By Dr Puneet Chandna
Patients with a history of breast cancer may benefit from vaginal oestrogen therapy
Low-dose vaginal oestrogen is an effective treatment for moderate to severe genitourinary syndrome of menopause (GSM) symptoms that are refractory to nonhormonal care (vaginal moisturisers, lubricants), but its safety in breast cancer patients is unknown. In a study of postmenopausal patients treated with aromatase inhibitors (AI) for early estrogen-positive breast cancer, those who used vaginal oestrogen after the diagnosis had a greater risk of breast cancer recurrence compared to nonusers (adjusted hazard ratio 1.39, 95% CI 1.04-1.85). This connection was not observed in tamoxifen-treated patients. While there are significant limitations to this trial, the findings confirm our current practise of administering vaginal oestrogen for the management of GSM in women with breast cancer who are taking tamoxifen but not AI.
Ref:
Adjuvant ibandronate had no benefit in postmenopausal women with breast cancer (September 2022)
In randomised studies, adjuvant bisphosphonates improved disease-free survival (DFS) results in postmenopausal women with at least a moderate risk of breast cancer recurrence. However, in a new randomised trial of approximately 1100 postmenopausal women, oral ibandronate 50 mg daily did not improve DFS compared to placebo. Although a recent head-to-head trial that included both pre- and postmenopausal women revealed equal DFS outcomes with clodronate, ibandronate, and zoledronic acid, this trial is now the second in postmenopausal women to fail to establish a DFS benefit from ibandronate over placebo. For patients with breast cancer who require an adjuvant bisphosphonate, we recommend zoledronic acid or clodronate, with ibandronate being a less favoured option.
Ref:
- Vliek SB, Noordhoek I, Meershoek-Klein Kranenbarg E, et al. Daily Oral Ibandronate With Adjuvant Endocrine Therapy in Postmenopausal Women With Estrogen Receptor-Positive Breast Cancer (BOOG 2006-04): Randomized Phase III TEAM-IIB Trial. J Clin Oncol 2022; 40:2934.
- von Minckwitz G, Möbus V, Schneeweiss A, et al. German adjuvant intergroup node-positive study: a phase III trial to compare oral ibandronate versus observation in patients with high-risk early breast cancer. J Clin Oncol 2013; 31:3531.
Pelvic intensity modulated radiation therapy for gynecologic cancers (August 2022)
Intensity modulated radiation therapy (IMRT) is an advanced type of radiation therapy that changes the amount of radiation in different parts of a single radiation beam. In a randomised trial with 289 people who had endometrial or cervical cancer and were getting pelvic radiation, those in the IMRT group had less severe diarrhoea than those in the conventional radiation therapy group one year after radiation therapy. At three years, patients in the IMRT group had better urinary function, while patients in the conventional radiation group had worsening urinary function. These results show that IMRT is a good way to treat Gynecologic cancers.
Ref:
