How to Improve Quality of Life in Patients with Breast Cancer Receiving Endocrine Therapy?

Women receiving endocrine therapy for the treatment or prevention of breast cancer commonly report vasomotor symptoms. Current treatments (gabapentin, low-dose antidepressants, acupuncture, lifestyle interventions, and complementary products like black cohosh) have not been very effective. In an industry-supported, phase 3 study, Cardoso et al. examined the effectiveness of the investigational drug elinzanetant in 474 women with moderate-to-severe vasomotor symptoms who were receiving endocrine therapy to treat or prevent breast cancer. Elinzanetant is a neurokinin (NK)-targeted therapy that specifically antagonizes NK-1 and NK-3 receptors, which are implicated in declining estrogenic activity that occurs with natural menopause or antiestrogen medications.

Participants were randomly assigned to once daily elinzanetant for 52 weeks or placebo for 12 weeks, followed by elinzanetant for 40 weeks. At baseline, they experienced a mean of about 11.5 daily moderate-to-severe vasomotor symptoms. At week 4, women taking elinzanetant experienced a significantly greater drop in symptoms than women on placebo (mean change, −6.5 vs. −3.0 episodes). The results remained significant at week 12 (−7.8 vs. −4.2 episodes). Elinzanetant was associated with improved sleep and quality of life. Most adverse events were mild or moderate. Somnolence, fatigue, and diarrhea were more frequent with elinzanetant than placebo through week 12. More than 90% of participants chose to continue elinzanetant through the 2-year extension.