If this is not your name, click here.
| | If this is not your name, click here. | | |
| | Contact Us | Order Now | Journals | Bookstore | Register a colleague | | |
| |  Medroxyprogesterone Most Effective Hormone Therapy for Reducing Hot Flushes in Men With Prostate Cancer NEW YORK -- December 6, 2009 -- Cyproterone acetate and medroxyprogesterone acetate show the highest efficacy in reducing hot flushes in men receiving hormone therapy for prostate cancer. But overall, medroxyprogesterone should become the standard treatment for preventing hot flushes in these patients. That’s the finding of a study published online (www.thelancet.com) and in an upcoming edition of The Lancet Oncology. Previous research has shown that hormonal treatments (eg, cyproterone acetate) and progestogens (eg, medroxyprogesterone), as well as non-hormonal treatments such as selective serotonin-reuptake inhibitor antidepressants (SSRIs, eg, venlafaxine) are all effective at preventing hot flushes, but direct comparisons between these drugs have not been made in men being treated with androgen-suppression therapy for prostate cancer. In this randomised trial, Jacques Irani, MD, Poitiers University Hospital, Poitiers, France, and colleagues examine the efficacy of 3 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 centres in France between 2004 and 2007. All patients were initially treated with the gonadotrophin-releasing hormone (GnRH) analogue leuprorelin for 6 months. After 6 months, patients who had 14 or more hot flushes in the week before assessment or those who spontaneously requested treatment were randomly assigned to further treatment with either venlafaxine (n = 102), medroxyprogesterone (n = 108), or cyproterone acetate (n = 101). Patients were assessed at weeks 4, 8, and 12 after randomisation, and 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 3 drugs reduced the occurrence of hot flushes with little difference in tolerance, but the hormonal treatments cyproterone acetate and medroxyprogesterone acetate were significantly more effective at reducing hot flushes than the SSRI venlafaxine over all time periods. After 4 weeks of treatment, 219 (70.9%) patients had an improvement of at least 50% in their hot flush scores, and 70 (22.7%) patients reported a complete absence of hot flushes. The median daily hot-flush score relative change between randomisation and week 4 was -47.2% for venlafaxine, -94.5% for cyproterone, and -83.7% for medroxyprogesterone. Serious side effects occurred in 16 patients -- 4, 7, and 5 cases in the venlafaxine, cyproterone, and medroxyprogesterone groups, respectively. Only 2 cases were thought to be related to the drugs. The authors conclude: “Cyproterone acetate and medroxyprogesterone acetate are more effective at 12 weeks for treating hot flushes in men treated with GnRH analogues for prostate cancer … [however] as cyproterone is a recognised treatment in prostate cancer, and its use could interfere with hormone therapy, medroxyprogesterone should be the standard treatment.” SOURCE: The Lancet Oncology
|
