Elinzanetant in Menopause: James A. Simon, MD, on Emerging Evidence in Women With Breast Cancer

Vasomotor symptoms associated with menopause represent a significant and often undertreated burden, particularly among women who cannot use hormonal therapies. An estimated 4 million breast cancer survivors in the US face this challenge acutely: many experience severe hot flashes and night sweats as a direct consequence of anti-estrogenic treatments taken for 5 to 10 years, and hormonal therapies for VMS are absolutely contraindicated in this population.

Elinzanetant (Lynkuet, Bayer), a selective neurokinin 1,3 receptor antagonist approved for moderate-to-severe VMS in menopausal women, has generated off-label data relevant to this underserved group. A study published in the New England Journal of Medicine evaluated elinzanetant in women experiencing hot flashes and night sweats while actively receiving anti-estrogenic therapy for breast cancer. The trial, conducted outside the US due to domestic ethical restrictions, demonstrated a clear benefit for VMS in this population. As the neurokinin antagonist class matures, attention is also turning toward the next generation of research questions, including how to better stratify patients to optimize the benefit-to-risk ratio for individual therapies.

James A. Simon, MD, medical director and founder of IntimMedicine Specialists in Washington, DC, discussed these topics at the 2025 ACOG Annual Clinical and Scientific Meeting. Below, Simon shares his perspective on the future of patient stratification for neurokinin receptor antagonists and the emerging evidence supporting elinzanetant use in women with breast cancer receiving anti-estrogenic therapy.