Breast Cancer Hormone Receptor Positive

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 .

What Is The Life Expectancy For Each Cancer Stage

Your outlook depends on the stage of your cancer when its discovered. Cancer is staged by number, starting with 0 and going to 4. Stage 0 is the very beginning and stage 4 is the last stage, also called the metastatic stage, because its when cancer has spread to other areas in the body.

Each number reflects different characteristics of your breast cancer. These characteristics include the size of the tumor and whether the cancer has moved into lymph nodes or distant organs, like the lungs, bones, or brain.

Research on survival statistics for people with breast cancer tends to separate participants into categories of women and men.

Survival statistics of women with the major subtypes of breast cancer such as ER-positive, HER2-positive, and triple-negative are grouped together. With treatment, most women with very early stage breast cancers of any subtype can expect a normal life span.

Survival rates are based on how many people are still alive years after they were first diagnosed. Five-year and 10-year survival are commonly reported.

Optimal Sequence Of Therapy

There are many options in the sequencing of therapy for endocrine receptor-positive, metastatic breast cancer in post-menopausal women. Although first-line treatment with a CDK/4/6 inhibition has significant improvement in PFS, the total PFS is similar regardless of the sequencing . Treatment decisions should be based on medical comorbidities, prior adjuvant therapies, and disease-free interval . First-line treatment with an aromatase inhibitor or fulvestrant are still viable options and offer a PFS of 14 and 16.6 months, respectively. Frontline use of the combination of a CDK4/6 inhibitor with an aromatase inhibitor, such as palbociclib/letrozole and ribociclib/letrozole, offer a greater than 24-month PFS. Subsequent-line therapies include the use of palbociclib or abemaciclib with fulvestrant, the combination of everolimus with exemestane, and single-agent abemaciclib. The use of PI3K-inhibitors both single-agent and in combination with fulvestrant are being studied for use in patients with endocrine-resistant disease. Immunotherapy and CAR-T therapy are also being explored as other options of treatment. The use of biomarkers, including ESR1 mutation, and genomic profiling may provide useful future tools to direct therapy.

Fig. 1

Progression-free survival using endocrine therapy. a The PFS when aromatase inhibitors are used first line. b The PFS with the use of front-line CDK4/6 inhibitors

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Side Effects Of Tamoxifen And Toremifene

The most common side effects of tamoxifen and toremifene are:

• Vaginal dryness or discharge
• Changes in the menstrual cycle

When tamoxifen treatment starts, a small number of women with cancer that has spread to the bones might have a tumor flare which can cause bone pain. This usually decreases quickly, but in some rare cases a woman may also develop a high calcium level in the blood that is hard to control. If this happens, the treatment may need to be stopped for a time.

Rare, but more serious side effects are also possible:

Can Hormone Therapy Be Used To Prevent Breast Cancer

Yes. Most breast cancers are ER positive, and clinical trials have tested whether hormone therapy can be used to prevent breast cancer in women who are at increased risk of developing the disease.

A large NCI-sponsored randomized clinical trial called the Breast Cancer Prevention Trial found that tamoxifen, taken for 5 years, reduces the risk of developing invasive breast cancer by about 50% in postmenopausal women who were at increased risk . Long-term follow-up of another randomized trial, the International Breast Cancer Intervention Study I, found that 5 years of tamoxifen treatment reduces the incidence of breast cancer for at least 20 years . A subsequent large randomized trial, the Study of Tamoxifen and Raloxifene, which was also sponsored by NCI, found that 5 years of raloxifene reduces breast cancer risk in such women by about 38% .

As a result of these trials, both tamoxifen and raloxifene have been approved by the FDA to reduce the risk of developing breast cancer in women at high risk of the disease. Tamoxifen is approved for this use regardless of menopausal status. Raloxifene is approved for use only in postmenopausal women.

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What This Means For Patients

Because the results of ER and PR testing can make a difference in a persons treatment and chance of recurrence, it’s important that these tests are accurate. This guideline was developed to help both doctors and laboratories know how to improve the accuracy of ER and PR testing for those with breast cancer. Understanding the ER/PR status of the primary tumor and any distant or recurrent tumors can help doctors make sure that patients receive the appropriate treatment and avoid side effects of a treatment that may not work. Use this guideline to talk with your doctor about the accuracy of your ER and PR test results and what that means for your treatment.

Treatment Tailoring In Hormone

RT-PCR, reverse transcriptase-PCR. Modified from Sotiriou & Pusztai .

One of such tools, the Oncotype DX, merits to be addressed in more details . This test was developed to answer the following question Is it possible to identify a woman with hormone receptor-positive, lymph node-negative breast cancer, for whom it may be necessary something more than just tamoxifen alone? Among the 16 genes that the Oncotype DX analyzes, some are related to the ER , other related to cell proliferation , and other, like HER2, which are not functionally related. The relative expression of these genes compared with that of five reference genes whose expression does not correlate with tumor aggressiveness is combined by a mathematical formula that results in a continuous score ) that is directly proportional to the risk of metastatic relapse. The RS has been into divided into three risk categories by cutoffs that were established studying the clinical outcome of women enrolled in the tamoxifen arm of the NSABP B-20 clinical trial . The low-risk group has been defined by a RS< 18, the intermediate by a RS between 18 and 30, and the high risk by a RS> 30.

RS, recurrence score NSABP, national surgical adjuvant breast and bowel project ECOG, eastern cooperative oncology group SWOG, south western oncology group.

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Treatment For Er Positive Breast Cancer

If your breast cancer is ER positive, you may be offered hormone therapy.

A number of hormone therapies work in different ways to block the effect of oestrogen or reduce the amount of oestrogen in the body.

It may be given to:

• Reduce the risk of breast cancer coming back after surgery
• Reduce the size of the cancer or slow down its growth
• Treat breast cancer that has come back or spread

Icb Monotherapy In Hr+ Breast Cancer

In the phase 1b JAVELIN trial, 168 heavily pretreated patients with metastatic breast cancer, regardless of subtype or PD-L1 status, were treated with the PD-L1 inhibitor, avelumab . Of the 168 patients, 72 had HR+/HER2- disease and the ORR for this group was 2.8% compared to 5.2% in the TNBC group. The median duration of response was not reached. In addition, subgroup analysis by PD-L1 status did not reveal any trend in efficacy. Given the low ORR, avelumab was determined to have limited therapeutic benefit as monotherapy in patients with metastatic HR+/HER2- breast cancer. Altogether, the KEYNOTE-028 and JAVELIN trials revealed the limited single-agent efficacy of ICB in HR+ breast cancer, particularly in heavily pretreated disease. The limited response to ICB monotherapy led to the inclusion of chemotherapy and other systemic therapeutics that may have synergism with ICB, a strategy used in TNBC.

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Hormone Receptor Status And Hormone Therapy

Hormone receptor-positive breast cancers can be treated with hormone therapies.

Hormone therapy drugs include tamoxifen and the aromatase inhibitors, anastrozole , letrozole and exemestane . Ovarian suppression, with surgery or drug therapy, is also a hormone therapy.

Hormone receptor-negative breast cancers are not treated with hormone therapies because they dont have hormone receptors.

Learn about hormone therapy for the treatment of metastatic breast cancers.

What Is A Hormone Receptor

Hormones are chemical messengers that circulate in the bloodstream. Hormone receptors are proteins located in and around breast cells. When the corresponding hormone binds to a receptor, it tells the cells how to grow and divide.

In the case of breast cancer, these receptors allow abnormal cells to grow out of control, which results in a tumor.

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Hormone Therapy After Surgery For Breast Cancer

After surgery, hormone therapy can be given to reduce the risk of the cancer coming back. Taking an AI, either alone or after tamoxifen, has been shown to work better than taking just tamoxifen for 5 years.

These hormone therapy schedules are known to be helpful for women who are post-menopausal when diagnosed:

• Tamoxifen for 2 to 3 years, followed by an AI for 2 to 3 years
• Tamoxifen for 2 to 3 years, followed by an AI for 5 years
• Tamoxifen for 4½ to 6 years, followed by an AI for 5 years
• Tamoxifen for 5 to 10 years
• An AI for 5 to 10 years
• An AI for 2 to 3 years, followed by tamoxifen for 2 to 3 years
• For women who are unable to take an AI, tamoxifen for 5 to 10 years is an option

For most post-menopausal women whose cancers are hormone receptor-positive, most doctors recommend taking an AI at some point during adjuvant therapy. Standard treatment is to take these drugs for about 5 years, or to take in sequence with tamoxifen for 5 to 10 years. For women at a higher risk of recurrence, hormone treatment for longer than 5 years may be recommended. Tamoxifen is an option for some women who cannot take an AI. Taking tamoxifen for 10 years is considered more effective than taking it for 5 years, but you and your doctor will decide the best schedule of treatment for you.

These therapy schedules are known to be helpful forwomen who are pre-menopausal when diagnosed:

Role Of Hormones In The Body

Our bodies naturally make hormones, including estrogen and progesterone.

Estrogen has multiple roles. It helps sex organs develop, makes pregnancy possible, strengthens bones, and more.

As you get older, the level of estrogen in your body changes.

• In premenopausal women who have periods, the ovaries make most of the bodys estrogen. Estrogen levels in premenopausal women are usually high.
• In perimenopause, the ovaries slow down and make less estrogen. But it is still possible to have menstrual periods, even when the ovaries are working more slowly. Periods may sometimes be irregular. This in-between time happens several years before menopause.
• In menopause, the ovaries gradually stop making estrogen. Periods become irregular and then stop altogether.
• Post-menopausal means a woman has not had any menstrual periods for 12 months in a row and blood work demonstrates hormonal levels are in post-menopausal range.

After menopause, the ovaries no longer make estradiol, the most active form of estrogen. But a womans body still makes estrone, another form of estrogen, after menopause. Estrone is made when an enzyme called aromatase converts the male sex hormone androstenedione made in the adrenal glands, ovaries, and fat cells into estrogen. In men, androstenedione is made in the testes.

Treatments for hormone receptor-positive breast cancer may include hormonal therapy, radiation therapy, chemotherapy, or targeted therapy.

Depending on the type, hormonal therapy works by:

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Finding The Type Of Cancer

A pathologist looks at the cancer cells under a microscope to see which type of breast cancer it is. They can tell this by the shape of the cells and the pattern of the cells in the breast tissue.

Pathologists also sometimes use particular dyes to stain the cells and show up certain proteins or features of the cells.

Why Are Triple Negative Breast Cancers More Common

Triple-negative breast cancer cells dont have estrogen or progesterone receptors and also dont make any or too much of the protein called HER2. These cancers tend to be more common in women younger than 40 years of age, who are Black, or who have a mutation in the BRCA1 gene. Triple-negative breast cancers grow and spread faster than most other types of breast cancer. Because the cancer cells dont have hormone receptors, hormone therapy is not helpful in treating these cancers. And because they dont have too much HER2, drugs that target HER2 arent helpful, either. Chemotherapy can still be useful. See Triple-negative Breast Cancer to learn more.

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What Does It Mean To Be Her2

If your breast cancer is HER2-negative, you do not have an excess of the HER2 gene. Tumors such as these will not respond to therapies that specifically target HER2 receptors.

If your breast cancer is HER2-positive, then you have too much HER2 protein or extra copies of the HER2 gene. These breast cancers tend to be fast-growing. HER2-positive breast cancer treatment typically includes targeted therapy drugs that slow the growth and kill these cancer cells. HER2-positive breast cancers account for about 25% of all breast cancer cases.

Knowing your HER2 status will help your WVCI cancer care team create the best treatment plan for you.

Study Of Acupuncture In The Treatment Of Hot Flashes In Patients With Hormone Receptor

Acupoint selection: 4 general points + syndrome differentiation acupoints , and adjust acupoints according to symptoms every week.

Frequency: 3 times a week for a total of 8 weeks of continuous treatment.

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Is Breast Cancer Caused By Estrogen

Estrogen detoxification: Calcium d-glucarate removes the harmful dirty estrogens, which are the harmful metabolites of estrogen that may be responsible for conditions such as fibrocystic breasts, breast lumps, ER+ breastcancers, thyroid nodules, thyroid cancer endometriosis, fibroids, infertility, mood swings, and PMS.

What Hormones Are Used To Block The Growth Of Breast Cancer Cells

The cells of this type of breast cancer have receptors that allow them to use the hormone estrogen to grow. Treatment with anti-estrogen hormone therapy can block the growth of the cancer cells. Progesterone receptor positive. This type of breast cancer is sensitive to progesterone, and the cells have receptors

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How To Manage A Hormone Receptor

Several -approved treatments available for hormone receptor-positive breast cancer are effective at reducing the risk of breast cancer . Because of this, you may hear people say that hormone receptor-positive breast cancer is the best breast cancer to have. We know hearing others say these kinds of things can be difficult or angering having any kind of cancer is challenging. Remember that your experience with breast cancer is your own. Its OK to feel overwhelmed, scared, depressed, and angry, because we all handle emotional and physical treatment side effects differently.

Its important after a cancer diagnosis to surround yourself with people you trust and who allow you space to experience your emotions as they come. Not everyone in your life will be able to do this, and that can feel isolating. Here are some strategies to help you navigate your emotions after diagnosis:

• Write your feelings a journal
• Talk to a trusted friend or family member

or anti-estrogen , only works in hormone receptor-positive cancers. Different hormonal therapies work in different ways. One way is to block the estrogen and progesterone that the cancer relies on to grow and survive. Another way is to decrease the amount of estrogen produced in the body. These treatments disrupt the growth signals sent by the hormone receptors to cancer cells.

Depending on the type, hormonal therapy works by:

When used as recommended, it can:

Learn more about Types of hormonal therapy.