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Best treatment for reducing hot flashes in men identified
Source: (cancerfacts.com)
Monday, December 07, 2009
POITIERS, France – Dec. 7, 2009 – Men undergoing hormone treatment for prostate cancer should be taking a commonly prescribed contraceptive to reduce hot flushes, say researchers.
Led by Dr. Jacques Irani, a professor at the University Hospital, Poitiers, France, the study compared two hormonal medications and a third nonhormonal drug used to treat the side effects of hormone-based prostate cancer therapy.
"Cyproterone acetate and medroxyprogesterone acetate are more effective at 12 weeks for treating hot flushes in men treated with GnRH analogues (hormone blocking drugs) for prostate cancer," the researchers wrote. "[however] as cyproterone is a recognized treatment in prostate cancer, and its use (for flushing) could interfere with hormone therapy, medroxprogesterone should be the standard treatment."
Androgen suppression therapy or hormone therapy is the gold standard treatment for advanced prostate cancer. It uses surgery or hormone-blocking drugs, called gonadotrophin-releasing hormone (GnRH) analogues such as leuprorelin to block the production of male producing sex hormones. Such hormones have been shown to stimulate prostate cancer cells to grow. Hot flushes are a common and unpleasant side effect experienced by up to 80 percent of patients undergoing this androgen blockade therapy.
Previous research has shown that hormonal treatments using cyproterone acetate or medroxyprogesterone, as well as non-hormonal treatments such as venlafaxine, are all effective at preventing hot flashes. However, direct comparisons between these drugs have not been made in men being treated with androgen suppression therapy for prostate cancer.
Cyproterone is not available in the U.S. but is used in Europe under brand names including Androcur, Cyprostat, Cyproteron, Procur, Cyprone, Cyprohexal, Ciproterona, Cyproteronum, Neoproxil, Siterone. Medroxyprogesterone is found in the commonly known contraceptive Depo-Provera®.
In this trial, Irani and colleagues compared the effectiveness of three drugs—cyproterone acetate, medroxyprogesterone acetate, and venlafaxine—at preventing hot flushes, to establish clear treatment recommendations for these patients.
A total of 919 men with prostate cancer were recruited from 106 urology centers in France between 2004 and 2007. All patients were initially treated with leuprorelin for 6 months. After 6 months, patients who had 14 or more hot flashes in the week before assessment or those who requested treatment were randomly assigned to further treatment. There were 102 treated with venlafaxine, 108 treated with medroxyprogesterone, and 101 treated with cyproterone acetate.
Patients were examined at weeks 4, 8, and 12 after starting the anti-flushing medications, and were asked to complete a self-evaluation questionnaire to calculate the frequency and severity of hot flushes for a week before each assessment.
Overall, findings showed that all three drugs reduced the occurrence of hot flushes with little difference in side effects, but the hormonal treatments cyproterone acetate and medroxyprogesterone acetate were significantly more effective at reducing hot flushes than venlafaxine over all time periods.
After 4 weeks of treatment, 219 patients (70.9 percent) had an improvement of at least 50 percent in their hot flush scores, and 70 patients (22.7 percent) reported a complete absence of hot flushes.
The median daily hot-flush score at week 4 showed a reduction in hot-flashes of 47.2% for venlafaxine, compared to reductions of 94.5% for cyproterone, and 83.7% for medroxyprogesterone.
After analyzing the data comparing the latter two, however, the researchers concluded that medroxyprogesterone should become the standard treatment for preventing hot flushes in these patients. The findings were published Online First on the website of the journal The Lancet Oncology.
SOURCE: adapted from press materials issued by The Lancet Oncology.
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