Breast Cancer Endocrine Therapy Profiles Prompt Individualized Toxicity Management Conversations: With Sara Nunnery, MD, MSCI; and Eleonora Teplinsky, MD

Breast Cancer Briefing, hosted by Sara Nunnery, MD, MSCI, a breast medical oncologist and the director of Breast Cancer Research at Tennessee Oncology in Nashville, is a podcast series that breaks down the latest news in breast cancer research, one conversation at a time.

In this episode, Dr Nunnery sat down with Eleonora Teplinsky, MD, the head of Breast and Gynecologic Medical Oncology at Valley-Mount Sinai Comprehensive Cancer Care in Paramus, New Jersey, as well as a clinical assistant professor of medicine at the Icahn School of Medicine.

The experts discussed how to manage the adverse effects associated with endocrine therapy in patients with hormone receptor–positive breast cancer, beginning by dispelling the misconception that the disease reflects a hormonal imbalance. Dr Teplinsky explained that estrogen does not cause breast cancer but rather feeds cells already growing abnormally, and she distinguished the mechanisms of tamoxifen, aromatase inhibitors, and ovarian function suppression, clarifying that tamoxifen does not induce menopause.

Turning to symptom management, Dr Teplinsky reviewed short-term effects, including vasomotor symptoms, fatigue, and mood changes, as well as long-term concerns, such as bone, cardiovascular, and brain health. For hot flash management, she described nonpharmacologic strategies and off-label options before highlighting the neurokinin receptor antagonists fezolinetant (Veozah) and elinzanetant (Lynkeut), noting their efficacy and the need for liver enzyme monitoring, particularly in combination with CDK4/6 inhibitors.

The conversation then addressed genitourinary syndrome of menopause, with Dr Teplinsky endorsing guideline-supported vaginal estrogen and prasterone (Intrarosa), emphasizing that symptoms extend beyond sexual health to recurrent urinary tract infections. She also detailed aromatase inhibitor–associated musculoskeletal symptoms, stressing movement, physical therapy, and acupuncture, and expressed enthusiasm for oral selective estrogen receptor degraders, given their lower discontinuation rates.

Finally, the experts underscored the importance of proactive cardiovascular screening, including lipoprotein (a) testing, and reassured that most effects are reversible. They emphasized exercise, alcohol reduction, and individualized care, and Dr Teplinsky previewed her forthcoming book, Beyond the Pink.