Is VEOZAH (generic name) safe for someone with breast cancer?

Safety of Veozah for Patients with Breast Cancer

Veozah (fezolinetant) is not recommended for patients with breast cancer due to potential safety concerns and lack of specific safety data in this population.

Understanding Veozah

Veozah (fezolinetant) is a medication that works as a neurokinin 3 receptor antagonist used for managing vasomotor symptoms (hot flashes) associated with menopause. The FDA label for Veozah indicates several safety concerns that are particularly relevant for patients with breast cancer:

Key Safety Concerns

1. Hepatotoxicity Risk

   • The FDA label reports cases of serious drug-induced hepatotoxicity occurring within 40 days of starting Veozah 1
   • Patients experienced elevated transaminases (up to 50x ULN), elevated alkaline phosphatase, and bilirubin elevations
   • These were accompanied by symptoms including fatigue, nausea, pruritus, jaundice, and changes in stool/urine color

2. Lack of Safety Data in Breast Cancer

   • There are no specific studies evaluating Veozah in breast cancer patients
   • The drug is relatively new, and its potential interactions with breast cancer or breast cancer treatments have not been well-established

Alternative Options for Breast Cancer Patients

For breast cancer patients experiencing menopausal symptoms, guidelines recommend several evidence-based approaches:

Non-Hormonal Options

• SERMs (Selective Estrogen Receptor Modulators):

  • Tamoxifen and raloxifene have established safety profiles in breast cancer patients 2
  • These medications actually reduce breast cancer risk while managing some menopausal symptoms

• Other Non-Hormonal Approaches:

  • The NCCN guidelines recommend consideration of non-hormonal approaches for symptom management in breast cancer patients 2

Decision Algorithm for Managing Menopausal Symptoms in Breast Cancer Patients

1. For patients with hormone receptor-positive breast cancer:

   • Consider tamoxifen (if not already on it for treatment) as it can both treat breast cancer and reduce some menopausal symptoms 2
   • Avoid Veozah due to lack of safety data and potential hepatotoxicity risk

2. For patients with hormone receptor-negative breast cancer:

   • Consider non-hormonal, non-medication approaches first
   • If medication is needed, established options with known safety profiles should be prioritized over Veozah

3. For all breast cancer patients:

   • Monitor liver function regularly if any medication is used for menopausal symptoms
   • Discontinue any medication immediately if signs of hepatotoxicity develop

Important Considerations

• Liver Monitoring: Breast cancer patients often receive treatments that can affect liver function. Adding Veozah, which has known hepatotoxicity risks, could potentially increase this risk 1

• Drug Interactions: Veozah is a substrate of CYP1A2, and many breast cancer treatments may interact with this pathway, potentially altering drug levels and increasing toxicity risk 1

• Risk-Benefit Assessment: For breast cancer patients, the risk of potential unknown effects on cancer progression or treatment efficacy outweighs the potential benefits of Veozah for hot flash management

Conclusion

Until specific safety data becomes available for Veozah in breast cancer patients, established alternatives with known safety profiles should be preferred. The potential hepatotoxicity risk and unknown interactions with breast cancer treatments make Veozah a poor choice for this patient population.