Lyn
02-02-2005, 03:10 AM
Hi there, while doing research on if I should change from Aromasin to something else because I am not hormone responsive but post menopausal thanks to chemo, Aromasin worked on getting rid of positive lymph glands while I was waiting for radiation for them, I have been on and off it but feel I may need to try something else because it returns. Not to be confused with hormone replacement therapy which is entirely different.
Big Hugs Lyn
Hormone Therapies Dampen Estrogen's Hold on Advanced Breast Cancer
Printer Friendly Version
Hormone Therapies Dampen Estrogen's Hold on Advanced Breast Cancer
Published on: 2002-07-30
The hormone estrogen, though it serves many important functions in a woman's body, is also the very thing that some breast cancer cells need to multiply. When estrogen binds to the estrogen receptor protein on the outside of a breast cancer cell it fuels that cancer cell's growth. The goal of treatment in these hormone-dependent cancers is to stop estrogen in its tracks. Approximately two-thirds of women with breast cancer are "hormone-receptor positive", which makes them good candidates for hormonal therapy.
But what is hormonal therapy? And how does it work? Below, breast cancer experts introduce this important treatment regimen in breast cancer care, and discuss the distinctions between the new hormonal therapy options.
What is hormonal therapy, and how was it first discovered as a treatment for breast cancer?
HYMAN MUSS, MD: There are several types of hormonal therapies in breast cancer. Historically, the first major treatment for breast cancer that had widespread use involved actually removing the ovaries in young women who were having their menstrual periods. It was found that by removing the ovaries, which is the body's main source of estrogen, that you could see cancer shrink. That led to the early knowledge that there was some relationship of female hormones-specifically estrogens-and breast cancer shrinkage.
What treatments were developed after the relationship between estrogen and cancer was first established?
ROB THOMAS, MD: Originally, we had a drug called tamoxifen, which has served us well through the decades and is still a very powerful and useful drug. And from tamoxifen, we have developed newer drugs. In the last two years, an exciting addition has been the development of drugs called aromatase inhibitors. Still, as it stands, we tend to rely on tamoxifen for premenopausal women, and aromatase inhibitors now are coming into the forefront as perhaps the drug of choice in postmenopausal women.
Do aromatase inhibitors work differently than tamoxifen?
HAL BURSTEIN, MD: Aromatase inhibitors differ from tamoxifen in their mechanism of action. Aromatase inhibitors suppress levels of estrogen production in postmenopausal women. By contrast, tamoxifen interferes with the binding of estrogen to the estrogen receptor, and that's how we think it works in treating breast cancer. For that reason, tamoxifen is a drug that can be used in both pre- and postmenopausal women, whereas aromatase inhibitors are only appropriate for postmenopausal women.
HOPE RUGO, MD: Three aromatase inhibitors, or inactivators, have been tested against tamoxifen for the first hormonal treatment for a woman who's been diagnosed with advanced breast cancer; we call that first-line treatment. And these drugs are Arimidex, Femara and Aromasin.
How did the aromatase inhibitors hold up to current treatment regimens?
EDGARDO RIVERA: The first study that came out was with Arimidex. It was being compared to tamoxifen in patients with advanced breast cancer. In that study, it was shown that Arimidex was superior to tamoxifen in terms of anticancer activity, or antitumor activity. But not only that, it was also found to be safer and it was better tolerated than tamoxifen. It's associated with fewer hot flashes and vaginal symptoms, and also there seems to be a lower risk of developing blood clots as well as a lower risk of developing uterine cancer.
HOPE RUGO, MD: In the Femara trial, they were able to show that women who took Femara had a longer time to progression of their cancer compared to women who took tamoxifen. That means that women have a longer time of symptom control, a longer time when they're taking an oral medication, and they feel relatively well in most cases and a longer time to change of treatment.
EDGARDO RIVERA: We found that Aromasin also seems to be better than tamoxifen and it's also associated fewer less side effects.
How do Aromatase inhibitors compare to each other?
CARSTEN ROSE, MD: Based on laboratory data and test systems in animals, we have reason to believe that there are differences between Femara and Arimidex in the degree of inhibition of the aromatase enzyme; the more the drug inhibits the enzyme, the less estrogen will be produced, and the less the cancer cells will be stimulated to grow. By performing a direct comparison in women with metastatic breast cancer, we were aiming to see whether these preclinical findings could be translated into a benefit for our patients. The findings from this study demonstrated that the major endpoint- time without symptoms, or what we call "time to progressive disease"-was similar between those two drugs.
HOPE RUGO, MD: In what we call a "head-to-head" comparison trial, the time to progression and overall survival was not different between the two drugs. However, it's very interesting that the response rates were much higher for Femara than they were for Arimidex. The difference was about 50% more patients responded to the Femara.
Some have criticized the nature of this head-to-head comparison. Why?
CARSTEN ROSE, MD: The data from this comparison between Femara and Arimidex can be criticized because it was an open-label study, which means that both the doctors and the patients knew exactly which of the drugs they got. And especially in analyzing the research, you can't put favor in one of the two drugs, so as a clinician, I would look for further information in the clinical setting.
How did the drugs compare in terms of quality of life?
ROB THOMAS, MD: I was involved in a trial specifically looking at quality of life and toxicity between Arimidex and Femara. And we did show that there was an improvement in quality of life in patients on Femara compared to Arimidex. It had a crossover design, so patients had the opportunity to take both drugs, and at the end of the trial, more patients chose Femara than Arimidex, which sort of substantiated the quality of life data, in other words, patients were able to choose what actually suited them best.
HYMAN MUSS, MD: Concerning patient preferences, selecting one type of aromatase inhibitor over the other, my own bias is there are probably not major patient preferences. By and large, all these compounds are extremely well-tolerated. It's very unusual for anybody to have any major nausea or vomiting. The drugs don't cause hair loss. They would rarely ever affect someone's blood counts or cause any other organ damage.
So what is the bottom line for women who need to understand the role of these drugs in breast cancer therapy?
HOPE RUGO, MD: The role of aromatase inhibitors in the treatment of advanced breast cancer has changed. We now use them universally as first-line treatment for advanced breast cancer, because we do see great response rates and a longer time to progression of breast cancer.
HAL BURSTEIN, MD: The goals of therapy are to control the disease for as long as possible, to help alleviate the symptoms that might be caused by advanced cancer and to keep the cancer from spreading. And the good news is that these hormone-type therapies can often be very effective for women. Many women are getting years and years of disease control with these drugs.
Hyman B. Muss, MD is the Director of Hematology/Oncology at Fletcher Allen Health Care in Vermont.
Dr. Hope S. Rugo is an oncologist/hematologist at the UCSF Comprehensive Cancer Center.
Dr. Harold Burstein is an oncologist at the Dana Farber Cancer Institute.
Dr. Rob Thomas is an oncologist at the Addenbrooke Hospital, UK.
Dr. Carsten Rose is the Director of the Department of Oncology at Lund University Hospital, Sweden.
Dr. Edgardo Rivera is an oncologist at the M.D. Anderson Cancer Center, Houston.
© 2005 Healthology, Inc.
Big Hugs Lyn
Hormone Therapies Dampen Estrogen's Hold on Advanced Breast Cancer
Printer Friendly Version
Hormone Therapies Dampen Estrogen's Hold on Advanced Breast Cancer
Published on: 2002-07-30
The hormone estrogen, though it serves many important functions in a woman's body, is also the very thing that some breast cancer cells need to multiply. When estrogen binds to the estrogen receptor protein on the outside of a breast cancer cell it fuels that cancer cell's growth. The goal of treatment in these hormone-dependent cancers is to stop estrogen in its tracks. Approximately two-thirds of women with breast cancer are "hormone-receptor positive", which makes them good candidates for hormonal therapy.
But what is hormonal therapy? And how does it work? Below, breast cancer experts introduce this important treatment regimen in breast cancer care, and discuss the distinctions between the new hormonal therapy options.
What is hormonal therapy, and how was it first discovered as a treatment for breast cancer?
HYMAN MUSS, MD: There are several types of hormonal therapies in breast cancer. Historically, the first major treatment for breast cancer that had widespread use involved actually removing the ovaries in young women who were having their menstrual periods. It was found that by removing the ovaries, which is the body's main source of estrogen, that you could see cancer shrink. That led to the early knowledge that there was some relationship of female hormones-specifically estrogens-and breast cancer shrinkage.
What treatments were developed after the relationship between estrogen and cancer was first established?
ROB THOMAS, MD: Originally, we had a drug called tamoxifen, which has served us well through the decades and is still a very powerful and useful drug. And from tamoxifen, we have developed newer drugs. In the last two years, an exciting addition has been the development of drugs called aromatase inhibitors. Still, as it stands, we tend to rely on tamoxifen for premenopausal women, and aromatase inhibitors now are coming into the forefront as perhaps the drug of choice in postmenopausal women.
Do aromatase inhibitors work differently than tamoxifen?
HAL BURSTEIN, MD: Aromatase inhibitors differ from tamoxifen in their mechanism of action. Aromatase inhibitors suppress levels of estrogen production in postmenopausal women. By contrast, tamoxifen interferes with the binding of estrogen to the estrogen receptor, and that's how we think it works in treating breast cancer. For that reason, tamoxifen is a drug that can be used in both pre- and postmenopausal women, whereas aromatase inhibitors are only appropriate for postmenopausal women.
HOPE RUGO, MD: Three aromatase inhibitors, or inactivators, have been tested against tamoxifen for the first hormonal treatment for a woman who's been diagnosed with advanced breast cancer; we call that first-line treatment. And these drugs are Arimidex, Femara and Aromasin.
How did the aromatase inhibitors hold up to current treatment regimens?
EDGARDO RIVERA: The first study that came out was with Arimidex. It was being compared to tamoxifen in patients with advanced breast cancer. In that study, it was shown that Arimidex was superior to tamoxifen in terms of anticancer activity, or antitumor activity. But not only that, it was also found to be safer and it was better tolerated than tamoxifen. It's associated with fewer hot flashes and vaginal symptoms, and also there seems to be a lower risk of developing blood clots as well as a lower risk of developing uterine cancer.
HOPE RUGO, MD: In the Femara trial, they were able to show that women who took Femara had a longer time to progression of their cancer compared to women who took tamoxifen. That means that women have a longer time of symptom control, a longer time when they're taking an oral medication, and they feel relatively well in most cases and a longer time to change of treatment.
EDGARDO RIVERA: We found that Aromasin also seems to be better than tamoxifen and it's also associated fewer less side effects.
How do Aromatase inhibitors compare to each other?
CARSTEN ROSE, MD: Based on laboratory data and test systems in animals, we have reason to believe that there are differences between Femara and Arimidex in the degree of inhibition of the aromatase enzyme; the more the drug inhibits the enzyme, the less estrogen will be produced, and the less the cancer cells will be stimulated to grow. By performing a direct comparison in women with metastatic breast cancer, we were aiming to see whether these preclinical findings could be translated into a benefit for our patients. The findings from this study demonstrated that the major endpoint- time without symptoms, or what we call "time to progressive disease"-was similar between those two drugs.
HOPE RUGO, MD: In what we call a "head-to-head" comparison trial, the time to progression and overall survival was not different between the two drugs. However, it's very interesting that the response rates were much higher for Femara than they were for Arimidex. The difference was about 50% more patients responded to the Femara.
Some have criticized the nature of this head-to-head comparison. Why?
CARSTEN ROSE, MD: The data from this comparison between Femara and Arimidex can be criticized because it was an open-label study, which means that both the doctors and the patients knew exactly which of the drugs they got. And especially in analyzing the research, you can't put favor in one of the two drugs, so as a clinician, I would look for further information in the clinical setting.
How did the drugs compare in terms of quality of life?
ROB THOMAS, MD: I was involved in a trial specifically looking at quality of life and toxicity between Arimidex and Femara. And we did show that there was an improvement in quality of life in patients on Femara compared to Arimidex. It had a crossover design, so patients had the opportunity to take both drugs, and at the end of the trial, more patients chose Femara than Arimidex, which sort of substantiated the quality of life data, in other words, patients were able to choose what actually suited them best.
HYMAN MUSS, MD: Concerning patient preferences, selecting one type of aromatase inhibitor over the other, my own bias is there are probably not major patient preferences. By and large, all these compounds are extremely well-tolerated. It's very unusual for anybody to have any major nausea or vomiting. The drugs don't cause hair loss. They would rarely ever affect someone's blood counts or cause any other organ damage.
So what is the bottom line for women who need to understand the role of these drugs in breast cancer therapy?
HOPE RUGO, MD: The role of aromatase inhibitors in the treatment of advanced breast cancer has changed. We now use them universally as first-line treatment for advanced breast cancer, because we do see great response rates and a longer time to progression of breast cancer.
HAL BURSTEIN, MD: The goals of therapy are to control the disease for as long as possible, to help alleviate the symptoms that might be caused by advanced cancer and to keep the cancer from spreading. And the good news is that these hormone-type therapies can often be very effective for women. Many women are getting years and years of disease control with these drugs.
Hyman B. Muss, MD is the Director of Hematology/Oncology at Fletcher Allen Health Care in Vermont.
Dr. Hope S. Rugo is an oncologist/hematologist at the UCSF Comprehensive Cancer Center.
Dr. Harold Burstein is an oncologist at the Dana Farber Cancer Institute.
Dr. Rob Thomas is an oncologist at the Addenbrooke Hospital, UK.
Dr. Carsten Rose is the Director of the Department of Oncology at Lund University Hospital, Sweden.
Dr. Edgardo Rivera is an oncologist at the M.D. Anderson Cancer Center, Houston.
© 2005 Healthology, Inc.