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Managing Common Estrogen Deprivation Side Effects in HR+ Breast Cancer: an Evidence-Based Review

  • Breast Cancer (AS Zimmer, Section Editor)
  • Published:
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Abstract

Purpose of Review

The article reviews the consequences of estrogen deprivation during endocrine therapy for breast cancer and provides an update on alternative therapies for the management of symptoms.

Recent Findings

Endocrine therapy has progressed substantially in recent years, and its use is recommended for all breast cancer patients expressing hormone receptors. The main adverse events of this treatment can be controlled with medications and nonpharmacological measures. Antidepressants are effective in controlling vasomotor symptoms. Vaginal discomfort can be treated with local lubricants and pelvic floor physiotherapy, which may help in sexual dysfunction. Pathophysiological mechanisms of musculoskeletal symptoms during aromatase inhibitors treatment are not well understood, but some studies evaluating treatment with duloxetine, yoga, and acupuncture have shown some benefits. For prevention of bone loss, patients with risk factors should be offered bisphosphonates or denosumab.

Summary

Individualization of treatment is crucial. Consideration should be given to therapy effects on quality of life, and strategies for controlling associated symptoms should be offered.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Davies C, Godwin J, Gray R, Clarke M, Cutter D, et al. Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials. Lancet. 2011;378(9793):771–84. https://doi.org/10.1016/S0140-6736(11)60993-8.

    Article  CAS  Google Scholar 

  2. Moon Z, Moss-Morris R, Hunter MS, Carlisle S, Hughes LD. Barriers and facilitators of adjuvant hormone therapy adherence and persistence in women with breast cancer: a systematic review. Patient Prefer Adherence. 2017;11:305–22. https://doi.org/10.2147/PPA.S126651.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet Lond Engl. 2005;365(9472):1687–717.

    Article  Google Scholar 

  4. Pistilli B, Paci A, Ferreira AR, Di Meglio A, Poinsignon V, Bardet A, et al. Serum detection of nonadherence to adjuvant tamoxifen and breast cancer recurrence risk. J Clin Oncol. 2020;38(24):2762–72. https://doi.org/10.1200/JCO.19.01758.

    Article  CAS  PubMed  Google Scholar 

  5. Whelan TJ, Goss PE, Ingle JN, Pater JL, Tu D, Pritchard K, et al. Assessment of quality of life in MA.17: a randomized, placebo-controlled trial of letrozole after 5 years of tamoxifen in postmenopausal women. J Clin Oncol. 2005;23(28):6931–40. https://doi.org/10.1200/JCO.2005.11.181.

    Article  CAS  PubMed  Google Scholar 

  6. Lemieux J, Brundage MD, Parulekar WR, Goss PE, Ingle JN, Pritchard KI, et al. Quality of life from Canadian cancer trials group MA.17R: a randomized trial of extending adjuvant letrozole to 10 years. J Clin Oncol. 2018;36(6):563–71. https://doi.org/10.1200/JCO.2017.75.7500.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Regan MM, Price KN, Giobbie-Hurder A, Thürlimann B, Gelber RD, International Breast Cancer Study Group and BIG 1-98 Collaborative Group. Interpreting breast international group (BIG) 1-98: a randomized, double-blind, phase III trial comparing letrozole and tamoxifen as adjuvant endocrine therapy for postmenopausal women with hormone receptor-positive, early breast cancer. Breast Cancer Res. 2011;13(3):209. https://doi.org/10.1186/bcr2837.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Jakesz R, Greil R, Gnant M, Schmid M, Kwasny W, Kubista E, et al. Austrian breast and colorectal cancer study group. Extended adjuvant therapy with anastrozole among postmenopausal breast cancer patients: results from the randomized Austrian Breast and Colorectal Cancer Study Group Trial 6a. J Natl Cancer Inst. 2007;99(24):1845–53. https://doi.org/10.1093/jnci/djm246.

    Article  CAS  PubMed  Google Scholar 

  9. •• Burstein HJ, Lacchetti C, Griggs JJ. Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: ASCO clinical practice guideline focused update. J Oncol Pract. 2019;15(2):106–7. https://doi.org/10.1200/JOP.18.00617This is a systematic review of randomized clinical trials from 2012 to 2018 on adjuvant endocrine therapy. The study demonstrated that extension of aromatase inhibitors treatment is associated with increased adverse effects that may affect quality of life. Extension of adjuvant endocrine treatment should be based on considerations of recurrence risk using established prognostic factors.

    Article  PubMed  Google Scholar 

  10. Gold EB, Colvin A, Avis N, Bromberger J, Greendale GA, Powell L, et al. Longitudinal analysis of the association between vasomotor symptoms and race/ethnicity across the menopausal transition: study of women’s health across the nation. Am J Public Health. 2006;96(7):1226–35. https://doi.org/10.2105/AJPH.2005.066936.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Goldfarb S, Mulhall J, Nelson C, Kelvin J, Dickler M, Carter J. Sexual and reproductive health in cancer survivors. Semin Oncol. 2013;40(6):726–44. https://doi.org/10.1053/j.seminoncol.2013.09.002.

    Article  PubMed  Google Scholar 

  12. Loprinzi CL, Kugler JW, Sloan JA, Mailliard JA, LaVasseur BI, Barton DL, et al. Venlafaxine in management of hot flashes in survivors of breast cancer: a randomized controlled trial. Lancet. 2000;356(9247):2059–63. https://doi.org/10.1016/S0140-6736(00)03403-6.

    Article  CAS  PubMed  Google Scholar 

  13. Johns C, Seav SM, Dominick SA, Gorman JR, Li H, Natarajan L, et al. Informing hot flash treatment decisions for breast cancer survivors: a systematic review of randomized trials comparing active interventions. Breast Cancer Res Treat. 2016;156(3):415–26. https://doi.org/10.1007/s10549-016-3765-4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Shams T, Firwana B, Habib F, Alshahrani A, Alnouh B, Murad MH, et al. SSRIs for hot flashes: a systematic review and meta-analysis of randomized trials. J Gen Intern Med. 2014;29(1):204–13. https://doi.org/10.1007/s11606-013-2535-9.

    Article  PubMed  Google Scholar 

  15. Condorelli R, Vaz-Luis I. Managing side effects in adjuvant endocrine therapy for breast cancer. Expert Rev Anticancer Ther. 2018;18(11):1101–12. https://doi.org/10.1080/14737140.2018.1520096.

    Article  CAS  PubMed  Google Scholar 

  16. Pandya KJ, Morrow GR, Roscoe JA, Zhao H, Hickok JT, Pajon E, et al. Gabapentin for hot flashes in 420 women with breast cancer: a randomised double-blind placebo-controlled trial. Lancet. 2005;366(9488):818–24. https://doi.org/10.1016/S0140-6736(05)67215-7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Shan D, Zou L, Liu X, Shen Y, Cai Y, Zhang J. Efficacy and safety of gabapentin and pregabalin in patients with vasomotor symptoms: a systematic review and meta-analysis. Am J Obstet Gynecol. 2020;222(6):564–579.e12. https://doi.org/10.1016/j.ajog.2019.12.011.

    Article  CAS  PubMed  Google Scholar 

  18. Sica DA, Grubbs R. Transdermal clonidine: therapeutic considerations. J Clin Hypertens (Greenwich). 2005;7(9):558–62. https://doi.org/10.1111/j.1524-6175.2005.04133.x.

    Article  CAS  Google Scholar 

  19. Prague JK, Roberts RE, Comninos AN, Clarke S, Jayasena CN, Nash Z, et al. Neurokinin 3 receptor antagonism as a novel treatment for menopausal hot flushes: a phase 2, randomised, double-blind, placebo-controlled trial. Lancet. 2017;389(10081):1809–20. https://doi.org/10.1016/S0140-6736(17)30823-1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Pinkerton JV, Santen RJ. Managing vasomotor symptoms in women after cancer. Climacteric. 2019;22(6):544–52. https://doi.org/10.1080/13697137.2019.1600501.

    Article  CAS  PubMed  Google Scholar 

  21. Tran S, Hickey M, Saunders C, Ramage L, Cohen PA. Nonpharmacological therapies for the management of menopausal vasomotor symptoms in breast cancer survivors. Support Care Cancer. 2020;29:1183–93. https://doi.org/10.1007/s00520-020-05754-w.

    Article  PubMed  Google Scholar 

  22. McCormick CA, Brennan A, Hickey M. Managing vasomotor symptoms effectively without hormones. Climacteric. 2020;22:1–7. https://doi.org/10.1080/13697137.2020.1789093.

    Article  Google Scholar 

  23. Cramer H, Peng W, Lauche R. Yoga for menopausal symptoms-a systematic review and meta-analysis. Maturitas. 2018;109:13–25. https://doi.org/10.1016/j.maturitas.2017.12.005.

    Article  PubMed  Google Scholar 

  24. •• Marsden J, Marsh M, Rigg A, British Menopause Society. British Menopause Society consensus statement on the management of estrogen deficiency symptoms, arthralgia and menopause diagnosis in women treated for early breast cancer. Post Reprod Health. 2019;25(1):21–32. https://doi.org/10.1177/2053369118824920This guidance provides an overview of the management strategies of estrogen deficiency symptoms associated with breast cancer treatment.

    Article  PubMed  Google Scholar 

  25. Santen RJ, Stuenkel CA, Davis SR, Pinkerton JV, Gompel A, Lumsden MA. Managing menopausal symptoms and associated clinical issues in breast cancer survivors. J Clin Endocrinol Metab. 2017;102(10):3647–61. https://doi.org/10.1210/jc.2017-01138.

    Article  PubMed  Google Scholar 

  26. Baumgart J, Nilsson K, Stavreus-Evers A, Kask K, Villman K, Lindman H, et al. Urogenital disorders in women with adjuvant endocrine therapy after early breast cancer. Am J Obstet Gynecol. 2011;204(1):26.e1–7. https://doi.org/10.1016/j.ajog.2010.08.035.

    Article  Google Scholar 

  27. Faubion SS, Loprinzi CL, Ruddy KJ. Management of hormone deprivation symptoms after cancer. Mayo Clin Proc. 2016;91(8):1133–46. https://doi.org/10.1016/j.mayocp.2016.04.009.

    Article  PubMed  Google Scholar 

  28. Goetsch MF, Lim JY, Caughey AB. A practical solution for dyspareunia in breast cancer survivors: a randomized controlled trial. J Clin Oncol. 2015;33(30):3394–400. https://doi.org/10.1200/JCO.2014.60.7366.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice, Farrell R. ACOG Committee Opinion No. 659: The use of vaginal estrogen in women with a history of estrogen-dependent breast cancer. Obstet Gynecol. 2016;127(3):e93–6. https://doi.org/10.1097/AOG.0000000000001351.

    Article  Google Scholar 

  30. Knight C, Logan V, Fenlon D. A systematic review of laser therapy for vulvovaginal atrophy/genitourinary syndrome of menopause in breast cancer survivors. Ecancermedicalscience. 2019;13:988. https://doi.org/10.3332/ecancer.2019.988.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Flynn KE, Reese JB, Jeffery DD, Abernethy AP, Lin L, Shelby RA, et al. Patient experiences with communication about sex during and after treatment for cancer. Psychooncology. 2012;21(6):594–601. https://doi.org/10.1002/pon.1947.

    Article  PubMed  Google Scholar 

  32. Beckwée D, Leysen L, Meuwis K, Adriaenssens N. Prevalence of aromatase inhibitor-induced arthralgia in breast cancer: a systematic review and meta-analysis. Support Care Cancer. 2017;25(5):1673–86. https://doi.org/10.1007/s00520-017-3613-z.

    Article  PubMed  Google Scholar 

  33. Burstein HJ. Aromatase inhibitor-associated arthralgia syndrome. Breast. 2007;16(3):223–34. https://doi.org/10.1016/j.breast.2007.01.011.

    Article  PubMed  Google Scholar 

  34. • Roberts KE, Rickett K, Feng S, Vagenas D, Woodward NE. Exercise therapies for preventing or treating aromatase inhibitor-induced musculoskeletal symptoms in early breast cancer. Cochrane Database Syst Rev. 2020;1(1):CD012988. https://doi.org/10.1002/14651858.CD012988.pub2In this systematic review and meta-analysis of 7 studies, authors have not found any clear evidence of benefit for exercise therapies for preventing or treating women with breast cancer and aromatase inhibitor-induced musculoskeletal symptoms.

    Article  PubMed  Google Scholar 

  35. Peppone LJ, Janelsins MC, Kamen C, Mohile SG, Sprod LK, Gewandter JS, et al. The effect of YOCAS©® yoga for musculoskeletal symptoms among breast cancer survivors on hormonal therapy. Breast Cancer Res Treat. 2015;150(3):597–604. https://doi.org/10.1007/s10549-015-3351-1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Chien TJ, Liu CY, Chang YF, Fang CJ, Hsu CH. Acupuncture for treating aromatase inhibitor-related arthralgia in breast cancer: a systematic review and meta-analysis. J Altern Complement Med. 2015;21(5):251–60. https://doi.org/10.1089/acm.2014.0083.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Hershman DL, Unger JM, Heather Greenlee ND, et al. Effect of acupuncture vs sham acupuncture or waitlist control on joint pain related to aromatase inhibitors among women with early-stage breast cancer - a randomized clinical trial. JAMA. 2018;320(2):167–76. https://doi.org/10.1001/jama.2018.8907.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Gupta A, Henry NL, Loprinzi CL. Management of aromatase inhibitor-induced musculoskeletal symptoms. JCO Oncol Pract. 2020;11:OP2000113. https://doi.org/10.1200/OP.20.00113.

    Article  Google Scholar 

  39. Hershman DL, Unger JM, Crew KD, Awad D, Dakhil SR, Gralow J, et al. Randomized multicenter placebo-controlled trial of omega-3 fatty acids for the control of aromatase inhibitor-induced musculoskeletal pain: SWOG S0927. J Clin Oncol. 2015;33(17):1910–7. https://doi.org/10.1200/JCO.2014.59.5595.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Shen S, Unger JM, Crew KD, Till C, Greenlee H, Gralow J, et al. Omega-3 fatty acid use for obese breast cancer patients with aromatase inhibitor-related arthralgia (SWOG S0927). Breast Cancer Res Treat. 2018;172(3):603–10. https://doi.org/10.1007/s10549-018-4946-0.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Rastelli AL, Taylor ME, Gao F, Armamento-Villareal R, Jamalabadi-Majidi S, Napoli N, et al. Vitamin D and aromatase inhibitor-induced musculoskeletal symptoms (AIMSS): a phase II, double-blind, placebo-controlled, randomized trial. Breast Cancer Res Treat. 2011;129(1):107–16. https://doi.org/10.1007/s10549-011-1644-6.

    Article  CAS  PubMed  Google Scholar 

  42. Khan QJ, Kimler BF, Reddy PS, Sharma P, Klemp JR, Nydegger JL, et al. Randomized trial of vitamin D3 to prevent worsening of musculoskeletal symptoms in women with breast cancer receiving adjuvant letrozole. The VITAL trial. Breast Cancer Res Treat. 2017;166(2):491–500. https://doi.org/10.1007/s10549-017-4429-8.

    Article  CAS  PubMed  Google Scholar 

  43. Shapiro AC, Adlis SA, Robien K, Kirstein MN, Liang S, Richter SA, et al. Randomized, blinded trial of vitamin D3 for treating aromatase inhibitor-associated musculoskeletal symptoms (AIMSS). Breast Cancer Res Treat. 2016;155(3):501–12. https://doi.org/10.1007/s10549-016-3710-6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. • Henry NL, Unger JM, Schott AF, Fehrenbacher L, Flynn PJ, Prow DM, et al. Randomized, multicenter, placebo-controlled clinical trial of duloxetine versus placebo for aromatase inhibitor-associated arthralgias in early-stage breast cancer: SWOG S1202. J Clin Oncol. 2018;36(4):326–32. https://doi.org/10.1200/JCO.2017.74.6651This randomized, double blind, phase 3 study compares duloxetine to placebo for AIMSS in breast cancer patients. By 12 weeks, pain and functioning scores were better for patients receiving duloxetine.

    Article  CAS  PubMed  Google Scholar 

  45. Henry NL, Unger JM, Till C, Schott AF, Crew KD, Lew DL, et al. Association between body mass index and response to duloxetine for aromatase inhibitor-associated musculoskeletal symptoms in SWOG S1202. Cancer. 2019;125(12):2123–9. https://doi.org/10.1002/cncr.32024.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Briot K, Tubiana-Hulin M, Bastit L, Kloos I, Roux C. Effect of a switch of aromatase inhibitors on musculoskeletal symptoms in postmenopausal women with hormone-receptor-positive breast cancer: the ATOLL (articular tolerance of letrozole) study. Breast Cancer Res Treat. 2010;120(1):127–34. https://doi.org/10.1007/s10549-009-0692-7.

    Article  CAS  PubMed  Google Scholar 

  47. Colleoni M, Luo W, Karlsson P, Chirgwin J, Aebi S, Jerusalem G, et al. Extended adjuvant intermittent letrozole versus continuous letrozole in postmenopausal women with breast cancer (SOLE): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2018;19(1):127–38. https://doi.org/10.1016/S1470-2045(17)30715-5.

    Article  CAS  PubMed  Google Scholar 

  48. Ramchand SK, Cheung YM, Yeo B, Grossmann M. The effects of adjuvant endocrine therapy on bone health in women with breast cancer. J Endocrinol. 2019;241(3):R111–24. https://doi.org/10.1530/JOE-19-0077.

    Article  CAS  PubMed  Google Scholar 

  49. Tseng OL, Spinelli JJ, Gotay CC, Ho WY, McBride ML, Dawes MG. Aromatase inhibitors are associated with a higher fracture risk than tamoxifen: a systematic review and meta-analysis. Ther Adv Musculoskelet Dis. 2018;10(4):71–90. https://doi.org/10.1177/1759720X18759291.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Hadji P, Aapro MS, Body JJ, Gnant M, Brandi ML, Reginster JY, et al. Management of aromatase inhibitor-associated bone loss (AIBL) in postmenopausal women with hormone sensitive breast cancer: joint position statement of the IOF, CABS, ECTS, IEG, ESCEO IMS, and SIOG. J Bone Oncol. 2017;7:1–12. https://doi.org/10.1016/j.jbo.2017.03.001.

    Article  PubMed  PubMed Central  Google Scholar 

  51. •• Shapiro CL, Van Poznak C, Lacchetti C, Kirshner J, Eastell R, Gagel R, et al. Management of osteoporosis in survivors of adult cancers with nonmetastatic disease: ASCO clinical practice guideline. J Clin Oncol. 2019;37(31):2916–46. https://doi.org/10.1200/JCO.19.01696Although this ASCO guideline provides recommendations for management of osteoporosis in all survivors of adult cancer, many studies reviewed have included breast cancer patients treated with endocrine therapy. Therefore, its recommendations can be applied only for this group of patients.

    Article  PubMed  Google Scholar 

  52. Coleman R, Hadji P, Body JJ, Santini D, Chow E, Terpos E, et al. Bone health in cancer: ESMO clinical practice guidelines. Ann Oncol. 2020. In press;31:1650–63. https://doi.org/10.1016/j.annonc.2020.07.019.

    Article  CAS  PubMed  Google Scholar 

  53. Howe TE, Shea B, Dawson LJ, Downie F, Murray A, Ross C, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev. 2011;7:CD000333. https://doi.org/10.1002/14651858.CD000333.pub2.

    Article  Google Scholar 

  54. Dalla Via J, Daly RM, Fraser SF. The effect of exercise on bone mineral density in adult cancer survivors: a systematic review and meta-analysis. Osteoporos Int. 2018;29(2):287–303. https://doi.org/10.1007/s00198-017-4237-3.

    Article  CAS  PubMed  Google Scholar 

  55. Fornusek CP, Kilbreath SL. Exercise for improving bone health in women treated for stages I-III breast cancer: a systematic review and meta-analyses. J Cancer Surviv. 2017;11(5):525–41. https://doi.org/10.1007/s11764-017-0622-3.

    Article  PubMed  Google Scholar 

  56. Brufsky AM, Harker WG, Beck JT, Bosserman L, Vogel C, Seidler C, et al. Final 5-year results of Z-FAST trial: adjuvant zoledronic acid maintains bone mass in postmenopausal breast cancer patients receiving letrozole. Cancer. 2012;118(5):1192–201. https://doi.org/10.1002/cncr.26313.

    Article  CAS  PubMed  Google Scholar 

  57. Coleman R, de Boer R, Eidtmann H, Llombart A, Davidson N, Neven P, et al. Zoledronic acid (zoledronate) for postmenopausal women with early breast cancer receiving adjuvant letrozole (ZO-FAST study): final 60-month results. Ann Oncol. 2013;24(2):398–405. https://doi.org/10.1093/annonc/mds277.

    Article  CAS  PubMed  Google Scholar 

  58. Mei M, Xiang Z, Yang J, Xiang R. Efficacy of zoledronic acid for prevention of bone loss in early-stage breast cancer patients receiving adjuvant therapy: a meta-analysis of 13 randomized controlled trials. Curr Probl Cancer. 2020;44(2):100507. https://doi.org/10.1016/j.currproblcancer.2019.100507.

    Article  PubMed  Google Scholar 

  59. Early Breast Cancer. Adjuvant bisphosphonate treatment in early breast cancer: meta-analyses of individual patient data from randomised trials. Lancet. 2015;386(10001):1353–61. https://doi.org/10.1016/S0140-6736(15)60908-4.

    Article  CAS  Google Scholar 

  60. Sestak I, Blake GM, Patel R, Coleman RE, Cuzick J, Eastell R. Comparison of risedronate versus placebo in preventing anastrozole-induced bone loss in women at high risk of developing breast cancer with osteopenia. Bone. 2019;124:83–8. https://doi.org/10.1016/j.bone.2019.04.016.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Livi L, Scotti V, Desideri I, Saieva C, Cecchini S, Francolini G, et al. Phase 2 placebo-controlled, single-blind trial to evaluate the impact of oral ibandronate on bone mineral density in osteopenic breast cancer patients receiving adjuvant aromatase inhibitors: 5-year results of the single-centre BONADIUV trial. Eur J Cancer. 2019;108:100–10. https://doi.org/10.1016/j.ejca.2018.12.005.

    Article  CAS  PubMed  Google Scholar 

  62. Kyvernitakis I, Kann PH, Thomasius F, Hars O, Hadji P. Prevention of breast cancer treatment-induced bone loss in premenopausal women treated with zoledronic acid: final 5-year results from the randomized, double-blind, placebo-controlled ProBONE II trial. Bone. 2018;114:109–15. https://doi.org/10.1016/j.bone.2018.06.007.

    Article  CAS  PubMed  Google Scholar 

  63. Wagner-Johnston ND, Sloan JA, Liu H, Kearns AE, Hines SL, Puttabasavaiah S, et al. 5-year follow-up of a randomized controlled trial of immediate versus delayed zoledronic acid for the prevention of bone loss in postmenopausal women with breast cancer starting letrozole after tamoxifen: N03CC (Alliance) trial. Cancer. 2015;121(15):2537–43. https://doi.org/10.1002/cncr.29327.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Gnant M, Pfeiler G, Dubsky PC, Hubalek M, Greil R, Jakesz R, et al. Adjuvant denosumab in breast cancer (ABCSG-18): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet. 2015;386(9992):433–43. https://doi.org/10.1016/S0140-6736(15)60995-3.

    Article  CAS  PubMed  Google Scholar 

  65. Coleman R, Finkelstein DM, Barrios C, Martin M, Iwata H, Hegg R, et al. Adjuvant denosumab in early breast cancer (D-CARE): an international, multicentre, randomised, controlled, phase 3 trial. Lancet Oncol. 2020;21(1):60–72. https://doi.org/10.1016/S1470-2045(19)30687-4.

    Article  CAS  PubMed  Google Scholar 

  66. Johansson H, Gray KP, Pagani O, Regan MM, Viale G, Aristarco V, et al. Impact of CYP19A1 and ESR1 variants on early-onset side effects during combined endocrine therapy in the TEXT trial. Breast Cancer Res. 2016;18(1):110. https://doi.org/10.1186/s13058-016-0771-8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Ingle JN, Schaid DJ, Goss PE, Liu M, Mushiroda T, Chapman JA, et al. Genome-wide associations and functional genomic studies of musculoskeletal adverse events in women receiving aromatase inhibitors. J Clin Oncol. 2010;28(31):4674–82. https://doi.org/10.1200/JCO.2010.28.5064.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. US Food and Drug Administration. FDA warns against use of energy-based devices to perform vaginal ‘rejuvenation’ or vaginal cosmetic procedures: FDA safety communication

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Authors and Affiliations

  1. Oncology Unit, Clementino Fraga Filho University Hospital - Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

    Bethânia Soares dos Santos

  2. Oncology Center, Hospital Moinhos de Vento, R. Tiradentes, 333, Porto Alegre, RS, 90560-030, Brazil

    Cláudia Bordignon & Daniela Dornelles Rosa

  3. Postgraduation program in Pathology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil

    Cláudia Bordignon & Daniela Dornelles Rosa

  4. Brazilian Breast Cancer Study Group (GBECAM), Porto Alegre, Brazil

    Daniela Dornelles Rosa

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Bethânia Soares dos Santos and Cláudia Bordignon declare no conflict of interest. Daniela Dornelles Rosa has received compensation from Roche, AstraZeneca, Eli Lilly, GlaxoSmithKline, Sanofi, Libbs Farmacêutica, and Novartis for service as a consultant and has received compensation from Roche, Eli Lilly, Novartis, Pfizer and Zodiac for providing expert testimony.

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dos Santos, B.S., Bordignon, C. & Rosa, D.D. Managing Common Estrogen Deprivation Side Effects in HR+ Breast Cancer: an Evidence-Based Review. Curr Oncol Rep 23, 63 (2021). https://doi.org/10.1007/s11912-021-01055-5

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