Wednesday, September 28, 2022

Anti Hormone Therapy For Breast Cancer

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Why Is This Medication Prescribed

Should You Get off of Anti-Hormone Therapy for Breast Cancer?

Anastrozole is used with other treatments, such as surgery or radiation, to treat early breast cancer in women who have experienced menopause . This medication is also used in women, who have experienced menopause, as a first treatment of breast cancer that has spread within the breast or to other areas of the body. This medication is also used to treat breast cancer in women whose breast cancer has worsened after taking tamoxifen . Anastrozole is in a class of medications called nonsteroidal aromatase inhibitors. It works by decreasing the amount of estrogen the body makes. This can slow or stop the growth of many types of breast cancer cells that need estrogen to grow.

Antiestrogen Vs Estrogen Blockers

Both antiestrogen and estrogen blockers aim to slow or stop the progression of breast cancer. The two different treatments dont work the same way, though.

Tamoxifen, a widely used estrogen blocker, stops estrogen from affecting breast tissue. Aromatase, an antiestrogen therapy, lowers the production of estrogen in postmenopausal women.

Tamoxifen is well known and widely used as chemoprevention a medication to prevent disease for women with a high risk of developing invasive breast cancer, according to

, researchers found that when postmenopausal women in the increased risk category took tamoxifen for 5 years, it lowered their risk of developing invasive breast cancer by 50 percent.

A 2017 study found that use of tamoxifen and antiestrogen medications led to a 50 to 65 percent decrease in breast cancer development in high risk groups.

Both estrogen blockers and antiestrogen therapies are effective, but there are side effects, too. Its important to weigh the benefits and risks with your care team before deciding on this course of action.

Drugs That Lower Estrogen Levels

Some drugs, called aromatase inhibitors , stop the body from making estrogen in tissues such as fat and skin. But, these drugs do not work to make the ovaries stop making estrogen. For this reason, they are used mainly to lower estrogen levels in women who have been through menopause . Their ovaries no longer make estrogen.

Premenopausal women can take AIs if they are also taking drugs that stop their ovaries from making estrogen.

Aromatase inhibitors include:

  • Exemestane

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Who Gets Hormone Therapy For Breast Cancer

When youâre diagnosed with breast cancer, your doctor will test cells from your tumor to see if they have parts on their surfaces called receptors that use estrogen or progesterone. If they do, it means that they depend on these hormones to grow. In that case, your doctor will probably recommend hormone therapy as part of your treatment plan.

If youâve already been treated for breast cancer, you might use hormone therapy to help keep it from coming back. It also helps lower your odds of getting new cancers in the other breast.

Also, if you don’t have the disease but have a family history of it, or genes that raise your risk, your doctor may recommend hormone therapy to lower your chances of getting it.

Benefits Of Hormone Therapies In Early And Locally Advanced Breast Cancer Treatment

PPT

Treatment with the hormone therapies tamoxifen and/or an aromatase inhibitor lowers the risk of :

  • Breast cancer recurrence
  • Breast cancer in the opposite breast
  • Death from breast cancer

Premenopausal women who get ovarian suppression plus tamoxifen or an aromatase inhibitor may lower these risks more than premenopausal women who get tamoxifen or an aromatase inhibitor alone .

Learn more about tamoxifen.

Aromatase inhibitor plus androgen deprivation therapy

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Vaginal Dryness Or Irritation

Lowered oestrogen levels cause the tissues of the vagina to become thin, dry and less elastic. The vagina becomes slightly shorter and narrower.

Water-based lubricants such as Sylk can reduce the discomfort, particularly during sex. Vaginal moisturizers such as Replens help to hydrate the vaginal tissue and have a long-lasting effect .

Hormone Therapy For Breast Cancer

Some types of breast cancer are affected by hormones, like estrogen and progesterone. The breast cancer cells have receptors that attach to estrogen and progesterone, which helps them grow. Treatments that stop these hormones from attaching to these receptors are called hormone or endocrine therapy.

Hormone therapy can reach cancer cells almost anywhere in the body and not just in the breast. It’s recommended for women with tumors that are hormone receptor-positive. It does not help women whose tumors don’t have hormone receptors .

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When You Are Taking Anastrozole Letrozole Or Exemestane :

Aromatase Inhibitors are generally well tolerated. Side effects may include hot flashes, joint pain and stiffness, vaginal dryness and rarely hair thinning, nausea, diarrhea, headaches, fluid retention, low energy, and rash.

Aromatase inhibitors have an increased risk of osteopenia , osteoporosis and fractures . Have a baseline Bone Mineral Density Scan . The bone density scan should be repeated every one to two years while taking an Aromatase Inhibitor. If there are signs of bone loss you should have treatment with a bisphosphonate . Talk with your health care provider about the treatment options available.

It is recommended to take Calcium and Vitamin D supplements. Be sure to get 1200mg of calcium and 800-2000 IU of Vitamin D per day. Aim to get the majority of calcium through your diet and supplement as needed.

These medications may increase your cholesterol and blood pressure. Have your cholesterol and blood pressure monitored by your health care provider and treat if elevated.

Tips:

Information or help with side effects?

What Types Of Hormone Therapy Are Used For Breast Cancer

Types of Anti-Estrogen Therapy 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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How To Choose The Best Kind Of Hormone Therapy

There are many hormone therapy types to cure breast cancer such as

Selective Estrogen Receptor Modulators

Even known as SERMs, these medications obstruct breast cancer cells from getting attached to estrogen. SERMs impede the effects of estrogen merely in breast tissue but not in other tissues within the body.

These drugs are traditionally only used in premenopausal women.

The commonly used SERMs consist

Tamoxifen

This medication stops estrogen from attaching to cells and thereby disables cancer from growing and dividing. People who have tamoxifen for a decade after breast cancer treatment are less supposed to see the cancer recurrence and more supposed to live longer in comparison to the ones who take the medicine for just 5 years.

Toremifene

This medication is approved only to cure breast cancer that has extended to other body parts and might not be useful in persons who have seen less success with tamoxifen.

Fulvestrant

This is an injected estrogen receptor-blocking medication that is usually used to cure advanced breast cancers. Different from other SERMs, it obstructs the effect of estrogen all through the total body.

Aromatase Inhibitors

AIs obstruct estrogen production from fat tissue, however, have no consequence on the estrogen made by the ovaries.

Common AIs consist

  • Exemestane

Ovarian Ablation or Suppression

Surgical ablation is carried on by the removal of ovaries. Without the manufacturing of estrogen from the ovaries, one will move into permanent menopause.

Turning Off Or Removing The Ovaries

Turning off or removing the ovaries lowers the levels of oestrogen in the blood. This is another way of starving cancer cells of oestrogen to stop them growing. This treatment only works before menopause.This treatment is not necessary for women who have already gone through menopause because the ovaries naturally stop making oestrogen after menopause.

Turning off or removing the ovaries:

  • reduces the risk of cancer returning or new cancer developing
  • can be combined with other treatments for breast cancer like breast surgery, radiotherapy, chemotherapy, aromatase inhibitors and tamoxifen

Surgical removal of the ovaries reduces the risk of breast cancer returning and has the added benefit of reducing the risk of developing cancer of the ovaries, although cancer of the ovaries is uncommon.

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What Are Hormones And Hormone Receptors

Hormones are substances that function as chemical messengers in the body. They affect the actions of cells and tissues at various locations in the body, often reaching their targets through the bloodstream.

The hormones estrogen and progesterone are produced by the ovaries in premenopausal women and by some other tissues, including fat and skin, in both premenopausal and postmenopausal women and in men. Estrogen promotes the development and maintenance of female sex characteristics and the growth of long bones. Progesterone plays a role in the menstrual cycle and pregnancy.

Estrogen and progesterone also promote the growth of some breast cancers, which are called hormone-sensitive breast cancers. Hormone-sensitive breast cancer cells contain proteins called hormone receptors that become activated when hormones bind to them. The activated receptors cause changes in the expression of specific genes, which can stimulate cell growth.

Breast cancers that lack ERs are called ER negative, and if they lack both ER and PR they may be called HR negative.

Approximately 67%80% of breast cancers in women are ER positive . Approximately 90% of breast cancers in men are ER positive and approximately 80% are PR positive .

How Much Hormone Therapy Costs

Figure 4 from Mechanisms of hormonal therapy resistance in breast ...

The cost of hormone therapy depends on:

  • the types of hormone therapy you receive
  • how long and how often you receive hormone therapy
  • the part of the country where you live

Talk with your health insurance company about what services it will pay for. Most insurance plans pay for hormone therapy for their members. To learn more, talk with the business office where you go for treatment. You can also go to the National Cancer Institute database, Organizations that Offer Support Services and search “financial assistance.” Or call toll-free 1-800-4-CANCER to ask for help.

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Can Genomic Assays Help With Treatment Decision Making

Genomic assays can provide a clue as to which drugs might or might not work. For example, if someone has a mutation in the estrogen receptor gene ESR1, aromatase inhibitors probably will not work. Emerging evidence also suggests that patients with the PIK3CA mutation are more likely to respond to the phosphoinositide 3-kinase inhibitor Piqray . Individuals being treated with hormone therapy for breast cancer should discuss the role of blood based genomic monitoring to detect resistant mutations and early cancer progression.

For The Population Studied As A Whole There Was An Overall Deterioration In The Quality Of Life At Two Years From Diagnosis This Deterioration Was Greater In Patients Who Had Received Hormone Therapy Especially After The Menopause By Contrast Chemotherapy Had A Bigger Effect On Quality Of Life In Non

It is important in the future that we are able to predict which women are going to develop severe symptoms with anti-hormonal treatment so that we can support them, added Dr Vaz-Luis. While it has been shown that hormone therapy provides a real benefit in reducing the relapse rate of hormone-dependent cancers which represent 75% of all breast cancers, the deterioration in quality of life may also have a negative effect on patient adherence to treatment. It is, therefore, important to offer them symptomatic treatment, in particular for menopausal symptoms, musculoskeletal pain, depression, severe fatigue and cognitive dysfunction and to combine this with supportive measures such as physical exercise and cognitive behaviour therapy.

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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

If Cancer Comes Back Or Has Spread

Are There Any Long Term Side Effects of Anti-Estrogen Therapy?

AIs, tamoxifen, and fulvestrant can be used to treat more advanced hormone-positive breast cancers, especially in post-menopausal women. They are often continued for as long as they are helpful. Pre-menopausal women might be offered tamoxifen alone or an AI in combination with an LHRH agonist for advanced disease.

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Endopredict Second Generation Test Can Be Performed Locally Within A Few Days

The EndoPredict breast cancer prognosis test is a CE-marked in vitro diagnostic test. It can be performed in local molecular pathology laboratories. The results are available within a few days. Results are fast and EndoPredict test cost refund is assured for eligible patients in many countries.

Out-of-country gene expression testing can slow patient results and affect test refund.

How Hormone Therapy Is Given

Hormone therapy may be given in many ways. Some common ways include:

  • Oral. Hormone therapy comes in pills that you swallow.
  • Injection. The hormone therapy is given by a shot in a muscle in your arm, thigh, or hip, or right under the skin in the fatty part of your arm, leg, or belly.
  • Surgery. You may have surgery to remove organs that produce hormones. In women, the ovaries are removed. In men, the testicles are removed.

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Surgery To Stop The Ovaries From Working

This is also a type of ovarian ablation. You might choose to have an operation to remove your ovaries instead of having drug treatment to stop them working. You have this operation as keyhole surgery. It is called laparoscopic oophorectomy and you have it under general anaesthetic . You usually stay in hospital overnight.

The surgeon makes a number of small cuts into your tummy . They put a long bendy tube called a laparoscope into one of the cuts. The laparoscope connects to a video screen.

The surgeon puts small instruments through the other cuts to carry out the operation and remove the ovaries. They close the cuts with stitches and cover them with small dressings.

Removing your ovaries causes you to have a sudden menopause. The symptoms include hot flushes, sweating and mood swings.

Possible Side Effects Of Ais

How does hormone therapy work?

The most common side effects of AIs are:

  • Hot flashes
  • Bone and joint pain
  • Muscle 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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Adjuvant Hormonal Therapy Treatment Time

For many years, women took hormonal therapy for five years after surgery for early-stage, hormone receptor-positive breast cancer. In most cases, the standard of care is five years of tamoxifen, or two to three years of tamoxifen followed by two to three years of an aromatase inhibitor, depending on menopausal status.

Recent research has found that in certain cases, taking tamoxifen for 10 years instead of five years after surgery lowered a womans risk of recurrence and improved survival.

In most cases, a post-menopausal woman diagnosed with early-stage, hormone receptor-positive breast cancer would take an aromatase inhibitor for five years after surgery to reduce the risk of recurrence. After that, if breast cancer had been found in the lymph nodes, called node-positive disease, a woman would take an aromatase inhibitor for an additional five years, for a total of 10 years of hormonal therapy treatment.

Doctors call taking hormonal therapy for 10 years after surgery extended adjuvant hormonal therapy.

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