What Are The Side Effects Of Hormone Therapy For Prostate Cancer
Because androgens affect many other organs besides the prostate, ADT can have a wide range of side effects , including:
- loss of interest in sex
Studer UE, Whelan P, Albrecht W, et al. Immediate or deferred androgen deprivation for patients with prostate cancer not suitable for local treatment with curative intent: European Organisation for Research and Treatment of Cancer Trial 30891. Journal of Clinical Oncology 2006 24:18681876.
Zelefsky MJ, Eastham JA, Sartor AO. Castration-Resistant Prostate Cancer. In: Vincent T. DeVita J, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology, 9e. Philadelphia, PA: Lippincott Williams & Wilkins 2011.
Smith MR, Saad F, Chowdhury S, et al. Apalutamide and overall survival in prostate cancer. European Urology 2021 79:150158.
Intermittent Versus Continuous Hormone Therapy
Most prostate cancers treated with hormone therapy become resistant to this treatment over a period of months or years. Some doctors believe that constant androgen suppression might not be needed, so they advise intermittent treatment. The hope is that giving men a break from androgen suppression will also give them a break from side effects like decreased energy, sexual problems, and hot flashes.
In one form of intermittent hormone therapy, treatment is stopped once the PSA drops to a very low level. If the PSA level begins to rise, the drugs are started again. Another form of intermittent therapy uses hormone therapy for fixed periods of time for example, 6 months on followed by 6 months off.
At this time, it isnt clear how this approach compares to continuous hormone therapy. Some studies have found that continuous therapy might help men live longer, but other studies have not found such a difference.
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:
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.
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.
Hormone Replacement Therapy For Breast Cancer
Determining the type of treatment for breast cancer depends on what caused the cancerous cells to grow. Normally, cancerous cells develop in the lining of milk ducts within the breast or in the lobules where milk is usually produced . These cells can accumulate over time, forming an obvious lump or mass which is a common symptom of breast cancer.
There are also cancer cells which are highly responsive to the hormones that are circulating in the body. These cells have receptors that can receive signals from estrogen and progesterone to promote their abnormal growth and spread in the body. Among the types of hormone-receptor cancers are:
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Surgical Removal Of The Ovaries
The operation to remove the ovaries is called oophorectomy. Surgical removal of the ovaries is a permanent way to reduce the levels of oestrogen.
It is a very effective treatment to stop early breast cancer returning or to slow the progress of metastatic cancer. This can also reduce the risk of developing ovarian cancer.
Surgery to remove the ovaries can be done with keyhole surgery or with an open operation .
Your surgeon will discuss with you the pros and cons of these different techniques. Oophorectomy is done under a general anaesthetic .
Usually the fallopian tubes are also removed but the uterus is left intact. After oophorectomy, the symptoms of menopause may come on suddenly. This is different to turning off the ovaries with medication which brings menopausal symptoms on gradually
Thingsthat Stop The Body From Making Essentials Hormones
Whiletalking about hormone therapy for breast cancer your doctor may suggest aromatizingmedicines that can reduce the amount of estrogen in your body. Thesemedications are useful according to medical experts as it is also mentioned on mayo clinic websites you can read there.
Thesemedications are useful for those who undergo menopause symptoms or surgery to prevent estrogen that helping cancer cells to grow.
Youshould know all about hormone therapy before using them for breast cancertreatment. Holistic approaches are most useful for treating them without anysurgery or hormone pills. This system is scientific and tested for breastcancer to uterine cancer treatment without any surgery.
Ovary removal is another condition when your doctor will suggest you use aromatizeinhibitors to use but you should use power hormone for them because they helpyou surgery-free treatment for those types of women health-related issues.
Rationale For Neoadjuvant Therapy As A Standard Of Care For Patients With Triple
Notably, two randomized neoadjuvant trials of PD-L1 antibodies, NeoTRIPaPDL1 which tested atezolizumab and chemotherapy and GeparNuevo which tested durvalumab and chemotherapy in TNBC, did not show increase in pCR with addition of this PD-L1 antibody compared to placebo. The GeparNuevo trial did show a significant increase in pCR in a subset of patients who received a window of 2 weeks of durvalumab before beginning chemotherapy .
A further rationale for NAC for TNBC is that subsequent adjuvant therapy can be implemented with the goal of improving outcomes for patients who lack a pCR result. The CREATE-X and GEICAM trials tested these approaches .
How Is Hormone Therapy Used To Treat Hormone
Hormone therapy may be used in several ways to treat hormone-sensitive prostate cancer, including:
Early-stage prostate cancer with an intermediate or high risk of recurrence. Men with early-stage prostate cancer that has an intermediate or high risk of recurrence often receive hormone therapy before, during, and/or after radiation therapy, or after prostatectomy . Factors that are used to determine the risk of prostate cancer recurrence include the grade of the tumor , the extent to which the tumor has spread into surrounding tissue, and whether tumor cells are found in nearby lymph nodes during surgery.
The use of hormone therapy before prostatectomy has not been shown to be of benefit and is not a standard treatment. More intensive androgen blockade prior to prostatectomy is being studied in clinical trials.
Relapsed/recurrent prostate cancer. Hormone therapy used alone is the standard treatment for men who have a prostate cancer recurrence as documented by CT, MRI, or bone scan after treatment with radiation therapy or prostatectomy.
Hormone therapy is sometimes recommended for men who have a “biochemical” recurrencea rise in prostate-specific antigen level following primary local treatment with surgery or radiationespecially if the PSA level doubles in fewer than 3 months.
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:
- Hot flashes
Stopping The Ovaries Working
In premenopausal 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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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. Accessed 10/10/2020.Breast Cancer Hormone Receptor Status.
- American Cancer Society. Accessed 10/10/2020.Hormone Therapy for Breast Cancer.
- American Cancer Society. Accessed 10/10/2020.Tamoxifen and Raloxifene for Lowering Breast Cancer Risk.
- BreastCancer.org. Accessed 10/10/2020.Low-Dose Tamoxifen May Be an Option to Reduce Risk of Recurrence, Invasive Disease After Non-Invasive Breast Cancer.
- BreastCancer.org. . Accessed 10/10/2020.Tamoxifen
- National Breast Cancer Foundation. Accessed 10/10/2020.Hormone Therapy.
- National Cancer Institute. Accessed 10/10/2020.Hormonal Therapy.
- Susan G. Komen. . Accessed 10/10/2020Side Effects of Tamoxifen
- Susan G. Komen. . Accessed 10/10/2020.Tamoxifen
- Susan G. Komen. Accessed 10/10/2020.Tamoxifen and Raloxifene to Reduce Breast Cancer Risk.
- Susan G. Komen. Accessed 10/10/2020.Tumor Characteristics: Hormone Receptor Status.
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Prognosis Following The Use Of Complementary And Alternative Medicine In Women Diagnosed With Breast Cancer
This analysis, by Saquib et al, was a secondary analysis of the Womens Healthy Eating and Living study. It looked at 2562 breast cancer survivors and surveyed for rejection of systemic treatment and use of CAM following surgical resection. All women had to be aged 18-70 and had operable Stage I-IIIa breast cancer. In this group, 177 women were identified who declined systemic treatment. 80% of this group used CAM. Compared to women that took chemotherapy, women that declined systemic treatment had a 90% greater risk of an additional breast cancer event, and the risk of death increased by 70%. CAM use had no effect on this finding. In addition, the lack of effect was consistent between high supplement users and low supplement users. The authors concluded that women that decline systemic treatment are at greater risk for subsequent recurrence and death due to breast cancer. The use of CAM had no measurable effect on the recurrence of breast cancer or on the risk of subsequent death.
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Not Taking Hormonal Therapy As Prescribed Leads To More Recurrence
After surgery, women diagnosed with hormone-receptor-positive breast cancer usually take hormonal therapy medicine to reduce the risk of the cancer coming back . Hormonal therapy medicines work in two ways:
There are several types of hormonal therapy medicines. Tamoxifen, a selective estrogen receptor modulator , is one of the most well-known. Tamoxifen can be used to treat both premenopausal and postmenopausal women. In the early 2000s, the aromatase inhibitors:
were shown to be more effective at reducing recurrence risk in postmenopausal women and are now used more often than tamoxifen to treat women whove gone through menopause. Aromatase inhibitors arent commonly used to reduce recurrence risk in premenopausal women.
Most women take hormonal therapy for 5 to 10 years after breast cancer surgery.
Both tamoxifen and aromatase inhibitors can cause side effects. Tamoxifen may cause hot flashes and increase the risk of blood clots and stroke. Aromatase inhibitors may cause muscle and joint aches and pains. Less common but more severe side effects of aromatase inhibitors are heart problems, osteoporosis, and broken bones. Research has shown that about 25% of women who are prescribed hormonal therapy to reduce the risk of recurrence after surgery either dont start taking the medicine or stop taking it early, in many cases because of side effects.
for postmenopausal women diagnosed with hormone-receptor-positive disease.
How Does Hormone Therapy Work
About 2 out of 3 breast cancers are hormone receptor-positive. Their cells have receptors for the hormones estrogen and/or progesterone which help the cancer cells grow and spread.
There are several types of hormone therapy for breast cancer. Most types of hormone therapy either lower estrogen levels or stop estrogen from acting on breast cancer cells.
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It Will Also Be Important In The Future To Differentiate Prior To Treatment Patients Who Are At High Risk Of Relapse From Those At Lower Risk In Order To Tailor Hormone Treatment This May Be Done To Avoid Escalation Of Anti
The CANTO cohort comprises 12,000 women with breast cancer treated in 26 French centres. It is sponsored by Unicancer and directed by Professor Fabrice André, specialist breast cancer oncologist at Gustave Roussy, Inserm research director and responsible of the lab Predictive Biomarkers and Novel Therapeutic Strategies in Oncology . Its objective is to describe adverse effects associated with treatment, to identify the populations at risk of developing them and to adjust therapy accordingly, so as to afford a better quality of life following cancer.
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J Clin Oncol. 2019 Feb 10 37:423-438 : https://doi.org/10.1200/JCO.18.01160
TO CITE THIS POST :
1INSERM Unit 981, Gustave Roussy, Cancer Campus, Villejuif, France
2Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
3Medical Oncology, Gustave Roussy, Cancer Campus, Villejuif
4Department of Supportive Care, Gustave Roussy, Cancer Campus, Villejuif
5Medical Oncology, Centre François Baclesse Caen, Caen
6Unicancer, Paris, France
7Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova
8Department of Internal Medicine and Medical Specialties , School of Medicine, University of Genova, Genova, Italy
9Surgical Oncology, Centre Georges-François Leclerc, Dijon
10Medical Oncology, Institut Curie, Paris
14Surgical Oncology, C.R.L.C Val dAurelle, Montpellier
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 high risk.
Other drugs that work in a similar way are used to treat advanced cancer that has spread:
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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
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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