Interview
with Neil Love, MD from Breast Cancer Update for Medical Oncologists,
Program 4 2000
Play
Audio Below:
Dr.
Loprinzi: What I’ve utilized has been the megestrol acetate,
40 mg/day. In our initial trial we used 20 twice a day, and that
was just because it seemed like low doses worked. It makes pharmacologic
sense to use a 40 mg tablet, a one dose per day, because it has
a very long half-life.
Dr.
Love: And how long do you usually have the patient on it?
Dr.
Loprinzi: 40 mg a day for one month, because that’s what we
utilized before. And then, in almost all of those patients, you
can decrease that dose down to 20 mg per day, and that will keep
the hot flashes controlled. We have some longer term data from after
our randomized trial, we allowed people to continue on it and modify
the dose, and then we went back and looked three years later or
so and 75% of women were on 20mg or less per day. Sometimes one
20 mg tablet every other day or every third day was enough to control
the hot flashes very nicely. And then continuing that as long, sometimes
you can stop it after a while, titrate if off and all. So that’s
what I use with megestrol acetate. Sometimes if you get down the
dose too low, you’ll get trouble with vaginal bleeding and
uterine bleeding, if you will. More recently, we have playing around,
experimenting in clinical practice and we are about to study it
formally, is using medroxyprogesterone acetate, 500 mg intramuscularly,
once every two weeks for three doses. These are doses more equivalent
to the higher progesterone doses used for treatment of breast cancer
over in Europe.
Biopsy
confirmed benign breast disease, postmenopausal use of exogenous
female hormones, and breast carcinoma risk. Byrne,
C.; Connolly, J. L.; Colditz, G. A., and Schnitt, S. J.. Cancer.
89(10):2046-2052, 2000 Nov 15.
Postmenopausal
estrogens - Opposed, unopposed, or none of the above Willett, W. C.; Colditz, G., and Stampfer, M. (Reprint available
from: Willett WC Harvard Univ, Sch Publ Hlth, Dept Nutr 667 Huntington
Ave Boston, MA 02115 USA).. Jama: Journal of the American Medical
Association. 283(4):534-535, 2000 Jan 26. No abstract
Re:
Effect of hormone replacement therapy on breast cancer risk: Estrogen
versus estrogen plus progestin Archer, D. F.; Bush, T., and Nachtigall, L. E. (Reprint available
from: Nachtigall LE NYU, Sch Med, Dept Obstet & Gynecol 251
E 33rd St New York, NY 10016 USA).. Journal of the National Cancer
Institute. 92(23):1950-1951, 2000 Dec 6. No abstract
Estrogen
deficiency: In search of symptom control and sexuality. Loprinzi,
C. L. and Barton, D. Journal of the National Cancer Institute. 92(13):1028-1029,
2000 Jul 5. No abstract
