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Annals of Oncology 13:883-888, 2002
© 2002 European Society for Medical Oncology

Original Paper

Intramuscular depot medroxyprogesterone versus oral megestrol for the control of postmenopausal hot flashes in breast cancer patients: a randomized study

G. Bertelli1,+, M. Venturini2, L. Del Mastro2, M. Bergaglio2, P. Sismondi3, N. Biglia3, S. Venturini4, G. Porcile5, P. Pronzato6, M. Costantini2 and R. Rosso2

1Medical Oncology, S.Croce General Hospital, Cuneo; 2National Cancer Institute, Genova; 3Gynecological Oncology, University of Torino, Torino; 4Medical Oncology, City Hospital, Massa; 5Medical Oncology, City Hospital, Alba; 6Medical Oncology, S. Andrea Hospital, La Spezia, Italy

Received 2 July 2001; revised 15 October 2001; accepted 14 December 2001.

Background

Hot flashes are frequent in postmenopausal breast cancer patients, especially when treated with tamoxifen. Estrogen replacement therapy is the most effective treatment for hot flashes, but its use is controversial in breast cancer survivors. Progestins may offer a good alternative for the control of hot flashes in this setting; in particular, oral megestrol acetate has been proven effective in a randomized, placebo-controlled clinical trial. With the aim of further improving these results, we have designed a randomized study comparing oral megestrol acetate with depot intramuscular (i.m.) medroxyprogesterone acetate (MPA) for the control of hot flashes in postmenopausal patients with a history of breast cancer.

Patients and methods

Seventy-one postmenopausal patients were randomized to receive an i.m. injection of depot MPA 500 mg on days 1, 14 and 28, or oral megestrol acetate 40 mg daily for 6 weeks. Patients recorded daily the number and severity of their hot flashes; response was defined as a >=50% decrease in the number and severity of hot flashes.

Results

At week 6, hot flashes were reduced by 86% on average in the whole group of patients, without significant differences between the two progestins. Response was obtained by 75 and 67% of patients receiving MPA or megestrol, respectively (P = 0.5). Responders were followed to assess maintenance of response (without further treatment), which was significantly better with i.m. MPA: in this group, 89% of responders still showed a benefit at week 24, compared with 45% in the megestrol group (P = 0.03).

Conclusions

Our study shows that a short cycle of i.m. depot MPA injections provides significant and long-lasting relief from postmenopausal hot flashes in patients with a history of breast cancer, offering an alternative to estrogen replacement therapy or prolonged administration of oral megestrol.

Key words: breast cancer, hot flashes, medroxyprogesterone acetate, megestrol acetate, postmenopausal symptoms, tamoxifen


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