ER+ breast cancer cells and eliminates the rapid rise in intracellular calcium that leads to apoptosis stimulated by TAM. The use of vitamin E acetate supplements may be inadvisable for women taking tamoxifen.