How Long Will I Be Given Goserelin For
If you have primary breast cancer, goserelin is usually given for up to five years or sometimes longer.
If you have secondary breast cancer, you will be given goserelin for as long as it keeps the cancer under control.
If youre having goserelin to try to preserve fertility, an injection of goserelin is usually given before chemotherapy starts, then every four weeks during chemotherapy, and a last dose after the final chemotherapy treatment.
Less Common Side Effects
Less common side effects include headaches and tingling in fingers and toes. Some women have also reported weight gain, tiredness and nausea .
Low mood and depression
Some people experience low mood or depression. Talk to your GP or treatment team about how to manage a change in mood. Counselling, mindfulness and regular exercise can be helpful. Your GP or specialist can refer you for counselling or may suggest you take an antidepressant drug. Your breast care nurse may also be able to help or tell you about support services in your local area.
Weve put together a mental health toolkit that may help you cope with the emotional side effects of breast cancer treatment.
Vaginal bleeding
During the first month of treatment you may have some vaginal bleeding caused by the withdrawal of the hormone oestrogen.
Joint pain and stiffness
When first starting goserelin treatment, some people notice joint pain and stiffness. This is due to the reduced oestrogen levels and usually improves over time. If it doesnt, talk to your specialist or breast care nurse. It can usually be relieved with mild pain relief like paracetamol or an anti-inflammatory drug such as ibuprofen. Before using anti-inflammatory pain relief, ask your treatment team about the correct dose, how long you should use it for and any possible side effects, especially if you have a stomach ulcer or asthma.
Hair and skin changes
Blood pressure changes
Osteoporosis
Tumour flare
High levels of calcium in the body
How Metastatic Breast Cancer Is Treated
In cancer care, different types of doctors often work together to create a patients overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Breast cancer multidisciplinary care teams typically include medical oncologists, surgical oncologists, radiation oncologists, radiologists, and pathologists. In addition, cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, genetic counselors, social workers, pharmacists, counselors, dietitians, financial advisors, and other supportive care members. Ask the doctor in charge of your treatment which health care professionals will be part of your treatment team and what they do. This can change over time as your health care needs change.
A treatment plan is a summary of your cancer and the planned cancer treatment. It is meant to give basic information about your medical history to any doctors who will care for you during your lifetime. Before treatment begins, ask your doctor for a copy of your treatment plan. The treatment plan can be updated over time as your treatments change.
The main goals of metastatic breast cancer treatment are to make sure that you have the:
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Longest survival possible with the disease
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Fewest possible side effects from the cancer and its treatment
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Best and longest quality of life possible
Treatment options for metastatic breast cancer vary based on:
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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:
Fulvestrant With Other Anti
Fulvestrant may be given with another drug called a targeted therapy, such as abemaciclib, palbociclib or ribociclib.
You may be offered this if:
- You have had hormone therapy for locally advanced or secondary breast cancer
- Your breast cancer has not responded to treatment, or has come back, while taking hormone therapy for primary breast cancer
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Hormone Therapies For Prostate Cancer Treatment
Male hormones cause prostate cancer cells to grow. Androgens support a healthy prostate gland however, they can also promote the growth of cancerous prostate cells.
When using hormone therapy for prostate cancer, the treatment can block the production or use of androgens in one of the following ways:
Hormonal Therapies For Breast Cancer
Hormonal therapy is used to treat breast cancers that are hormone receptor positive. These cancers have receptors for the hormones oestrogen and/or progesterone they are called ER and/or PR positive cancer. Around 70% of breast cancers are ER positive.
Hormonal therapy may be recommended after other treatments for breast cancer like surgery, chemotherapy or radiotherapy. Sometimes it is used to shrink breast cancer before other treatment is given. The aim of hormonal therapy is to starve breast cancer cells of the hormone that makes them grow. This lowers the risk of breast cancer coming back or a new breast cancer developing in the treated breast or in the other breast.
There are several different types of hormonal therapies. Some are taken as tablets and others may involve surgery, injections or radiotherapy to turn off ovaries in premenopausal women.
This brochure explains the following types of hormonal therapies to turn off ovaries in premenopausal women:
- turning off or removing the ovaries
Hormonal therapies can also be used to treat ductal carcinoma in situ and to reduce the risk of breast cancer in women with a strong family history or other risk factors for breast cancer.
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How Does Hormone Therapy For Breast Cancer Work
Hormones control nearly all of our bodily functions, from growth and development to emotions, sexual function and even sleep. But hormones, which occur naturally in our bodies, can also fuel the growth of certain breast cancers. We talked with breast medical oncologist Rachel Layman, M.D., to learn about hormone therapy for breast cancer, which can stop or slow the cancer-fueling action of hormones.
What is hormone therapy for breast cancer?
Hormone therapy is a form of treatment that deprives breast cancer of estrogen and progesterone, the two main female hormones that it needs to survive and grow.
Estrogen and progesterone are carried along in the bloodstream. When they encounter a breast cancer cell, they stick to proteins called hormone receptors on the cells surface. This connection acts as an on switch and triggers the cancer cell to grow. The goal of hormone therapy is to prevent hormones from attaching to cancer cells, which deprives the cancer cells of the fuel they need to grow.
Are all breast cancers fueled by hormones?
No, but most are. About 70% of all breast cancers depend on estrogen or progesterone for growth.
How do hormone therapies for breast cancer work?
Hormone therapies reduce or eliminate contact between hormones and breast cancer cells in several different ways:
How and when are hormone therapy medications delivered?
Most hormone therapy drugs are taken as a daily oral pill, though a few are given as injections in the clinic.
Who Should Use Tamoxifen
Tamoxifen can help women and men with hormone receptor-positive breast cancer. The drug can lower the risk of breast cancer in:
- Women who are high-risk of breast cancer due to a family history of disease or mutated breast cancer genes.
- Women and men who have already been diagnosed with breast cancer to prevent recurrence of cancer, including:
- Development of breast cancer in the opposite, untreated breast.
- American Cancer Society. Breast Cancer Hormone Receptor Status. Accessed 11/18/2021.
- American Cancer Society. Hormone Therapy for Breast Cancer. Accessed 11/18/2021.
- American Cancer Society. Tamoxifen and Raloxifene for Lowering Breast Cancer Risk. Accessed 11/18/2021.
- BreastCancer.org. Low-Dose Tamoxifen May Be an Option to Reduce Risk of Recurrence, Invasive Disease After Non-Invasive Breast Cancer. Accessed 11/18/2021.
- BreastCancer.org. Tamoxifen . Accessed 11/18/2021.
- National Breast Cancer Foundation. Hormone Therapy. Accessed 11/18/2021.
- National Cancer Institute. Hormonal Therapy. Accessed 11/18/2021.
- Susan G. Komen. Side Effects of Tamoxifen. Accessed 11/18/2021.
- Susan G. Komen. Tamoxifen. Accessed 11/18/2021.
- Susan G. Komen. Tamoxifen and Raloxifene to Reduce Breast Cancer Risk. Accessed 11/18/2021.
- Susan G. Komen. Tumor Characteristics: Hormone Receptor Status. Accessed 11/18/2021.
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Managing The Side Effects Of Hormone Therapy
Before hormone therapy begins, talk with your doctor about what side effects could happen and how they can be managed. Ask questions about anything that is unclear to you. This will help you feel more prepared if you start experiencing those side effects. Let your health care team know about any new or worsening medical problems you have as soon as possible. This is important to do even if you do not think your symptoms are serious or related to your hormone therapy. Tracking your side effects can make getting the relief you need easier. One way to track side effects is using the free Cancer.Net Mobile app. You can securely record when side effects occur and their severity, and you can easily share these details with your health care team to describe your experience.
Some people may need to take hormone therapy for a long time. Working with your health care team to manage side effects can help maintain quality of life while on this kind of extended cancer treatment.
Do I Need To Use Contraception While Taking Goserelin
Youre advised not to become pregnant while youre having goserelin because the drug could harm a developing baby. Its possible to become pregnant while having goserelin, even if your periods have stopped or become irregular.
Use a non-hormonal method of contraception to avoid getting pregnant, such as condoms, Femidoms or a diaphragm. It may also be possible to use a coil . However, you would need to discuss this with your specialist as not all types are suitable for women with breast cancer.
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How Does Fulvestrant Work
Some breast cancers use oestrogen in the body to help them to grow. These are known as oestrogen receptor positive or ER+ breast cancers.
Hormone therapies block or stop the effect of oestrogen on breast cancer cells. Different hormone therapy drugs do this in different ways.
Oestrogen receptors are usually tested on primary breast cancers using tissue from a biopsy or after surgery. If you have secondary breast cancer your treatment team may discuss taking a sample of tissue from the site of the secondary breast cancer to retest the hormone receptors. This will depend on your individual situation.
Side Effects Are Different For Everyone
Side effects can vary, depending on which specific drug is prescribed. Not everyone will react the same way to a drug or have the same side effects.
Talk with your healthcare provider about whether these drugs are right for you. They can discuss the potential risks along with the benefits, given your medical situation.
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Drugs That Stop Androgens From Working
Anti-androgens
For most prostate cancer cells to grow, androgens have to attach to a protein in the prostate cancer cell called an androgen receptor. Anti-androgens are drugs that also connect to these receptors, keeping the androgens from causing tumor growth. Anti-androgens are also sometimes called androgen receptor antagonists.
Drugs of this type include:
They are taken daily as pills.
In the United States, anti-androgens are not often used by themselves:
- An anti-androgen may be added to treatment if orchiectomy or an LHRH agonist or antagonist is no longer working by itself.
- An anti-androgen is also sometimes given for a few weeks when an LHRH agonist is first started. This can help prevent a tumor flare.
- An anti-androgen can also be combined with orchiectomy or an LHRH agonist as first-line hormone therapy. This is called combined androgen blockade . There is still some debate as to whether CAB is more effective in this setting than using orchiectomy or an LHRH agonist alone. If there is a benefit, it appears to be small.
- In some men, if an anti-androgen is no longer working, simply stopping the anti-androgen can cause the cancer to stop growing for a short time. This is called the anti-androgen withdrawal effect, although it is not clear why it happens.
Newer anti-androgens
Enzalutamide , apalutamide and darolutamide are newer types of anti-androgens. They can sometimes be helpful even when older anti-androgens are not.
These drugs are taken as pills each day.
Hormones And Breast Cancer
The hormones estrogen and progesterone make some breast cancers grow. They are called hormone-sensitive breast cancers. Most breast cancers are sensitive to hormones.
Estrogen and progesterone are produced in the ovaries and other tissues such as fat and skin. After menopause, the ovaries stop producing these hormones. But the body continues to make a small amount.
Hormone therapy only works on hormone-sensitive cancers. To see if hormone therapy may work, doctors test a sample of the tumor that has been removed during surgery to see if the cancer might be sensitive to hormones.
Hormone therapy can work in two ways:
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Less Common Types Of Hormone Therapy
Some other types of hormone therapy that were used more often in the past, but are rarely given now include:
- Megestrol acetate , a progesterone-like drug
- Androgens , like testosterone
These might be options if other forms of hormone therapy are no longer working, but they can often cause side effects.
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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Hormone Therapies For Breast Cancer Treatment
Several treatment options are available for treating hormone-sensitive breast cancers. Some drugs block the effects of estrogen on the cancer cells in the breast, while others prevent estrogen production altogether.
Common hormone therapy drugs include Tamoxifen , Arimidex® , and Femara® , along with Faslodex® for recurrent breast cancer.
Breast cancer in males may also be treated with tamoxifen. Tamoxifen is currently being studied as hormone therapy for the treatment of other types of cancer.
What Are Different Types Of Hormone Therapy
Of the five types of hormone therapy, the two most common are:
- Drugs that block estrogen receptors
- Treatments that lower estrogen levels
Three other types of hormone treatments that are rarely used now include:
- Increased risk of fracture
If you have been put on AI, your bone density may be tested. Your doctor may prescribe drugs such as zoledronic acid or denosumab to strengthen and improve bone density.
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Lowering Estrogen Levels From The Ovaries
This type of treatment only works in premenopausal women who have functioning ovaries. It can help some types of hormone therapy work better. It is also used to treat cancer that has spread.
There are three ways to lower estrogen levels from the ovaries:
- Surgery to remove the ovaries
- Radiation to damage the ovaries so they no longer function, which is permanent
- Drugs such as goserelin and leuprolide that temporarily stop the ovaries from making estrogen
Any of these methods will put a woman into menopause. This causes symptoms of menopause:
Stopping The Ovaries Working
In pre menopausal women, doctors might use a type of hormone treatment to stop the ovaries from producing oestrogen. This type of drug is called a luteinising hormone releasing hormone . For example, goserelin and leuprorelin . You might have this on its own or with other hormone therapy drugs.
LHRH drugs work by blocking a hormone made in the pituitary gland that stimulates your ovaries to make and release oestrogen. This stops your ovaries from working. So you won’t have periods or release eggs while you are having the injections.
When you stop taking the drug, your ovaries should start working again. But, if you’re close to the age at which your menopause would naturally start, your periods might not start again.
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What Is Hormonal Therapy
Hormones help control how cells grow and what they do in the body. The hormones oestrogen and progesterone, particularly oestrogen, can encourage some breast cancers to grow.
Hormonal therapies reduce the amount of oestrogen in the body or stop it attaching to the cancer cells. They only work for women with oestrogen-receptor positive cancers.
Your cancer doctor will advise you to take hormonal therapy to reduce the risk of the breast cancer coming back. It also helps reduce the risk of getting a new breast cancer in your other breast. Sometimes hormonal therapy drugs are given before surgery to shrink a cancer and avoid a mastectomy.
You usually take hormonal therapy drugs for a number of years. For some women, this could be up to 10 years. You usually start taking them after surgery or chemotherapy.
The type of hormonal therapy you have depends on:
- whether you have been through the menopause or not
- the risk of the cancer coming back
- how the side effects are likely to affect you.