SPECIAL DEPARTMENTS
Authors: Pascale This, Henri Magdelenat, Charles L. Loprinzi, Susan K. Quella, Debra L. Barton
Journal: Journal of Clinical Oncology (2000)

Article Tools SPECIAL DEPARTMENTS Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.2000.18.14.2792 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 10894883 Pascale ThisxPascale ThisSearch for articles by this author , Henri MagdelenatxHenri MagdelenatSearch for articles by this author Charles L. LoprinzixCharles L. LoprinziSearch for articles by this author , Susan K. QuellaxSusan K. QuellaSearch for articles by this author , Debra L. BartonxDebra L. BartonSearch for articles by this author Show More Institut Curie ParisFranceDivision of Medical Oncology Mayo Clinic RochesterMN https://doi.org/10.1200/JCO.2000.18.14.2792 First Page Full Text PDF Figures and Tables © 2000 by American Society of Clinical OncologyjcoJ Clin OncolJournal of Clinical OncologyJCO0732-183X1527-7755American Society of Clinical OncologyResponse14072000In Reply:To address the first question posed by This and Magdelenat, the rationale for testing soy phytoestrogens in patients receiving tamoxifen1 was based on the following assertions: (1) hot flashes are a major problem in women receiving tamoxifen, (2) soy phytoestrogens have been widely touted as being helpful for alleviating hot flashes, and (3) previous experience has revealed that the eventual effects of various drugs on hot flashes are not dependent on whether a patient is taking tamoxifen.2-5 For these reasons, patients receiving tamoxifen were included in our study.This and Magdelenat describe that phytoestrogens, such as genistein, have estrogen-agonist properties. We agree and feel that phytoestrogens might readily be classified as selective estrogen receptor modu- lators (SERMs). We accept that soy phytoestrogens might affect the activity of tamoxifen and/or raloxifene. What we do not know, however, is if this effect is clinically favorable, unfavorable, or neutral. Clinical studies would be necessary to adequately answer such a question.Given the possibility that soy phytoestrogens might be detrimental in terms of breast cancer itself or tamoxifen’s antitumor activity, why did we proceed to study them? There are several reasons. First, epidemiologic and other preclinical data suggest that soy phytoestrogens have cancer chemopreventive properties and thus might be protective.6 Second, physicians do not generally proscribe diets rich in soy and other vegetable products (many of which also contain phytoestrogens), but, rather, we generally favor such a diet over a more meat-based diet. Third, there has been intense interest in the use of soy-based products for the treatment of hot flashes, supported by noting that 182 patients entered our clinical trial in approximately 2 months. These factors led us to conclude that it seemed both safe and appropriate for soy phytoestrogens to be tested in breast cancer survivors, including those receiving tamoxifen.Although our trial did not try to test the effects of soy phytoestrogens on breast cancer pathophysiology (knowing that such a study might require the investment of thousands of patients), it did conclusively determine that the chosen soy phytoestrogen product does not alleviate hot flashes to any substantial degree. Notably, the bulk of available preliminary information from other randomized placebo-controlled clinical trials, testing other soy phytoestrogen products, arrive at the same conclusion.7 Information from these randomized trials allows patients, and their physicians, to make more informed decisions about whether to utilize soy phytoestrogens for treating hot flashes. 8. Quella SK, Loprinzi CL, Barton DL, et al: Evaluation of soy phytoestrogens for the treatment of hot flashes in breast cancer survivors: A North Central Cancer Treatment Group Trial. J Clin Oncol 18::1068,2000-1074, Link, Google Scholar8. Loprinzi CL, Michalak JC, Quella SK, et al: Megestrol acetate for the prevention of hot flashes. N Engl J Med 331::347,1994-352, Crossref, Medline, Google Scholar8. Goldberg RM, Loprinzi CL, O’Fallon JR, et al: Transdermal clonidine for ameliorating tamoxifen-induced hot flashes. J Clin Oncol 12::155,1993-158, Google Scholar8. Barton DL, Loprinzi CL, Quella SK, et al: Prospective evaluation of vitamin E for hot flashes in breast cancer survivors. J Clin Oncol 16::495,1998-500, Link, Google Scholar8. Loprinzi CL, Pisansky TM, Fonseca R, et al: Pilot evaluation of venlafaxine hydrochloride for the therapy of hot flashes in cancer survivors. J Clin Oncol 16::2377,1998-2381, Link, Google Scholar8. Kelloff GJ, Boone CW, Steele VE, et al: Mechanistic considerations in chemopreventive drug development. J Cell Biochem 20::1,1994-24, Google Scholar8. Patterson AG: Menopause. The Soy Connection 8:4-6, Spring 2000 Google Scholar