Breast Cancer Research and Treatment

, Volume 106, Issue 3, pp 389–397 | Cite as

A phase II trial of Afimoxifene (4-hydroxytamoxifen gel) for cyclical mastalgia in premenopausal women

  • Robert Mansel
  • Amit Goyal
  • Elisabeth Le Nestour
  • Valérie Masini-Etévé
  • Katharine O’Connell
  • Afimoxifene (4-OHT) Breast Pain Research Group
Clinical Trial



Many women experience symptoms of cyclical mastalgia, such as breast pain, tenderness, and nodularity. Tamoxifen and other drugs have been used to alleviate cyclical mastalgia symptoms; however, their use is associated with potentially serious side effects. The current study compared the safety and efficacy of two doses of a topical gel containing 4-hydroxytamoxifen (Afimoxifene, formerly known as 4-OHT) with placebo gel for the treatment of moderate to severe cyclical mastalgia.


Premenopausal women aged at least 18 years experiencing moderate to severe symptoms were randomized to receive placebo, 2 mg, or 4 mg of Afimoxifene daily delivered as a transdermal hydroalcoholic gel for 4 menstrual cycles. The primary efficacy parameter was change in mean pain intensity as measured by the Visual Analog Scale (VAS) for the seven worst pain score days within a cycle from baseline to the fourth cycle.


After 4 cycles of treatment, statistically significant improvements relative to placebo were measured in mean VAS score in the 4-mg Afimoxifene group (−12.71 mm [95% confidence interval, −0.96 to −24.47; P = 0.034]). Patient global assessment of pain, physician’s assessment of pain, tenderness on palpation, and nodularity following 4 cycles of treatment were significantly more likely to show improvements in the 4-mg group, compared with placebo (P = 0.010 [pain]; P = 0.012 [tenderness]; P = 0.017 [nodularity]). Overall, Afimoxifene was well tolerated with few adverse events and no drug-related SAE occurred in any group.

There were no changes in menstrual pattern or plasma hormone levels and no breakthrough vaginal bleeding in patients treated with Afimoxifene.


After 4 months of treatment, daily topical breast application of Afimoxifene resulted in statistically significant improvements in signs and symptoms of cyclical mastalgia across patient- and physician-rated scales with excellent tolerability and safety.


4-Hydroxytamoxifen Afimoxifene Mastalgia Cyclical mastalgia Breast tenderness Breast pain 



Conflict of Interest: R Mansel had full access to all the data in the study and had final responsibility for the decision to submit for publication; A Goyal and K O’Connell have no conflict of interest; E Le Nestour and Valérie Masini-Etévé are full-time employees of Besins International.


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Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Robert Mansel
    • 1
  • Amit Goyal
    • 1
  • Elisabeth Le Nestour
    • 2
  • Valérie Masini-Etévé
    • 2
  • Katharine O’Connell
    • 3
  • Afimoxifene (4-OHT) Breast Pain Research Group
  1. 1.Department of Surgery, Wales College of MedicineCardiff UniversityCardiffUK
  2. 2.Besins InternationalParisFrance
  3. 3.Columbia University Medical CenterNew YorkUSA

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