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01-04-2018 | Original Article

Systemic and local effects of vaginal dehydroepiandrosterone (DHEA): NCCTG N10C1 (Alliance)

Authors: Debra L. Barton, Lynne T. Shuster, Travis Dockter, Pamela J. Atherton, Jacqueline Thielen, Stephen N. Birrell, Richa Sood, Patricia Griffin, Shelby A. Terstriep, Bassam Mattar, Jacqueline M. Lafky, Charles L. Loprinzi

Published in: Supportive Care in Cancer | Issue 4/2018

Abstract

Background

Dehydroepiandrosterone (DHEA) is helpful for treating vaginal symptoms. This secondary analysis evaluated the impact of vaginal DHEA on hormone concentrations, bone turnover, and vaginal cytology in women with a cancer history.

Methods

Postmenopausal women, diagnosed with breast or gynecologic cancer, were eligible if they reported at least moderate vaginal symptoms. Participants could be on tamoxifen or aromatase inhibitors (AIs). Women were randomized to 3.25 versus 6.5 mg/day of DHEA versus a plain moisturizer (PM) control. Sex steroid hormone levels, biomarkers of bone formation, vaginal pH, and maturation index were collected at baseline and 12 weeks. Analysis included independent t tests and Wilcoxon rank tests, comparing each DHEA arm with the control.

Results

Three hundred forty-five women contributed evaluable blood and 46 contributed evaluable cytology and pH values. Circulating DHEA-S and testosterone levels were significantly increased in those on vaginal DHEA in a dose-dependent manner compared to PM. Estradiol was significantly increased in those on 6.5 mg/day DHEA but not in those on 3.25 mg/day DHEA (p < 0.05 and p = 0.05, respectively), and not in those on AIs. Biomarkers of bone formation were unchanged in all arms. Maturation of vaginal cells was 100% (3.25 mg/day), 86% (6.5 mg/day), and 64% (PM); pH decreased more in DHEA arms.

Conclusion

DHEA resulted in increased hormone concentrations, though still in the lowest half or quartile of the postmenopausal range, and provided more favorable effects on vaginal cytology, compared to PM. Estrogen concentrations in women on AIs were not changed. Further research on the benefit of vaginal DHEA is warranted in hormone-dependent cancers.

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Title: Systemic and local effects of vaginal dehydroepiandrosterone (DHEA): NCCTG N10C1 (Alliance)
Authors: Debra L. Barton
Lynne T. Shuster
Travis Dockter
Pamela J. Atherton
Jacqueline Thielen
Stephen N. Birrell
Richa Sood
Patricia Griffin
Shelby A. Terstriep
Bassam Mattar
Jacqueline M. Lafky
Charles L. Loprinzi
Publication date: 01-04-2018
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 4/2018
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-017-3960-9

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