Antiestrogen conclusion (SERMs and AIs)

[AlaskaAngel]

How many with bc are aware of this scientific conclusion:

"According to Lombardi medical oncologist Minetta Liu, MD, it is expected that all hormone receptor positive metastatic breast cancers will eventually develop resistance to endocrine therapies."

and

"Anti-hormonal therapies are some of the most effective treatments for breast cancer because estrogen, a natural female sex hormone, can drive the growth of the tumor. Tamoxifen and other anti-hormonal therapies cut off the tumor’s access to estrogen, causing the tumor to stabilize and sometimes even shrink. However according to Clarke, many cancers become insensitive to these treatments over time – more than half of all recurring breast cancers lose sensitivity – because they have found a way to keep growing in the absence of estrogen."<O:p</O:p

http://explore.georgetown.edu/news/?ID=26261<!-- / message -->

[Becky]

This is much the same as "Herceptin resistance" in that life will find a way and learn to grow using other mechanisms. This is very much the same as bacteria growing antibiotic resistance. Like the development of new antibiotics, cancer researchers can and do continue to find new drugs to combat our disease.

[AlaskaAngel]

Yes! That is what is encouraging about the discovery of what they think is one of the mechanisms that causes resistance. I'm hoping they can use new leads like this mostly to try to find ways to figure out when resistance starts being lost, as well as what to use when it has been lost.

A.A.

[Hopeful]

I think the key is better monitoring, not just putting patients on a 5 year course of therapy and expecting it to work. The endocrine system is very delicate and finicky; small changes can have large effects. The need to be vigilant about the effectiveness of the treatment is great.

Hopeful

[Vi Schorpp]

So Hopeful, do you think it would be wise to work with an endocrinologist while taking AIs, or other drugs? I've never seen an endocrinogist but that's an interesting thought.

[Hopeful]

Vi Schorpp,

More than that, I think endocrinologists should be part of the tumor boards that review bc cases. I would love to find an endocrinologist who specialized in bc and is not strictly a researcher. The only one of my docs who is really looking at my hormones is my gyn, but she is no substitute for an endo.

Hopeful

[Vi Schorpp]

That's something I (we) need to ponder...while I don't relish more doctor visits I believe this would be another tool.

[Hopeful]

Just to follow up Becky's point (and underscore my own about involving an endo) research is showing that hormone resistance is a relative state, i.e., once you become resistant to hormone therapy, there is a possibility that the sensitivity can be restored by changing the treatment. I don't know if the same holds true for antibiotics; we are talking about mutated bacteria in the latter, while in the former (hormone sensitive bc) we are looking at an extensive array of complex signaling that seems capable of being sucessfully maniupulated if we only had the key. We need more study in this arena, less in the "blast it to heck" cytotoxic field. Incremental benefits are seen to accure from large random tests in the latter where dosage, timing and combinations may be slightly modified for marginal gains. The measurable improvements in bc tx have come from entirely different approaches and agents, most notably, Herceptin. Since something like 70% of all bc is ER+, it is appalling to me so little is done to explore areas other than SERMS and AI's for tx, which are relatively simple approaches to controlling the disease, as research continues to reveal more and more layers of complexity in signaling and greater opportunity for intervention. The fact that ER+ bc has a longer and more persistent relapse rate over time than ER- bc is all the more reason to put the pressure on researchers to focus their efforts on what can be done to maintain ER+ bc patients NED for 20, 30 or more years after initial dx and tx.

Thanks for letting me get on my soapbox :)

Hopeful