What Are The Side Effects Of Hormonal Therapy
Any disruption to the balance of hormoneswhether it occurs naturally or is part of treatmentcan cause side effects. The specific side effects that come from blocking a persons estrogen, progesterone or androgen production will depend on the individual and the type of hormonal therapy they receive. Some common side effects people experience are as follows:
Hormonal therapy can be administered in the following ways:
- Oral medications
- Injectable medications given under the skin
- Surgery to remove or ablate the hormone-producing ovaries or testicles
What Are Hormone Inhibitors And How Do They Work
Hormone inhibitors also target breast cancer cells with hormone receptors, but unlike hormone blockers, they work by reducing the bodys hormone production. When breast cancer cells are cut off from the food supply the tumor begins to starve and die.Generally, the benefits of using hormone therapy and chemotherapy together have a much greater combined effect than using either alone. If your breast cancer is positive for hormone receptors, your doctor may recommend both therapies.
What Is Hormone Therapy
Hormone therapy slows or stops the growth of hormone-sensitive tumors by blocking the bodys ability to produce hormones or by interfering with effects of hormones on breast cancer cells. Tumors that are hormone insensitive do not have hormone receptors and do not respond to hormone therapy.
Hormone therapy for breast cancer should not be confused with menopausal hormone therapy treatment with estrogen alone or in combination with progesterone to help relieve symptoms of menopause. These two types of therapy produce opposite effects: hormone therapy for breast cancer blocks the growth of HR-positive breast cancer, whereas MHT can stimulate the growth of HR-positive breast cancer. For this reason, when a woman taking MHT is diagnosed with HR-positive breast cancer she is usually asked to stop that therapy.
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What Types Of Cancer Is Hormonal Therapy Used For
- Breast cancer: An estimated 80% of breast cancers are hormone-sensitive , which means they are fueled by hormones. More specifically, these are called estrogen-receptor-positive or progesterone-receptor-positive breast cancers. These terms mean this particular cancer has estrogen and/or progesterone receptors, which invite hormones to bind to them. Hormone-receptor-negative cancers are not influenced by hormones.
- Prostate cancer: Most prostate cancers are stimulated by male sex hormones called androgens, says Dr. Leapman this is why urologists also refer to this treatment as androgen deprivation therapy. These hormones are made in the adrenal glands and testicles. Hormonal therapy for prostate cancer is used in several ways, including as short-term therapy for men prior to and during radiation therapy, as well as for men with advanced or metastatic cancer.
Hormonal therapy is sometimes used to destroy hormone-sensitive cancer cells that have spread to other parts of the body or those that have returned .
Hormonal therapy can also be used to ease a cancer patients symptoms . This is especially helpful for patients who are not able to have surgery or radiotherapy because of other health concerns.
Possible Side Effects Of Ais
The most common side effects of AIs are:
- Bone and joint pain
AIs tend to have side effects different from tamoxifen. They don’t cause uterine cancers and very rarely cause blood clots. They can, however, cause muscle pain and joint stiffness and/or pain. The joint pain may be similar to a feeling of having arthritis in many different joints at one time. Options for treating this side effect include, stopping the AI and then switching to a different AI, taking a medicine called duloxetine , or routine exercise with nonsteroidal anti-inflammatory drugs . But the muscle and joint pain has led some women to stop treatment. If this happens, most doctors recommend using tamoxifen to complete 5 to 10 years of hormone treatment.
Because AIs drastically lower the estrogen level in women after menopause, they can also cause bone thinning, sometimes leading to osteoporosis and even fractures. If you are taking an AI, your bone density may be tested regularly and you may also be given bisphosphonates or denosumab , to strengthen your bones.
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What Is Hormone Therapy For Cancer
Also referred to as hormonal or endocrine therapy, this cancer treatment is different from menopausal hormone replacement therapy , which refers to the prescription of supplemental hormones to help relieve the symptoms of menopause.
Certain cancers rely on hormones to grow. In these cases, hormone therapy may slow or stop their spread by blocking the bodys ability to produce these particular hormones or changing how hormone receptors behave in the body.
Breast and prostate cancers are the two types most commonly treated with hormone therapy. Most breast cancers have either estrogen or progesterone receptors, or both, which means they need these hormones to grow and spread. By contrast, prostate cancer needs testosterone and other male sex hormones, such as dihydrotestosterone , to grow and spread. Hormone therapy may help make these hormones less available to growing cancer cells.
Hormone therapy is available via pills, injection or surgery that removes hormone-producing organs, namely the ovaries in women and the testicles in men. Its typically recommended along with other cancer treatments.
If hormone therapy is part of your treatment plan, discuss potential risks or side effects with your care team so that you know what to expect and can take steps to reduce them. Let doctors know about all your other medications to avoid interactions.
What Types Of Hormone Therapy Are Used For Breast Cancer
Several strategies are used to treat hormone-sensitive breast cancer:
Blocking ovarian function: Because the ovaries are the main source of estrogen in premenopausal women, estrogen levels in these women can be reduced by eliminating or suppressing ovarian function. Blocking ovarian function is called ovarian ablation.
Ovarian ablation can be done surgically in an operation to remove the ovaries or by treatment with radiation. This type of ovarian ablation is usually permanent.
Alternatively, ovarian function can be suppressed temporarily by treatment with drugs called gonadotropin-releasing hormone agonists, which are also known as luteinizing hormone-releasing hormone agonists. By mimicking GnRH, these medicines interfere with signals that stimulate the ovaries to produce estrogen.
Estrogen and progesterone production in premenopausal women. Drawing shows that in premenopausal women, estrogen and progesterone production by the ovaries is regulated by luteinizing hormone and luteinizing hormone-releasing hormone . The hypothalamus releases LHRH, which then causes the pituitary gland to make and secrete LH and follicle-stimulating hormone . LH and FSH cause the ovaries to make estrogen and progesterone, which act on the endometrium .
Examples of ovarian suppression drugs are goserelin and leuprolide .
Blocking estrogens effects: Several types of drugs interfere with estrogens ability to stimulate the growth of breast cancer cells:
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Following Patients For More Than A Decade
The NCI-supported National Surgical Adjuvant Breast and Bowel Project , now part of NRG Oncology, led the US phase 3 trial. NSABP researchers randomly assigned 4,216 patients with breast cancer who had recently received a lumpectomy to treatment with APBI or WBI.
Of this group, 25% had ductal carcinoma in situ , 65% had stage 1 breast cancer, and 10% had stage 2 breast cancer. Eighty-one percent of the patients had hormone receptorpositive cancer, and 61% of the patients were postmenopausal.
Women assigned to APBI received either brachytherapy or three-dimensional conformal external beam radiation therapy
After a median follow-up of 10.2 years, 161 patients had a breast cancer recurrence: 90 patients who received APBI and 71 who received WBI. There were modest differences between the groups in terms of side effects.
Selective Estrogen Receptor Modulators
Selective estrogen receptor modulators including tamoxifen , raloxifene and toremifene selectively block estrogen from certain tissues, namely the breast, while increasing its availability in other areas such as the bones.
When and why theyre used: Doctors may recommend SERMs after surgery for early ER-positive breast cancer in men or women, to reduce the chances that it recurs. Theyre also approved to treat advanced breast cancer, and may be used to prevent breast cancer in high-risk individuals. Toremifene is only approved for advanced stage breast cancer that has spread.
Risks: In addition to more common side effects of hormone therapy such as hot flashes, tamoxifen risks may include blood clots, stroke, bone loss, mood changes, depression and loss of sex drive. Men who take tamoxifen may experience headaches, nausea, vomiting, rashes, impotence and loss of sex drive. Raloxifene may increase a patients chances of having a stroke or developing potentially fatal blood clots in the lungs or legs. Fortunately, these side effects are considered relatively rare. Have your doctor explain the potential side effects associated with each SERM when discussing the pros and cons of these medications with you.
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Radiation For Breast Cancer
Radiation therapy is treatment with high-energy rays that destroy cancer cells. Some women with breast cancer will need radiation, in addition to other treatments.
Depending on the breast cancer’s stage and other factors, radiation therapy can be used in several situations:
- After breast-conserving surgery, to help lower the chance that the cancer will come back in the same breast or nearby lymph nodes.
- After amastectomy, especially if the cancer was larger than 5 cm , if cancer is found in many lymph nodes, or if certain surgical margins, such as the skin or muscle, have cancer cells.
- If cancer has spread to other parts of the body, such as the bones, spinal cord, or brain.
Drugs That Block Estrogen
Some drugs work by blocking estrogen from causing cancer cells to grow.
Tamoxifen is a drug that prevents estrogen from telling cancer cells to grow. It has a number of benefits:
- Taking Tamoxifen for 5 years after breast cancer surgery cuts the chance of cancer coming back by half. Some studies show that taking it for 10 years may work even better.
- It reduces the risk that cancer will grow in the other breast.
- It slows the growth and shrinks cancer that has spread.
- It reduces the risk of getting cancer in women who are at high risk.
Other drugs that work in a similar way are used to treat advanced cancer that has spread:
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Side Effects Of Hormone Therapy
Like any treatment, hormone therapy can cause side effects. Everyone reacts differently to drugs and some people have more side effects than others.
Side effects can often be managed and those described here will not affect everyone.
Some side effects are common to all hormone therapies, while others are specific to certain drugs. You can read about specific side effects on our individual drug pages .
If youre concerned about any side effects, whether or not they are listed here, talk to your treatment team as soon as possible.
Types Of Hormone Therapy For Prostate Cancer
Hormone therapy may be part of prostate cancer treatment if the cancer has spread and cant be cured by surgery or radiation therapyor if the patient isnt a candidate for these other types of treatment. It may also be recommended if cancer remains or returns after surgery or radiation therapy, or to shrink the cancer before radiation therapy.
Additionally, hormone therapy may be combined with radiation therapy initially if theres a high risk of cancer recurrence. It can also be given before radiation therapy to shrink the cancer and make other treatments more effective. Other types of hormone therapy for prostate cancer include:
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The Types Of Radiotherapy
The type of radiotherapy you have will depend on the type of breast cancer and the type of surgery you have. Some women may not need to have radiotherapy at all.
Types of radiotherapy include:
- breast radiotherapy after breast-conserving surgery, radiation is applied to the whole of the remaining breast tissue
- chest-wall radiotherapy after a mastectomy, radiotherapy is applied to the chest wall
- breast boost some women may be offered a boost of high-dose radiotherapy in the area where the cancer was removed however, this may affect the appearance of your breast, particularly if you have large breasts, and can sometimes have other side effects, including hardening of breast tissue
- radiotherapy to the lymph nodes where radiotherapy is aimed at the armpit and the surrounding area to kill any cancer that may be in the lymph nodes
What Is Targeted Therapy For Breast Cancer
Targeted therapy focuses only on killing cancer cells and minimizing damage to normal, healthy cells. It can provide a better outcome with fewer side effects for certain types of breast cancer.
HER2+ breast cancer is a primary diagnosis that calls for the use of targeted therapy for breast cancer. HER2 is an acronym for Human Epidermal Growth Factor Receptor 2. This type of cancer diagnosis means that the cancerous cells are producing too much of the protein. An overabundance of HER2 protein creates more rapid and aggressive cancer growth. However, targeted therapies specific to HER2 tend to be very effective at stopping cancer from continuing to grow and replicate.
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What Are The Side Effects Of Targeted Therapies
Targeted therapies have far fewer side effects than chemotherapy or radiation. While many of the side effects are similar, there are some key differences. One of the most pertinent is that you dont experience hair loss. Additionally, chemotherapy frequently damages the surrounding healthy cells in addition to cancerous cells, while targeted therapy tends to damage only cancerous cells. Some of the most common side effects of targeted therapy may include:
- Diarrhea or nausea
- Loss of appetite, weight loss
- Muscle or joint pain
When Are Hormone Therapy Given
Hormone therapy medications control hormones by blocking the bodys hormone production or altering the way hormones work in the body. Organs that secrete hormones may be removed by surgery, radiation, or the drug goserelin to fight cancer.
Before Surgery: This is called neoadjuvant treatment. The goal is to reduce the tumors size, so there is less to remove during surgery. Not everyone has treatments before surgery. Your oncologist will let you know if this is right for you.
Adjuvant therapy for early-stage breast cancer uses hormone therapy after surgery to stop cancer from coming back. It blocks the effects of estrogen or progesterone on cancer cells but does not stop the hormone from being produced.
After cancer has gone into remission, women with estrogen-positive breast cancer can use a hormone therapy regimen for about five years to help keep it from returning. Some women may benefit from treatment periods that last longer than five years.
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Estrogen Receptor Blockers Estrogen Receptor Blocker Drugs Attach Directly To And Block The Estrogen Receptors On Cancer Cells So That The Cancer Cells Cant Use Estrogen They Do Not Affect The Level Of Estrogen In The Body Estrogen Receptor Blockers Are Also Called Selective Estrogen Receptor Modulators
Tamoxifen
Tamoxifen is the most commonly used anti-estrogen drug. It is used in post-menopausal and premenopausal women. Tamoxifen is given by mouth as a pill.
Tamoxifen is the hormonal therapy drug used most often to lower the risk that DCIS or LCIS will lead to an invasive breast cancer.
Tamoxifen very slightly increases the risk for uterine cancer, deep vein thrombosis and stroke. Doctors will carefully weigh these risks against the benefits of giving this drug before they offer it to women who have a personal or a strong family history of these conditions. Usually the benefits of taking tamoxifen outweigh these risks.
Fulvestrant
Fulvestrant is an anti-estrogen drug that reduces the number of estrogen receptors on breast cancer cells. It is given as an injection into the muscles of the buttocks.
Fulvestrant is used in post-menopausal women if the breast cancer has grown after they were treated with tamoxifen. It is also used in postmenopausal women with locally advanced or metastatic breast cancer that have never been treated with hormonal therapy.
If You Cant Have Surgery
Surgery is the main treatment for breast cancer, but some women have health problems that mean they cant have surgery. Some women choose not to have surgery.
In this case, if your breast cancer is oestrogen receptor positive, your doctor might recommend hormone therapy. This treatment won’t get rid of the cancer but can stop it growing or shrink it.
The treatment can often control the cancer for some time. Your doctor might change you to a different type of hormone treatment if your cancer starts growing again.
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Can Other Drugs Interfere With Hormone Therapy
Certain drugs, including several commonly prescribed antidepressants , inhibit an enzyme called CYP2D6. This enzyme plays a critical role in the body’s use of tamoxifen because CYP2D6 metabolizes, or breaks down, tamoxifen into molecules, or metabolites, that are much more active than tamoxifen itself.
The possibility that SSRIs might, by inhibiting CYP2D6, slow the metabolism of tamoxifen and reduce its effectiveness is a concern given that as many as one-fourth of breast cancer patients experience clinical depression and may be treated with SSRIs. In addition, SSRIs are sometimes used to treat hot flashes caused by hormone therapy.
Many experts suggest that patients who are taking antidepressants along with tamoxifen should discuss treatment options with their doctors, such as switching from an SSRI that is a potent inhibitor of CYP2D6, such as paroxetine hydrochloride , to one that is a weaker inhibitor, such as sertraline or citalopram , or to an antidepressant that does not inhibit CYP2D6, such as venlafaxine . Or doctors may suggest that their postmenopausal patients take an aromatase inhibitor instead of tamoxifen.
Other medications that inhibit CYP2D6 include the following:
- quinidine, which is used to treat abnormal heart rhythms
Radiation May Be Better Than Anti
Researchers may have identified a treatment alternative for older women with low-risk forms of breast cancer. It could offer fewer adverse side effects than anti-hormonal drug therapies.
The study found slightly higher survival rates for women over 70 with hormone receptor-positive breast cancer and took anti-estrogen medications than those who were treated with a short dose of radiation. All of the patients had undergone a lumpectomy before these treatments, according to a new report published Monday in the International Journal of Radiation Oncology.
Radiation therapy costs $3,800 or more than anti-hormonal therapy over the average patient’s lifetime, the report found.
Still, researchers suggested radiation therapy could be a good alternative to anti-estrogen medications for some women because it could improve their quality of life without higher mortality risks.
“The reality is anti-hormone therapy is not easy to take long-term and doesn’t offer significantly greater benefits. It can dramatically impact quality of life.” said Dr. Frank Vicini, the report’s co-author and principal investigator at 21st Century Oncology, a Florida-based cancer care services operator of 165 centers across 15 states.
Anti-estrogen treatment may be necessary for five to ten years, according to current recommendations. Vicini said as many as 50% of patients who start anti-estrogen treatment had difficulty managing the side effects and end up stopping the treatment during that time.
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