Tag Archives: Endocrine therapy

Endocrine Therapy for Postmenopausal Women

April 21, 2015

Endocrine Therapy for Postmenopausal Women: Positive Early Breast Cancer

Endocrine Therapy for Postmenopausal Women

Endocrine Therapy for Postmenopausal Women

Endocrine therapy is an important systemic treatment for all stages of hormone receptor-positive breast cancer and has seen significant advances since Beatson first made the link between the endocrine system and breast cancer more than 100 years ago. In the past few decades, modern endocrine therapies, such as the orally administered selective estrogen receptor modulator (SERM) tamoxifen, have revolutionized early breast cancer therapy, offering a real improvement in terms of both disease-free (DFS) and overall survival. Treatment guidelines now call for the determination of estrogen and progesterone receptor status in all primary breast tumors and endocrine therapy for postmenopausal women. Nonetheless it is important to note that these therapies are only recommended for women with known hormone receptor-positive disease.

Experts at AWAREmed Health and Wellness Resource Center under the able leadership of Doctor Akoury’s care are stating that unlike advanced disease, early detection of breast cancer is hypothetically curable. However treatment of early breast cancer may involve adjuvant therapy consisting of systemic endocrine therapy, chemotherapy or both. This can be done after initial surgery to remove the tumor to prevent or delay tumor recurrence. The ultimate goal of adjuvant endocrine therapy is to increase the chances of curing invasive early breast cancer, with as low a level of adverse side-effects as possible.

Historically, tamoxifen was the first successful hormonal treatment and became the ‘gold standard’ adjuvant endocrine therapy in postmenopausal women. It has been shown to be more effective than chemotherapy in women of over 50 years of age with hormone receptor-positive early breast cancer. These findings have prompted its investigation as a chemo-preventive agent in women at risk of breast cancer. Bearing in mind that this study had a short follow-up, tamoxifen was found to be associated with almost 50% reduction in new tumors compared with placebo. As a result, Nolvadex™ (tamoxifen citrate) was approved by the US Food and Drug Administration (FDA) for reducing the incidence of breast cancer in women at high risk of developing the disease. However, despite its proven effectiveness, tamoxifen therapy is still linked to a number of serious side-effects including an increased risk of endometrial cancer and sarcoma and thromboembolic disorders all of which are potentially life-threatening. This clearly limits its use both as adjuvant therapy (where it is usually recommended for up to 5 years) and in particular, as a preventative therapy. This shortcoming has prompted the search for, and development of, new agents with equal or improved efficacy and fewer side-effects.

Alternatively postmenopausal women with hormone receptor positive breast cancer may be offered adjuvant therapy with either tamoxifen or with an aromatase inhibitor. Aromatase inhibitors belong to a class of drugs that work by reducing the levels of estrogen in the body. Even if you have stopped menstruating, your body may still produce small amounts of estrogen in the adrenal glands, fat tissue and even breast tissue. These drugs for over two decades have been shown to reduce the risk of breast cancer recurrence in postmenopausal women with early stage breast cancer. Such drugs include anastrozole (Arimidex®), exemestane (Aromasin®) and letrozole (Femara®).

Postmenopausal women with hormone-positive tumors may do just as well or perhaps a bit better with an aromatase inhibitor when compared to tamoxifen. It is not recommended for these women to undergo ovarian suppression as adjuvant treatment since their ovaries are not producing estrogen. Oophorectomy would be considered in this case in women who are BRCA 1 or 2 mutation carriers or have a strong family history of ovarian cancer as a preventive measure. Experts recommend that patients who are diagnosed with early stage non-invasive breast cancer (DCIS) may be given tamoxifen to prevent breast cancer from occurring in the unaffected breast. But in all this, it is important to understand that the use of aromatase inhibitors in postmenopausal women with DCIS is under investigation.

Many women stop menstruating after receiving chemotherapy, often for several months or even a few years. This does not necessarily mean they are postmenopausal. It is possible that these women could still have functioning ovaries and premenopausal hormonal levels despite the absence of their menstrual periods. Also, ovarian function could still return unexpectedly. That said, women who are premenopausal, regardless of whether they experience temporary menopause because of treatments, should not be prescribed aromatase inhibitors (unless they are participating in specific clinical research studies). Aromatase inhibitors are typically reserved for postmenopausal women with breast cancer.

Endocrine Therapy for Postmenopausal Women: Side effects of aromatase inhibitors

Like in all other medications aromatase inhibitors are also having their side effects which are generally mild and well-tolerated. They may include the following:

  • High cholesterol – You may need routine screenings. If cholesterol becomes a problem, you may be asked to reduce your intake of fat from meats and other animal products.
  • Hair thinning
  • Hot flashes
  • Decreased interest in sexual activity
  • Mood swings
  • Joint stiffness and pain, including carpal tunnel symptoms – In a small number of patients, this can be quite severe. If you develop severe symptoms your doctor may recommend that you temporarily stop taking it and then try another kind of aromatase inhibitor or tamoxifen.

Endocrine Therapy for Postmenopausal Women: Complications

The use of aromatase inhibitors may trigger complications where the patient loses the bone density. It is therefore advisable that all women who are considering using aromatase inhibitors to consult with their doctors about having a bone density study (DEXA scan). Besides that such patients should also take at least the minimum recommended daily allowances dose of calcium and vitamin D. and for those patients with some evidence of bone loss, your doctor may recommend that you increase your exercise level or take a calcium supplement. However if you are still experiencing problems with bone loss, a prescription of bone building drugs like a class of medications called bisphosphonates may be recommended. The drug Evista® (raloxifene) is quite similar to tamoxifen and in general should be avoided by women who were previously diagnosed with breast cancer.

Endocrine Therapy for Postmenopausal Women: Positive Early Breast Cancer

 

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Endocrine Therapy for Premenopausal and Postmenopausal for Women

April 20, 2015

Endocrine Therapy for Premenopausal and Postmenopausal for Women: Breast Cancer

Endocrine Therapy for Premenopausal and Postmenopausal for Women

Endocrine Therapy for Premenopausal and Postmenopausal for Women are very essential in the cancer treatment for all women of all ages

At the mention of the disease cancer people frown and frustration follows almost immediately. Knowing how the kind of pain and suffering the cancer patients go through, a painless treatment solution would be highly recommended. Unfortunately as things stand now this is not the case further complicating the painful lives of cancer patients. Even though cancer does not discriminate on gender or otherwise, women are hard hit by this unhealthy condition. A lot of treatment procedures are being used including the endocrine therapy for premenopausal and postmenopausal for women. Speaking to doctor Dalal Akoury MD and founder of AWAREmed Health and Wellness Resource Center about this condition, she states that women who have been diagnosed with estrogen receptor-positive breast cancer will often most likely be prescribed for daily oral medication after all other treatment ends. However, it is important to note that for endocrine therapy prescription will be done differently for each patient depending on whether they are premenopausal or postmenopausal.

Endocrine Therapy for Premenopausal and Postmenopausal for Women: Endocrine Therapy for Premenopausal Women

Under normal circumstances premenopausal women with breast cancers that express the estrogen or progesterone receptor (ER or PR-positive) will in most cases advised to take tamoxifen for sometimes normally up to five years. This drug impacts the effects of estrogen in cancer cells and helps reduce the risk that the breast cancer will recur in women of any age by almost 50 percent.

Remember that this medication (Tamoxifen) can also be helpful in the reduction of the risk of developing a new breast cancer in the portions of the breast not affected yet. In some cases, women who are younger than 35-40 may also be considered for combined endocrine therapy with medications that temporarily stop ovarian function.

Doctor Akoury registers that in many cases majority of women stop menstruating after receiving chemotherapy, often for several months even though this may extend to a few years. It is also possible that these women despite this changes they are experiencing could still have functioning ovaries and premenopausal hormonal levels despite the absence of their menstrual periods. Besides, the ovarian function could still return unexpectedly. That said, women who are premenopausal, regardless of whether they experience temporary menopause because of treatments, should not be prescribed aromatase inhibitors (unless they are participating in specific clinical research studies). Aromatase inhibitors are typically reserved for postmenopausal women with breast cancer.

Endocrine Therapy for Premenopausal and Postmenopausal for Women: Side effects of tamoxifen

Like with all other drugs the side effects of tamoxifen are generally mild and decreases with time. They include:

  • Hot flashes
  • Decreased interest in sexual activity
  • Weight changes
  • Insomnia or trouble sleeping
  • Vaginal discharge
  • Fertility issues
  • Memory loss
  • Fatigue
  • Joint pain
  • Headaches
  • Hair loss
  • Skin changes
  • Menstrual irregularity
  • Increased sweating
  • Nausea
  • Mood swings

Note that some side these effects can be alleviated through symptom management and other positive lifestyle changes.

Endocrine Therapy for Premenopausal and Postmenopausal for Women: Risk Factors

Serious complications with tamoxifen are rare, especially in women below the age of 50. Some of the complications may include blood clots (deep venous thrombosis or pulmonary embolism) or uterine (endometrial) cancer.

Endocrine Therapy for Premenopausal and Postmenopausal for Women: Ovarian Suppression or Ablation

For premenopausal women with estrogen receptor-positive breast tumors, ovarian ablation or suppression (stopping ovary function) may be an option. Since a premenopausal woman’s ovaries are the main source of estrogen production, temporarily or permanently shutting off their function has been shown to be effective (when used alone) in reducing the chances of a breast cancer recurrence. Studies are now confirming their usefulness when given with tamoxifen instead of chemotherapy or after chemotherapy. This is called ovarian ablation or suppression and can be done through surgery (permanently) or monthly hormonal injections (temporarily). The injection of medication will prevent you from ovulating or menstruating and will put you in temporary menopause. Surgery will prevent you from having to undergo monthly injections, but will put you in irreversible menopause. You should speak to your doctor regarding any plans to conceive children so that together you can decide which option is best for you and your family.

Endocrine Therapy for Premenopausal and Postmenopausal for Women: Ovarian Ablation

A bilateral oophorectomy or ovarian ablation is the surgical removal of your ovaries. This procedure is sometimes recommended if you have been identified as carrying a BRCA1 or BRCA2 genetic mutation and have an increased risk of developing ovarian cancer.  The surgical removal of your ovaries will reduce circulating estrogens in your body down to postmenopausal levels. This surgery is permanent and cannot be undone. For premenopausal women, an oophorectomy will prevent you from conceiving children and will cause permanent menopause.

Endocrine Therapy for Premenopausal and Postmenopausal for Women: Ovarian Suppression

Ovary suppression can be achieved by hormonal drug injections known as gonadotropin-releasing hormone (LH-RH or GnRH) agonist. This works by temporarily suppressing ovulation and, as a result, limiting the amount of estrogen circulating in your body. Estrogen levels usually are reduced to postmenopausal levels within two weeks. Treatment is generally administered by monthly injections. Although you will be in a temporary menopause while taking this drug, it is important to note that this is generally reversible and menstruation often begins shortly after treatment stops. This is not a fail-proof birth control method so you should use a non-hormonal form of contraception too, like an IUD or barrier methods such as condoms or a diaphragm. Side effects are similar to menopausal symptoms and include decreased sex drive, hot flashes, weight gain and bone pain. And to maximize on its effectiveness, ovarian suppression drugs and tamoxifen can be prescribed alongside.

Endocrine Therapy for Premenopausal and Postmenopausal for Women: Drug interactions

Antidepressants – It is estimated that as many as 30 percent of all breast cancer patients in the United States are prescribed an antidepressant at some time during their treatment. However some of these antidepressants may interfere with how tamoxifen works and therefore should be avoided. The following are some of the antidepressants which are expected to interfere with tamoxifen:

Paxil® (paroxetine)
Prozac® (fluoxetine)
Wellbutrin® (bupropion)

In conclusion the endocrine therapy for premenopausal is conclusively addressed in this article and we are going to be concentrating on the postmenopausal in the next article. We want to request you to stay on the link for more health information. But in the meantime, if you have any concern you can about such treatments, you can schedule for an appointment with doctor Akoury for more professional clarification.

Endocrine Therapy for Premenopausal and Postmenopausal for Women: Breast Cancer

 

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Applying Endocrine Therapy for Breast Cancer Treatment

March 2, 2015

Applying Endocrine Therapy for Breast Cancer Treatment: Not everyone is Eligible for Endocrine Therapy

Applying Endocrine Therapy for Breast Cancer Treatment

Applying Endocrine Therapy for Breast Cancer Treatment is one of the best treatment methods available today.

The treatment of cancer is one that makes so many people to panic in fear. Owing to the dangers associated with this disease people are often very worried of the outcomes of the treatment even as they hope for the best. We enquired from the experts at AWAREmed Health and Wellness Resource Center and doctor Dalal Akoury shared with us very useful information about endocrine therapy as a treatment option. Doctor Akoury who is also the CEO of this facility says that in applying endocrine therapy for breast cancer treatment careful attention should be taken not to confuse the hormones. There are certain hormones that can attach to breast cancer cells and affect their ability to multiply. The purpose of endocrine therapy, formerly called hormone therapy, is to add, block, or remove hormones. Doctor Akoury continues that with breast cancer, the female hormones estrogen and progesterone can promote the growth of some breast cancer cells. Therefore in some patients, endocrine therapy is given to block the body’s naturally occurring estrogen to slow or stop the cancer’s growth. There are two types of hormone therapy for breast cancer.

  • Drugs that prevent estrogen and progesterone from promoting breast cancer cell growth.
  • Drugs or surgery to turn off the production of hormones from the ovaries.

Take note, not to be confused between the hormone therapies applicable in treating women with breast cancer to that hormone replacement therapy that is typically used by postmenopausal women.

  • Hormone therapy for cancer treatment also known as endocrine therapy stops hormones from getting to breast cancer cells.
  • Hormone therapy for postmenopausal women without cancer called which is known as hormone replacement therapy adds more hormones to your body to counter the effects of menopause.

Applying Endocrine Therapy for Breast Cancer Treatment: Who can Get Endocrine Therapy for Breast Cancer

As part of the diagnosis process, tests are done to determine if the breast cancer cells have estrogen or progesterone receptors. If so, that means that growth of the cancer can be stimulated with these hormones. If a cancer is found to have these receptors, endocrine therapy is recommended as part of the treatment plan.

Applying Endocrine Therapy for Breast Cancer Treatment: Hormone Therapy Drugs Used for Breast Cancer

We have several common hormone therapy drugs used for breast cancer and they may include the following:

  • Tamoxifen
  • Arimidex
  • Aromasin
  • Femara
  • Zoladex/Lupron
  • Megace

Applying Endocrine Therapy for Breast Cancer Treatment: Breast Cancer and Tamoxifen

This pill has been used for over three decades now in treating breast cancer. Originally it was first used in metastatic breast cancer (cancer that spread) because it decelerate the development of cancer cells in the body. Tamoxifen also decreases the chance that some early-stage breast cancers will recur in premenopausal or post-menopausal women and it can reduce the risk of cancer developing in the unaffected breast. Besides that, it may offer an alternative to watchful waiting or prophylactic (preventative) mastectomy for women at high risk for developing breast cancer.

Tamoxifen is a type of drug called a selective estrogen-receptor modulator (SERM). At the breast, it functions as an anti-estrogen. Estrogen promotes the growth of breast cancer cells. Tamoxifen blocks estrogen from attaching to estrogen receptors on these cells. By doing this, it is believed that the growth of the breast cancer cells will be halted. Tamoxifen can also be considered as an option for the following cases:

  • Treatment of ductal carcinoma in situ (DCIS) along with breast-sparing surgery or mastectomy.
  • Adjuvant treatment of lobular carcinoma in situ (LCIS) to reduce the risk of developing more advanced breast cancer.
  • Adjuvant treatment of breast cancer in men and women whose cancers are estrogen-receptor positive.
  • Treatment of recurrent and metastatic breast cancer.
  • To prevent breast cancer in women at high risk for developing the disease.

Even though Tamoxifen is useful in cancer treatment, it is not applicable to everyone. The following people should not use tamoxifen:

  • Pregnant women
  • Women planning to become pregnant
  • Men or women with a history of blood clots or stroke

If the three points describe you then before considering this treatment mode, you will need to talk to your doctor to see if tamoxifen is right for you. Nevertheless as for women, the side effects of tamoxifen are similar to some of the symptoms of menopause. Two of the most common side effects are hot flashes and vaginal discharge. Other tamoxifen side effects in women may include:

  • Vaginal dryness or itching
  • Irregular menstrual periods
  • Headache
  • Nausea or vomiting
  • Skin rash
  • Fatigue
  • Fluid retention or weight gain

While some of its side effects are similar to menopausal symptoms, tamoxifen does not trigger or cause menopause in women. It’s (Tamoxifen) side effects in men may include:

While applying endocrine therapy for breast cancer treatment the question that many would be asking would be, “are there some risks involve for those people taking tamoxifen for treatment?” this is a valid concern, doctor Dalal Akoury agrees. In her response she gives a resounding YES. Therefore the following are some of the known risks involved when taking tamoxifen:

  • Fertility – Tamoxifen may affect fertility, so it is important to use some form of barrier birth control while you are taking it. However, do not use oral contraceptives like the pill since they may change the effects of tamoxifen and affect the breast cancer. Tell your doctor right away if you think you may have become pregnant while taking this medication.
  • Increased blood clots – Women taking tamoxifen may have a slightly increased risk of developing blood clots in the lungs or large veins. This risk is increased in smokers.
  • Increased risk of stroke
  • Uterine cancer/sarcoma – Tamoxifen may increase a woman’s risk of developing uterine cancer (cancer of the lining of the uterus) or uterine sarcoma. However, this risk is very small and needs to be balanced against the significant benefits of taking tamoxifen for breast cancer.
  • Cataracts – Taking tamoxifen appears to put some women at increased risk for developing cataracts, a clouding of the lens inside the eye. People have also reported eye problems such as corneal scarring or retinal changes.
  • Medications – Tamoxifen may affect the metabolism of other drugs.

Applying Endocrine Therapy for Breast Cancer Treatment: Tamoxifen and Breast Cancer Prevention

Over the years efforts has been made by different researchers with an objective of establishing whether tamoxifen would reduce the occurrence of breast cancer in healthy women known to be at high risk. The outcome of the trials indicated a 50% reduction in both invasive and non-invasive breast cancer in the women treated with tamoxifen. Besides that, tamoxifen has also been shown to significantly reduce the risk of developing invasive breast cancer in women who have had ductal carcinoma in situ (DCIS). We may not be able to exhaust everything in this article and I want to introduce you to the expert for further consultation. You can schedule for an appointment with doctor Akoury for all the concerns you may have about applying endocrine therapy for breast cancer treatment.

Applying Endocrine Therapy for Breast Cancer Treatment: Not everyone is Eligible for Endocrine Therapy

 

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