Induced Vasomotor Symptoms (iVMS)

Induced Vasomotor Symptoms (iVMS)

Induced Vasomotor Symptoms Description

Hot flashes, flushing, night sweats are known as Vasomotor symptoms (VMS), and most often occur in women who are entering/in menopause. VMS are causally related to decreasing estradiol concentrations, mainly in the serum and subsequently also in the temperature regulating center located in the hypothalamus. The lack of estrogen alters neurotransmitter activity, especially in the serotonergic and noradrenergic pathways. Because sex steroids act as potent neuromodulators, the substitution of ovarian sex steroids by hormone replacement therapy (HRT) is the most effective treatment option for VMS. While VMS associated with menopause can be often be treated with HRT, there are patients who experience VMS who are not in menopause and for whom HRT is contraindicated.

Vasomotor symptoms that are induced by either chemical or surgical intervention are referred to as induced Vasomotor Symptoms (iVMS). For example, patients receiving tamoxifen treatment for breast cancer, men receiving leuprolide treatment for prostate cancer, and women who are BRCA-positive who elect to have bilateral salpingo-oophorectomy (BSO)2, 3, all exhibit severe iVMS and should not receive HRT to alleviate these symptoms because their cancer is sensitive to hormones which could cause disease recurrence.1,4

iVMS Epidemiology

In women with HR+ Breast Cancer (CaB) receiving Tamoxifen:

  • 84% of women experienced hot flashes5
  • 80% experienced night sweats
  • 60% experienced severe symptoms
  • Symptoms persisted throughout 5 years of treatment and were mainly attributed to tamoxifen
  • After 4.5 years, 46% of women had discontinued tamoxifen6

In men with HR+ Prostate Cancer (CaP) receiving Leuprolide:

  • 80% of men experience hot flashes7
  • 15-27% of patients consider hot flashes the most distressing side effect
  • 30-40% experienced moderate-to-severe symptoms
  • 20% discontinued or disrupted treatment

In women who are BRCA+ and have bilateral salpingo-oophorectomy (BSO):

  • 67% of women have symptoms of menopause such as hot flashes
  • Up to 35% complain of “extremely bothersome” symptoms up to two years after their surgery9

iVMS Management

Induced vasomotor symptoms (iVMS) are well documented with the use of hormonal cancer therapies and certain surgical procedures. Symptoms such as hot flashes can appear immediately and be severe. Traditional HRTs are usually contraindicated. Non-adherence to therapy can be associated with side effects that can increase the mortality risk or shorten the time to recurrence. Therefore, a non-hormonal treatment for patients with iVMS is needed to potentially help increase the quality of life (QOL) and improve outcomes.10

References

  1. L. Holmberg, O.E. Iversen, C.M. Rudenstam, et al., Increased risk of recurrence after hormone replacement therapy in breast cancer survivors, J. Natl. Cancer Inst. 100 (7) (2008) 475–482.
  2. Kotsopoulos J, Huzarski T, Gronwald J, Moller P, Lynch HT, Neuhausen SL, et al. Hormone replacement therapy after menopause and risk of breast cancer in BRCA1 mutation carriers: a case-control study. Breast Cancer Research and Treatment 2016;155(2):365–73.
  3. Guidozzi F. Hormone therapy after prophylactic riskreducing bilateral salpingo-oophorectomy in women who have BRCA gene mutation. Climacteric 2016;19(5): 419–22.
  4. Chlebowski RT, Kuller LH, Prentice RL, et al. Breast cancer after use of estrogen plus progestin in postmenopausal women. N Engl J Med. 2009;360(6):573-587.
  5. Moon, Z. et al., Journal of Pyschosomatic Obstetrics & Gynecology, 2017 VOL. 38, NO. 3, 226–235.
  6. Nichols, H, et al., JNCI J Natl Cancer Inst, 2015, 1–8.
  7. Challapalli, A, et al., Clinical and Translational Radiation Oncology 10 (2018) 29–35.
  8. L. Johnson, et al. American Society for Reproductive Medicine, 2014 Vol 102 No. 3, Supplement, e249.
  9. Robson M, Hensley M, Barakat R, et al. Quality of life in women at risk for ovarian cancer who have undergone risk-reducing oophorectomy. Gynecol Oncol 2003;89(2):281–7.
  10. A. Finch, S.A. Narod. Quality of life and health status after prophylactic salpingo-oophorectomy in women who carry a BRCA mutation: A review. Maturitas 70 (2011) 261– 265.
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