The management of “hot flashes” for men on ADT

Perhaps the most interesting new data from the annual meeting of the American Society of Clinical Oncology yesterday (Sunday) was a negative result from a four-arm, randomized clinical trial.

There have previously been suggestions from some studies that either soy products or the drug venlaxafine (Effexor) could be used to reduce the impact of “hot flashes” in the significant percentage of men for whom this side effect of androgen deprivation therapy (ADT) is a significant and serious problem. (About two-thirds of men on ADT are reported to be significantly affected by this side effect of hormone therapy.)

Vitolins et al. reported data from a trial in which 120 androgen-deprevied patients were randomized to receive one of the following four treatments for thir hot flashes:

  • A placebo pill and casein protein (Group A, n = 30)
  • Soy protein and a placebo pill (Group B, n = 30)
  • Venlafaxine and Casein Protein (Group C, n = 30)
  • Soy protein and venlafaxine (Group D, n = 30).

The patients were followed for 12 weeks, and the primary endpoint of the trial was the hot flash symptom severity score (HFSSS), which was defined as the number of hot flashes multiplied by their severity.

The results of this study showed the following:

  • The men were aged between 46 and 91 years (median, 69 years).
  • 78 percent of the men were Caucasian and 83 percent were either overweight or obese.
  • The characteristics of the men in the four groups were similar at baseline.
  • Treatment compliance was 88 percent. Toxicity was minimal.
  • All groups showed a reduction in HFSSS, but there were no significant differences between groups at all (the abstract provides a detailed table).
  • Quality of life was also not affected significantly over time and did not differ between groups.

The authors conclude that, “In androgen-deprived men, neither venlafaxine nor soy protein had a significant effect on HFSSS” or on quality of life. They are careful to note that their results contrast with data from an earlier study by Quella et al., who (in 1999, based on a small, pilot study) had reported a significant decrease in the impact of venlaxafine on the frequency and severity of hot flashes in men who were androgen deprived.

3 Responses

  1. They should have added another option ~ acupuncture

  2. Tony: That may well be true, but the historic, small, non-randomized studies of acupuncture have shown very variable results, and while it sometimes seems to work early on, the effect is commonly not sustainable over time.

  3. Following on from my paper on ADT Side Effects

    Stephen Strum, MD, a medical oncologist who used to specialize in the treatment of recurring and advanced prostate cancer, wrot: “I am not a user of Megace in this setting since it is metabolized to DHEA and then to androstenedione and then to testosterone. When the PSA is in good control and the testosterone is low, I use Depo-Provera intramuscular injection 400 mg ONCE and that usually eliminates hot flashes forever.”

    A. Oliver Sartor, MD, another medical oncologist who specializes in the treatment of advanced forms of prostate cancer has written that: “”Megace® is used at times for patients who have hot flashes, and at times for patients to boost their appetite. But in prostate cancer, Megace may interact with the androgen receptor, particularly mutants, and cause excessive cancer growth. And you can actually get responses by withdrawing Megace. I do not prescribe the use of Megace in prostate
    cancer patients (even for hot flashes), because I don’t know who has a mutant and who doesn’t.”

    More recently Steve Jordan, a patient with prostate cancer, wrote regarding Depo-Provera (medroxyprogesterone): “There is a clinical study on PubMed: Langenstroer P, et al., “Parenteral medroxyprogesterone for the management of luteinizing hormone releasing hormone induced hot flashes in men with advanced prostate cancer.”

    “CONCLUSIONS: This study is the first multi-institutional evaluation of hot flashes demonstrating significant reduction in quantity and severity with MPA (medroxyprogesterone acetate). Based on these data we now manage hot flashes associated with LHRH analogues with 400 mg of MPA.”

    Note that they used 400 mg, but I understand from my own and others’ experience that 208 mg (two pre-loaded 104 mg syringes, one in each anterior thigh) does the job.

    NB: Medroxyprogesterone acetate is a progesterone analog. It can increase the adrenal production of testosterone precursors, so a careful watch on PSA would likely be prudent. In fact, I would recommend caution if PSA is higher than undetectable before starting.

    Anecdote alert: I had the 208-mg injections a few years ago and my hot flashes were totally relieved within a couple of weeks. This was the result for about half of the study cohort. Overall, over 90% had some relief.”

    Yet another regarding 0.025 estradiol patches: Medical oncologist Charles E “Snuffy” Myers, MD prescribes this dosage with a Vivelle dot changed every 3½ days.

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