Prasterone to treat Genitourinary Syndrome of Menopause in breast cancer survivors treated with aromatase inhibitors

Due to safety concerns on estrogen-based treatments for Genitourinary Syndrome of Menopause (GSM) in Breast Cancer Survivors (BCS), new options are appearing on the board, such as androgens-based treatments, which according to its proprieties would not be transformed systemically to estrogens in patients receiving aromatase inhibitors (AI). The aim of this pilot study is to assess security and efficacy of vaginal prasterone (DHEA) in BCS treated with AI. Methods: This is an open, prospective, pilot study including 10 BCS treated with AI. All participants complained with severe GSM. DHEA was administrated as a vaginal ovule. Participants were instructed to use one ovule every night, during the first month, and one ovule every two nights, for the entire 5 resting months. The patients were requested to attend seriated visits after the beginning of the prasterone treatment to evaluate symptoms, physical improvement, and serum estradiol. Laboratory analysis: In order to evaluate serum ultrasensitive estradiol, 30 mL (no additive) and 10 mL (EDTA) of whole blood were drawn after an overnight fast and tobacco abstinence. Samples were shipped on the same day with a cold pack to be processed into serum and plasma, respectively. To determinate the concentration of estradiol the measurement of circulating estrogens was made using enzyme linked immunoassays (ELISAs) [21]. The security limit of serum estradiol was 27.5 pg/ml [22].