Could a Menopause Drug Help Men with Prostate Cancer?
A UVM Cancer Center study examines a new way to treat hot flashes caused by hormone therapy.
A University of Vermont Health - UVM Cancer Center study is exploring whether fezolinetant, a drug approved to treat hot flashes in menopausal women, could also help men undergoing hormone therapy for prostate cancer.
Steven Ades, MD, Medical Director of the Clinical Trials Office at UVM Cancer Center, is leading one of a small number of unique trials in the United States. Researchers are evaluating whether fezolinetant can reduce the frequency and severity of hot flashes in men receiving hormone therapy for prostate cancer.
“For the 20% to 30% of men undergoing this treatment who experience moderate to severe hot flashes, it’s a huge quality-of-life issue,” Dr. Ades says. “In some cases, men stop cancer treatment because the hot flashes are just intolerable.”
The study, which started a year ago, aims to enroll 32 men with prostate cancer who experience moderate to severe hot flashes while receiving hormone therapy. Researchers are assessing whether a 30-day course of fezolinetant can provide symptom relief.
“In some cases, men stop cancer treatment because the hot flashes are just intolerable for them.”
Hot flashes aren’t just a menopause symptom
Most people associate hot flashes with menopause. But they can also affect men being treated for prostate cancer.
A hot flash is a sudden feeling of intense heat that may, in more severe cases, be accompanied by a racing heart and anxiety. Hot flashes can disrupt sleep, interfere with daily activities and reduce quality of life.
For men with advanced prostate cancer, hormone therapy is a cornerstone of treatment. These medications work by significantly lowering testosterone levels, which can slow cancer growth. However, the drop in testosterone can also cause a range of side effects, including hot flashes.
In 2023, the FDA approved fezolinetant as the first nonhormonal treatment for moderate to severe hot flashes associated with menopause. The drug is not approved for use in men.
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Similar biology may hold the key
Dr. Ades believes the same mechanism that reduces hot flashes in menopausal women may also work in men.
During menopause, a woman’s estrogen levels drop. Men receiving hormone therapy for prostate cancer experience a similar decline in testosterone. In both cases, the loss of these hormones removes the brain’s natural “brakes” on the system that regulates body temperature, making hot flashes more likely, and in some cases, more severe.
“That only leaves the gas pedal,” says Dr. Ades, referring to a signaling protein called neurokinin B (NKB). Without those hormonal brakes, the NKB pathway can become overactive, triggering hot flashes.
Fezolinetant works by taking the foot off the gas pedal, blocking the neurokinin-3 receptor in the brain that responds to the NKB protein and interrupting the pathway that causes hot flashes.
Early results are encouraging
“Anecdotally, it appears to be very effective at reducing both the frequency and severity of hot flashes, although the study is not complete,” Dr. Ades says.
If the findings hold up, the study could pave the way for a larger placebo-controlled trial and eventually expand treatment options for men receiving hormone therapy for prostate cancer.
For patients struggling with one of the treatment’s most disruptive side effects, that could mean staying on therapy as prescribed and enjoying a better quality of life.
