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.
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Blocking The Effects Of Estrogen
Different kinds of drugs are used to block the effects of estrogen.
Selective estrogen receptor modulators block the effects of estrogen in breast tissue. SERMs mimic estrogen and attach to the estrogen receptors, preventing estrogen from binding to receptors.
Examples of SERMs include:
Another drug that blocks the effects of estrogen is Faslodex . The difference is that, unlike SERMs, Faslodex doesnt mimic estrogen.
Benefits Of Hormone Therapies In Early And Locally Advanced Breast Cancer Treatment
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.
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Breast Cancer And Tamoxifen
Tamoxifen is a pill that doctors have prescribed for more than 30 years to treat breast cancer. It works by keeping estrogen from attaching to the cancer cells.
Doctors first used tamoxifen to treat women whose breast cancer had spread in their bodies because it slowed or stopped the growth of the disease. The drug also lowers the chance that some early stage breast cancers will come back. And it can lower the risk that a woman will get cancer in the other breast later on.
Women who are at high risk for breast cancer can take tamoxifen to try to lower their chances of getting the disease. Itâs an alternative to watchful waiting or having surgery to remove a breast, called a mastectomy, before they get the disease.
Tamoxifen is an option for:
- Treatment of the earliest form of breast cancer, ductal carcinoma in situ , along with surgery
- Treatment of abnormal cells in the glands that make milk, called lobular carcinoma in situ , to lessen the chance that theyâll become more advanced breast cancer
- Treatment of breast cancer in men and women whose cancers use estrogen
- Treatment of breast cancer that has spread to other parts of the body or that comes back after treatment
- To prevent breast cancer in women at high risk for the disease
Some people should not use tamoxifen:
- Women planning to get pregnant
- Men or women whoâve had blood clots or a stroke
Talk to your doctor to see if tamoxifen is right for you.
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What Are The Side Effects Of Hormone Therapy
The side effects of hormone therapy depend largely on the specific drug or the type of treatment . The benefits and harms of taking hormone therapy should be carefully weighed for each person. A common switching strategy used for adjuvant therapy, in which patients take tamoxifen for 2 or 3 years, followed by an aromatase inhibitor for 2 or 3 years, may yield the best balance of benefits and harms of these two types of hormone therapy .
Hot flashes, night sweats, and vaginal dryness are common side effects of all hormone therapies. Hormone therapy also may disrupt the menstrual cycle in premenopausal women.
Less common but serious side effects of hormone therapy drugs are listed below.
Tamoxifen
- breathing problems, including painful breathing, shortness of breath, and cough
- loss of appetite
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Stroke And Heart Attacks
The latest analysis from Womenâs Health Concern regarding the risk of heart disease and stroke for women taking HRT states that:
- the risk of stroke is increased in women who smoke and are overweight
- women starting HRT and aged below 60 are not at an increased risk of stroke
- HRT is not recommended for women with a history of stroke or deep vein thrombosis
Speak to your GP if you are taking HRT and are worried about the risk of stroke or heart disease.
Treating And Managing Symptoms Related To Midlife Hormone Flux: What To Know
Mood swings, hot flashes, and many of the symptoms of perimenopause and menopause are treatable. When you consult with a physician, bring a list of your experiences so far, and what you have done to cope. Also, check with your doctor before taking herbs and supplements, because some can interfere with your current medications, or are not recommended for women who have had breast cancer.
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Looking After Your Bones While Taking An Aromatase Inhibitor
Aromatase inhibitors can reduce bone density. This may increase the risk of breaks in the bones. To keep your bones healthy while you are taking this medication, your doctor may recommend that you:
- have a bone density test before and during treatment
- do regular weight-bearing exercise
- maintain a healthy intake of calcium
- ensure a healthy intake of vitamin D
- take other prescription medications to build up your bones if your bone density is already low
If you do show signs of bone thinning or weakening you may need to see your GP or specialist for special treatment for your bones.
What Happens When Hormone Therapy Stops Working
After some months or years the hormone treatment usually stops working and the cancer starts to grow again. Your doctor might recommend stopping or changing hormone treatment at this stage. If youre having anti androgens and your PSA level has started to rise again your doctor might get you to stop taking them.
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Hormone Replacement Therapy : Is It Right For You
Hormone replacement therapy is a treatment in which hormones are prescribed to treat certain medical conditions. It is most commonly used to treat symptoms of menopause. The hormones used in HRT are synthetic , but they function like natural hormones.
Hormone TherapyPostmenopausal hormone therapyoften referred to as hormone therapyis a broad term that describes the use of estrogen, or estrogen-progestin in combination, to replace the hormones no longer produced by the body after menopause. The goal of hormone therapy is to relieve menopausal symptoms. It can also help prevent bone loss.
Common symptoms that tend to occur during menopause and have been shown to respond to hormone therapy include:
- Vaginal dryness and atrophy
At one time, hormone therapy was also used for prevention of coronary heart disease and osteoporosis however, results from large-scale randomized trials by the Womens Health Initiative in 2002 showed that HRT raised the risk of breast cancer, heart attack, blood clots and stroke. The clinical trials were stopped, and women tossed away their hormones.
If youre starting to feel confused, youre not alone. Even researchers sometimes struggle with sorting out the seemingly conflicting reports to find answers. What is the best age for women to start HRT? How long should treatment last? Is a combination HRT always better than estrogen alone?
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Hormone Therapy Vs Targeted Therapy For Breast Cancer Treatment
5 min read
The landscape of breast cancer treatment has been rapidly changing. Advances in diagnosis and treatment provide very effective options for breast cancer and dramatically improve survival rates when breast cancer is diagnosed and treated early. One of the biggest changes are treatments that can target specific receptors or proteins on breast cancer cells to further help patients in their fight against breast cancer.
Breast cancer tumors are tested for molecular and genetic changes as well as the presence of hormone receptors and HER2 receptors. The findings of a breast biopsy reveal if specific receptors are present in the cancer cells. There can be receptors present for:
Identifying which receptors are present makes it possible for the oncologist to develop the best treatment plan available today to destroy the cancer cells while protecting your healthy cells from as much damage as possible.
Some of these treatments are in a category called hormone therapy, while other drugs are considered targeted therapies. Not every type of breast cancer can be treated with hormone therapy and/or targeted therapy, depending on the molecular findings. Lets take a look at what hormone and targeted therapies do, who can use them, and the types of side effects breast cancer patients might expect from each type of treatment.
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How Hormone Therapy Is Used Against Cancer
Hormone therapy is used for two main reasons.
- Treat cancer. Hormone therapy can stop or slow cancer’s growth and reduce the chance it will return.
- Ease cancer symptoms. Hormone therapy may be used to reduce or prevent symptoms in men with prostate cancer who are not able to have surgery or radiation therapy.
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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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.
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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.
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If Cancer Comes Back Or Has Spread
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.
Treatments To Stop Ovarian Function In Premenopausal Women
Women who haven’t undergone menopause â either naturally or as a result of cancer treatment â may opt to undergo treatment to stop their ovaries from producing hormones.
Options may include:
- Surgery to remove the ovaries
- Radiation therapy aimed at the ovaries
- Medications, such as goserelin
Treatments to stop ovarian function may allow premenopausal women to take medications only available to postmenopausal women.
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Hormone Therapy For Reducing The Risk Of Breast Cancer
Women at moderate or high risk of breast cancer because of their family history may be offered hormone therapy to reduce their risk of developing breast cancer.
Drugs used to reduce the risk of breast cancer in women who have not had breast cancer include:
These drugs are usually taken for five years.
What Is Hormone Replacement Therapy
HRT medicines usually contain the hormones estrogen, progesterone, or both, to replace the hormones a womans body stops making after menopause.
HRT is different than hormonal therapy medicines that block estrogen to treat hormone receptor-positive breast cancer.
There are two main types of HRT:
-
combination HRT, which contains both estrogenand progesterone
Estrogen-only HRT usually is taken only by women who have had a hysterectomy .
Combination HRT usually is taken by women who still have their uterus. Estrogen-only HRT can cause the lining of the uterus to become too thick a condition called estrogen-associated endometrial hyperplasia. This can increase the risk of cancer of the uterus, called endometrial or uterine cancer. The progesterone in combination HRT helps to prevent thiscondition.
In combination HRT, both hormones can either be combined into one medicine or given as separate medicines. The same dose of estrogen and progesterone can be taken daily , or in different amounts on different schedules .
There are several ways to take or use HRT:
Systemic HRT effectively treats many symptoms of menopause, including hot flashes and night sweats. Topical HRT only works on vaginal symptoms, such as dryness and discomfort during sex.
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Use Caution With Soy And Other Phytoestrogens
Theres a tentative link between menopause symptoms and a high consumption of soy and other plant estrogens. But the research on this
Exercise can stabilize your blood sugar levels, give you more energy, and boost your mood.
And if you exercise regularly, the benefits increase.
For example, regular exercise can help reduce your risk of osteoporosis and improve your sleep quality in the long term. It aid in weight management. That may reduce hot flashes.
For maximum benefit, your exercise routine should include each of these four types of exercise:
Hormone Therapy For Breast Cancer Treatment
Most cases of breast cancer are fueled by the hormones estrogen and progesterone. Hormone therapy, also called endocrine therapy, is used to remove or block hormones and stop or slow down the growth of cancer cells. If your cancer is hormone-sensitive, then hormone therapy may be part of your treatment plan.
If your healthcare professional prescribes this for your early-stage breast cancer, plan on taking hormonal therapy for five years after completing your primary treatments. The main benefit of this type of therapy is to prevent estrogen from fueling estrogen-responsive positive cancer cells, thus reducing your risk of recurrence. For breast cancer that is estrogen receptor-negative, hormonal therapy is not effective.
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Results Of Direct Comparisons
The nine studies comprised 2133 patients. The duration of treatment was from 12 to 24 weeks. An investigation into the optimal duration of exemestane was reported in one study. To make a distinction, we defined exemestane if the duration of exemestane was less than 20 weeks, and exemestane if the treatment duration was than 20 weeks. There were three arms in two studies, respectively. One study was about anastrozole plus different treatment protocols of gefitinib compared with anastrozole, and we considered anastrozole versus anatrozole plus gifitinib. As a result, ten arms were assessed including, chemotherapy, tamoxifen, letrozole, anastrozole, exemestane , exemestane , anastrozole plus tamxifen, letrozole plus everomilus, anatrozole plus gefitinib, and exemestane plus celecoxib. All patients were postmenopausal women diagnosed with non-metastatic breast cancer. All patients except for four were HR-positive. Four studies reported the levels of HER2,,,. Characteristics of the eligible studies are listed in .