Vaginal estrogen products in hormone receptor-positive breast cancer patients on aromatase inhibitor therapy

Elisabeth Sulaica, Tiffany Han, Weiqun Wang, Raksha Bhat, Meghana V. Trivedi, Polly A. Niravath

Research output: Contribution to journalReview articlepeer-review

14 Scopus citations

Abstract

Atrophic vaginitis represents a major barrier to compliance with aromatase inhibitor (AI) therapy in breast cancer (BC) survivors. While local estrogen therapy is effective for postmenopausal vaginal dryness, the efficacy of such therapies has not been evaluated systematically in hormone receptor-positive (HR+) BC patients on AI therapy. Furthermore, the potential risk of breast cancer recurrence with vaginal estrogen therapy represents a long-term safety concern for the patients with HR + BC. Unfortunately, there is no standardized assay to measure very low concentrations of estradiol (E2) in these women being treated with AI therapy. This makes it difficult to evaluate even indirectly the potential risk of BC recurrence with vaginal estrogen therapy in HR + BC patients on AI therapy. In this review, we describe available assays to measure very low concentrations of E2, discuss the Food and Drug Administration-approved vaginal estrogen products on the market, and summarize published and ongoing clinical trials evaluating the safety and efficacy of vaginal estrogen in HR + BC patients on AI therapy. In the absence of any randomized controlled clinical trials, this review serves as a summary of available clinical data and ongoing studies to aid clinicians in selecting the best available option for their patients.

Original languageEnglish (US)
Pages (from-to)203-210
Number of pages8
JournalBreast Cancer Research and Treatment
Volume157
Issue number2
DOIs
StatePublished - Jun 1 2016

Keywords

  • Aromatase inhibitor
  • Breast cancer
  • Hormone receptor
  • Vaginal atrophy
  • Vaginal estradiol
  • Vaginal estriol
  • Vaginal estrogen
  • Vaginal symptoms

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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