Safety Monitoring and Multidisciplinary Care for VMS in Breast Cancer Survivors

In this episode, "Safety Monitoring and Multidisciplinary Care for VMS in Breast Cancer Survivors," two menopause experts explore the practical considerations of elinzanetant's safety profile and the importance of a team-based approach to care for breast cancer survivors experiencing VMS. The experts outline elinzanetant's common side effects — including headache, fatigue, dizziness, and somnolence — noting that many of these tend to dissipate within the first few weeks of treatment, and that somnolence may actually serve as a beneficial side effect for patients struggling with sleep disturbance. They highlight that liver function monitoring with elinzanetant requires only a baseline assessment and a follow-up at three months, with no ongoing monitoring required thereafter.

By contrast, the experts note that fezolinetant carries a risk of liver injury that prompted post-marketing changes to its monitoring recommendations, now requiring liver enzyme checks at baseline and five additional timepoints within the first year. This distinction is framed as clinically meaningful, as the more intensive monitoring schedule imposes cost, time, and emotional burden on both patients and clinicians, and may negatively impact adherence.

The conversation then shifts to the value of multidisciplinary collaboration, with the experts emphasizing that no single clinician can possess expertise across all the specialties relevant to a breast cancer survivor's care. They advocate for building patient care teams that span oncology, menopause medicine, endocrinology, and other disciplines, stressing that honest communication about the limits of one's own knowledge is a strength rather than a weakness. The experts note with encouragement that cancer survivorship clinics are increasingly adopting multidisciplinary models, reflecting a growing recognition that menopause in the context of cancer survivorship affects virtually every organ system and demands a coordinated, whole-patient approach.

The next episode in this series, "A Case of a 54-Year-Old Woman with VMS and Cardiovascular Considerations," features the panelists discussing the central role of primary care in identifying and managing VMS, the lasting impact of WHI misinformation on both patients and providers, and how evolving patient awareness is reshaping conversations around menopause treatment.