Induced Vasomotor Symptoms (iVMS)

Induced Vasomotor Symptoms (iVMS)

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.

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)1,2, all exhibit severe iVMS.

iVMS Epidemiology

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

  • 84% of women experienced hot flashes4
  • 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 tamoxifen5

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

  • 80% of men experience hot flashes6
  • 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 surgery8

iVMS Management

Induced vasomotor symptoms (iVMS) are well documented with the use of cancer therapies and certain surgical procedures. Symptoms such as hot flashes can appear immediately and be severe. Non-adherence to therapy can be associated with side effects that can increase the mortality risk or shorten the time to recurrence.

References

  1. 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.
  2. Guidozzi F. Hormone therapy after prophylactic riskreducing bilateral salpingo-oophorectomy in women who have BRCA gene mutation. Climacteric 2016;19(5): 419–22.
  3. 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.
  4. Moon, Z. et al., Journal of Pyschosomatic Obstetrics & Gynecology, 2017 VOL. 38, NO. 3, 226–235.
  5. Nichols, H, et al., JNCI J Natl Cancer Inst, 2015, 1–8.
  6. Challapalli, A, et al., Clinical and Translational Radiation Oncology 10 (2018) 29–35.
  7. L. Johnson, et al. American Society for Reproductive Medicine, 2014 Vol 102 No. 3, Supplement, e249.
  8. 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.
  9. 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.
QUICK
NAV