Female hormonal therapy
Hormonal therapy for breast cancer:
For hormone receptor positive breast cancer: hormonal therapy is a possible option.
For hormone receptor negative breast cancer: hormonal therapy is NOT beneficial.
Estrogen and Progesterone Receptor Testing
Hormonal therapy for ovarian or uterine cancer:
For hormone receptor positive ovarian and uterine cancer: hormonal therapy may be beneficial in some patients.
Hormonal therapy drugs include:
- Tamoxifen (Nolvadex)
- Arimidex (Anastrozole)
- Femara (Letrozole)
- Aromasin (Exemestane)
- Faslodex (Fulvestrant)
- Zoladex, Lupron, Megestrol, Estrogen (Estradiol), and others
Estrogen can be used for treating advanced breast cancer that has become resistant to the above mentioned drugs and may be beneficial to some patients.
Treatment methods:
For premenopausal women with early-stage breast cancer:
- Tamoxifen is appropriate for both premenopausal and postmenopausal women.
- Aromatase inhibitors (Anastrozole, (Letrozole, Exemestane) and Faslodex can NOT be used unless :
- their ovary function is suppressed by Zoladex or Lupron
- or rendered post-menopausal by removal of ovaries or by radiation (which is now rarely done).
- For women who cannot tolerate tamoxifen or for other reason,
- suppression of ovary function chemically with Zoladex or Lupron may be considered.
- With suppression of ovarian function, an aromatase inhibitor may be considered.
- It is not clear at this time if adding an aromatase inhibitor or Tamoxifen on top of ovary suppression improves efficacy.
For postmenopausal women with early-stage breast cancer:
There are several ways to take hormonal treatment for reducing the risk of breast cancer relapse.
- Starting either with Tamoxifen or an aromatase inhibitor would be appropriate.
- If starting with Tamoxifen, switching over to an aromatase inhibitor after 2-3 years, is a common practice.
- This is because sequential therapy has been shown to be more effective than taking Tamoxifen for the entire 5-year duration..
- It is also appropriate to switch from an aromatase inhibitor to Tamoxifen after 2-3 years.
- Taking an aromatase inhibitor for a straight five-year period of time is appropriate.
For patients with metastatic breast cancer:
Your oncologist may use these drugs one at a time during different phases of your treatment, depending on how well you tolerate them and how responsive your cancer is to a treatment.
Hormonal therapy sometimes can keep a patient’s cancer under control from several months to even years. Of course, for some patients it may not work. In others, only some hormonal therapy drugs may work.
Breast cancer preventive therapy:
Women without a history of breast cancer, but with an increased risk for developing breast cancer, may consider taking Tamoxifen or Raloxifene for reducing their risk of developing breast cancer.
Women at increased risk of developing breast cancer are those with:
- significant family history of breast cancer or ovarian cancer
- tissue confirmation biopsy demonstrating lobular carcinoma in situ (a benign condition), or other conditions.
Lobular carcinoma in situ is different than ductal carcinoma in situ in which:
- Ductal carcinoma in situ (DCIS)can evolve to become invasive breast cancer (breast cancer that can spread beyond the breast)
- Lobular carcinoma in situ (LCIS) does not usually develop into breast cancer but signals an increased risk of breast cancer that can occur in either breast.
Risk reduction with Tamoxifen or Raloxifene:
- Studies have shown taking Tamoxifen or Raloxifene for 5 years can reduce the risk of having breast cancer by 50% in those women with increased risk of having breast cancer.
- Raloxifene is also used in postmenopausal women for treating osteoporosis and is currently only used for postmenopausal women.
- For premenopausal women who are at increased risk of having breast cancer, Tamoxifen is considered.
- Raloxifene cannot be used for treating invasive breast cancer or ductal carcinoma in situ.
- Tamoxifen is the only drug that has been shown to reduce the risk of cancer relapse in women with ductal carcinoma in situ.
- Tamoxifen and aromatase inhibitors can be used for invasive breast cancer.
Side effects of tamoxifen or raloxifene
1. Most common side effects:
- Hot flashes
- Weight gain
- Fatigue
- Vaginal dryness
- Decreased libido,
- Depression
2. Blood clot and uterine cancer:
- Both Raloxifene and Tamoxifen increase the risk of blood clot (called deep vein thrombosis-DVT), but the risk is small.
- When Tamoxifen is used for several years, it can cause a slightly increased risk of uterine cancer.
- However, the risk of uterine cancer caused by Tamoxifen is very small
- Raloxifene does not increase the risk of uterine cancer, unlike Tamoxifen.
- Aromatase inhibitors are not associated with these two side effects.
3. Bone density:
- In premenopausal women, Tamoxifen can cause a mild thinning of bones
- However, in postmenopausal women, Tamoxifen can help maintain bone density. Aromatase inhibitors can cause slightly increased risk of osteoporosis (thinning of bones).
4. Sexual changes:
Aromatase inhibitors can cause more vaginal dryness, dyspareunia (pain with intercourse), and loss of libido, compared to Tamoxifen in postmenopausal women.
To learn more about sexuality for women with cancer:
5. Cholesterol:
- Tamoxifen can slightly increase the level of good cholesterol (high density cholesterol)
- Aromatase inhibitors can slightly increase the level of bad cholesterol (low density cholesterol).
6. Joint pain:
- Joint pain occurs more often in women taking aromatase inhibitors
- it is not common in women who are on Tamoxifen
- The joint pain is normally mild to moderate, more prominent in hand joints, with a brief period (less than five minutes) of morning stiffness.
More information about hormonal therapy drugs:
Tamoxifen (Nolvadex)
