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Behandlung von klimakterischen Beschwerden nach Brustkrebs

Therapy of climacteric symptoms in women with history of breast cancer

  • Leitthema
  • Published:
Gynäkologische Endokrinologie Aims and scope

Zusammenfassung

Hintergrund

Frauen mit Brustkrebs in der Vorgeschichte leiden häufig unter klimakterischen Beschwerden. Eine menopausale Hormontherapie kann die Beschwerden zwar reduzieren, wird für dieses Patientenkollektiv jedoch aufgrund eines erhöhten Rezidivrisikos nicht empfohlen.

Ziel der Arbeit

Ziel ist die Darlegung der aktuellen Datenlage zur nichthormonellen Therapie für das genannte Patientenkollektiv.

Material und Methoden

In einer PubMed-Recherche wurden Studien und Metaanalysen von 1997 bis 2014 gesucht, die eine menopausale Hormontherapie mit einer nichthormonellen Therapie bei klimakterischen Symptomen nach Mammakarzinom verglichen.

Ergebnisse

Der Einsatz einer menopausalen Hormontherapie wird Frauen mit einer Brustkrebsdiagnose in der Vorgeschichte nicht empfohlen. Lebensstiländerungen sind die therapeutische Basis bei klimakterischen Beschwerden. Die tägliche Einnahme von 50–60 mg Isoflavon kann die Frequenz und Schwere von Hitzewallungen signifikant senken, wenn nicht mehr als 4 Episoden pro Tag auftreten. Cimicifuga racemosa mildert Hitzewallungen und depressive Symptome, zudem könnte eine Assoziation mit einem verlängerten krankheitsfreien Überleben bestehen. Die Wirksamkeit ist vergleichbar mit transdermalem Östrogen. Antidepressiva und Antikonvulsiva sind erwiesenermaßen wirksam und können als Zweitlinientherapie zum Einsatz kommen.

Schlussfolgerungen

Studien zur nichthormonellen Therapie klimakterischer Beschwerden zeigen, dass sie wirksam ist. Brustkrebspatientinnen haben also eine Therapiealternative zur Hormontherapie, die jedoch weiterhin die wirksamere Option darstellt. Weitere Studien sind notwendig, um die Effektivität und die Wirkmechanismen nichthormoneller Therapien weiter zu untersuchen.

Abstract

Background

Women with a history of breast cancer often suffer from climacteric symptoms. Hormonal therapies are known to reduce these symptoms but are not recommended in women with a history of breast cancer due to their potential adverse effects.

Objectives

The goal of this work is to give a literature overview on the efficacy of non-hormonal therapies as a therapy option for this patient group.

Materials and methods

In a PubMed search, relevant studies and meta-analyses from 1997–2014 that provided data on treatment of menopausal symptoms with hormonal replacement therapy versus nonhormonal therapies were identified.

Results

Hormone replacement therapy is not recommended in patients with history of breast cancer. Lifestyle modification is the basis in treating climacteric symptoms. Daily isoflavone intake of 50–60 mg can significantly reduce frequency and severity of hot flushes if not present more than 4 times/day. Cimicifuga racemosa allays hot flushes, depressive mood, and might be associated with prolonged disease-free survival. Its efficacy is comparable to transdermal estrogen. Off-label use of antidepressants like paroxetin and venlafaxin and anticonvulsants like gabapentin can be used as second line treatment with good efficacy.

Conclusion

Studies on nonhormonal therapies provide evidence for efficacy so that breast cancer patients do have an alternative treatment option for climacteric disorders. Nevertheless, hormone replacement is still more effective. More well-designed trials are needed to further investigate nonhormonal therapies.

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Literatur

  1. (o A) (1997) Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52,705 women with breast cancer and 108,411 women without breast cancer. Collaborative Group on Hormonal Factors in Breast Cancer. Lancet 350:1047–1059

  2. Beral V, Reeves G, Bull D et al (2011) Breast cancer risk in relation to the interval between menopause and starting hormone therapy. J Natl Cancer Inst 103:296–305

  3. Chlebowski RT, Hendrix SL, Langer RD et al (2003) Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women’s Health Initiative Randomized Trial. JAMA 289:3243–3253

    Article  CAS  PubMed  Google Scholar 

  4. (o A) (2006) Tibolone: cancers of the breast and endometrium. Prescrire Int 15:107

  5. Col NF, Hirota LK, Orr RK et al (2001) Hormone replacement therapy after breast cancer: a systematic review and quantitative assessment of risk. J Clin Oncol 19:2357–2363

  6. Col NF, Kim JA, Chlebowski RT (2005) Menopausal hormone therapy after breast cancer: a meta-analysis and critical appraisal of the evidence. Breast Cancer Res 7:R535–R540

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Holmberg L, Anderson H, HABITS steering and data monitoring committees (2004) HABITS (hormonal replacement therapy after breast cancer – is it safe?), a randomised comparison: trial stopped. Lancet 363:453–455

    Article  CAS  PubMed  Google Scholar 

  8. Dew JE, Wren BG, Eden JA (2002) Tamoxifen, hormone receptors and hormone replacement therapy in women previously treated for breast cancer: a cohort study. Climacteric 5:151–155

    Article  CAS  PubMed  Google Scholar 

  9. Pritchard KI, Khan H, Levine M, Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer (2002) Clinical practice guidelines for the care and treatment of breast cancer: 14. The role of hormone replacement therapy in women with a previous diagnosis of breast cancer. CMAJ 166:1017–1022

    PubMed Central  PubMed  Google Scholar 

  10. Kroenke CH, Chen WY, Rosner B, Holmes MD (2005) Weight, weight gain, and survival after breast cancer diagnosis. J Clin Oncol 23:1370–1378

  11. Key TJ, Appleby PN, Reeves GK et al (2003) Body mass index, serum sex hormones, and breast cancer risk in postmenopausal women. J Natl Cancer Inst 95:1218–1226

  12. Colditz GA (2005) Menopausal hormone therapy after breast cancer. Breast Cancer Res 7:168–170

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Davis SR (2001) Phytoestrogen therapy for menopausal symptoms? BMJ 323:354–355

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. North American Menopause Society (2004) Treatment of menopause-associated vasomotor symptoms: position statement of The North American Menopause Society. Menopause 11:11–33

    Article  Google Scholar 

  15. Maggiolini M, Bonofiglio D, Marsico S et al (2001) Estrogen receptor alpha mediates the proliferative but not the cytotoxic dose-dependent effects of two major phytoestrogens on human breast cancer cells. Mol Pharmacol 60:595–602

    CAS  PubMed  Google Scholar 

  16. Chen M, Rao Y, Zheng Y et al (2014) Association between soy isoflavone intake and breast cancer risk for pre- and post-menopausal women: a meta-analysis of epidemiological studies. PLoS One 9:e89288

    Article  PubMed Central  PubMed  Google Scholar 

  17. Obi N, Chang-Claude J, Berger J et al (2009) The use of herbal preparations to alleviate climacteric disorders and risk of postmenopausal breast cancer in a German case-control study. Cancer Epidemiol Biomarkers Prev 18:2207–2213

    Article  PubMed  Google Scholar 

  18. Krebs EE, Ensrud KE, MacDonald R, Wilt TJ (2004) Phytoestrogens for treatment of menopausal symptoms: a systematic review. Obstet Gynecol 104:824–836

    Article  CAS  PubMed  Google Scholar 

  19. Lethaby AE, Brown J, Marjoribanks J et al (2007) Phytoestrogens for vasomotor menopausal symptoms. Cochrane Database Syst Rev:CD001395

    Google Scholar 

  20. Taku K, Melby MK, Kronenberg F et al (2012) Extracted or synthesized soybean isoflavones reduce menopausal hot flash frequency and severity: systematic review and meta-analysis of randomized controlled trials. Menopause 19:776–790

    Article  PubMed  Google Scholar 

  21. North American Menopause Society (2011) The role of soy isoflavones in menopausal health: report of The North American Menopause Society/Wulf H. Utian Translational Science Symposium in Chicago, IL (October 2010). Menopause 18:732–753

    Article  Google Scholar 

  22. Uebelhack R, Blohmer JU, Graubaum HJ et al (2006) Black cohosh and St. John’s wort for climacteric complaints: a randomized trial. Obstet Gynecol 107(2 Pt 1):247–255

    Article  PubMed  Google Scholar 

  23. Nappi RE, Malavasi B, Brundu B, Facchinetti F (2005) Efficacy of Cimicifuga racemosa on climacteric complaints: a randomized study versus low-dose transdermal estradiol. Gynecol Endocrinol 20:30–35

    Article  PubMed  Google Scholar 

  24. Rebbeck TR, Troxel AB, Norman S et al (2007) A retrospective case-control study of the use of hormone-related supplements and association with breast cancer. Int J Cancer 120:1523–1528

    Article  CAS  PubMed  Google Scholar 

  25. Henneicke-von Zepelin HH, Meden H, Kostev K et al (2007) Isopropanolic black cohosh extract and recurrence-free survival after breast cancer. Int J Clin Pharmacol Ther 45:143–154

    Article  Google Scholar 

  26. Stearns V, Isaacs C, Rowland J et al (2000) A pilot trial assessing the efficacy of paroxetine hydrochloride (Paxil) in controlling hot flashes in breast cancer survivors. Ann Oncol 11:17–22

    Article  CAS  PubMed  Google Scholar 

  27. Weitzner MA, Moncello J, Jacobsen PB, Minton S (2002) A pilot trial of paroxetine for the treatment of hot flashes and associated symptoms in women with breast cancer. J Pain Symptom Manage 23:337–345

  28. Loprinzi CL, Kugler JW, Sloan JA et al (2000) Venlafaxine in management of hot flashes in survivors of breast cancer: a randomised controlled trial. Lancet 356:2059–2063

    Article  CAS  PubMed  Google Scholar 

  29. Guttuso T Jr, Kurlan R, McDermott MP, Kieburtz K (2003) Gabapentin’s effects on hot flashes in postmenopausal women: a randomized controlled trial. Obstet Gynecol 101:337–345

    Article  CAS  PubMed  Google Scholar 

  30. Loibl S, Schwedler K, Minckwitz G von et al (2007) Venlafaxine is superior to clonidine as treatment of hot flashes in breast cancer patients – a double-blind, randomized study. Ann Oncol 18:689–693

    Article  CAS  PubMed  Google Scholar 

  31. http://www.agoonline.de/fileadmin/downloads/leitlinien/mamma/maerz2012/26_2012D_Komplementaere_Therapie.pdf. Zugegriffen: 20. April 2014

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M.-K. von Wahlde und L. Kiesel geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland

    M.-K. von Wahlde &  L. Kiesel

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  1. M.-K. von Wahlde
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  2. L. Kiesel
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Correspondence to L. Kiesel.

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von Wahlde, MK., Kiesel, L. Behandlung von klimakterischen Beschwerden nach Brustkrebs. Gynäkologische Endokrinologie 12, 156–161 (2014). https://doi.org/10.1007/s10304-013-0624-9

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