Chemioterapy and Hormonoterapy

[kykeon22]

I was wondering, it's a good choice making chemioterapy and hormonetherapy at the same time? Isn't it better to do first chemiotherapy and then hormonoterapy? what do you think about it? Has someone already had a combination of chemio and hormone therapy?

[hutchibk]

From what I know and have experienced, it is quite common to do chemo and anti-estrogens together. In my case I have taken Aromasin and then switched to Tamoxifen with in conjunction with non-stop chemo very successfully over the last 6 years.

[kykeon22]

Hi Brenda,

Thank you for you answer. I was wondering about chemio and hormone therapies given simultaneously because I have read somewhere (now I don't remember exactly where or if I have just imagined it, because I'm reading a very lot of things about breast cancer and maybe I'm a little overwhelmed and confused by the amount of information I'm taking in) that chemio and hormone therapies usually are never given together, but in succession, either chemio before hormone or the the other way. I even remember having read that combining the two therapies could result in a less effective treatment. So I have been looking around reading the history of many members of this forum and found out that usually hormone therapy is really given after chemio and not at the same time. Then I reasoned out trying to make sense of it and got this explanation. Chemio and hormone therapy work differently, that's clear. Chemio kill scells that replicates fast, and the faster they replicate the more effective chemio is on these cells. On the other hand hormone therapy works by slowing down the growth and replication of tumor cells. As a result chemio and hormone therapy don't work synergetically, but on the contrary in opposite direction. Hence to resume up, if hormone therapy is given tumor cells grow slower thus chemio is less effective on those tumor cells. if on the contrary chemio is given first, as a mean to kill as many fast growing cancer cells as possible, and then in a second moment hormone therapy is added to slow down or block the growth and multplication of the few remaining tumor cells then the therapy could yields better a outcome.

This is what I came up with, but maybe I'm wrong (yes very likely) because I don't have all the theory and the knowledge, I don't see al the picture, maybe I'm missing something- But I'm always concerned about my mother and want her to receive the best therapy with the less side effects. Like you Brenda she has already received targeted therapy with aromatase inhibitor, but targed therapy don't work like traditional chemios, targeted therapy inhibit cells growing like hormone therapy. Now she is receiving mitotraxane, aromase and tyverb. The fact that she is receiving three kind of therapy should make me feel comfortable, after all three weapons are better than two, but now those doubts about weather chemio and hormone therapies are or are note really effective if given in combo are haunting me.

I was wondering if someone with more experience and insight could chime in and help me untangle this doubts.

Thank you in advance

kykeon

[Debbie L.]

Dear Son of Ha,

You're right, it's more typical not to give the two together. The theory is that chemo targets the fastest-growing cancer cells, and endocrine (hormone) therapy slows growth rates, so the two together would be counterproductive. But that is mostly just a theory, and there's little evidence to support (or refute) it. There is one older study that found no benefit to combining the two types of treatment (but neither did it find harm) -- but it was a large and very mixed study group, so it's still possible that for some subgroups there was a benefit. There are better studies looking at concurrent therapy for adjuvant treatment (no benefit, suggestion of detriment) -- but we don't know that it's the same for metastatic disease.

The only reason I know this is that we recently tried to find more information on this, for a friend. She had consults with several (big name) experts and all told her that they did not do simultaneous chemo and endocrine therapy.

That said, it seems to me that we could look at this differently. We know that especially by the time the cancer has metastasized, the cancer cells have become quite diverse (heterogenous). If we were able to test, cell-by-cell, for markers and behavior, we'd probably find lots of different things going on -- in the same body, and even in the same tumor. So it seems to me that it's not unreasonable to use chemo to kill the fast-growing, aggressive cells (perhaps the ER-/HER2+ ones), while at the same time targeting the slower ER+ probably chemo-resistant cells with an endocrine treatment.

Given what we know now about strongly positive ER+ cells and their lack of response to chemo (for example, oncotype low risk cancers), it seems to me like that would refute the theory upon which this "no dual therapy" edict is based. In other words, it's not the endocrine treatment that renders the ER+ cells invulnerable to chemo, it's the basic characteristics of the ER+ cell that does that.

I don't feel like I'm explaining this very well. Does it make any sense?

Debbie Laxague

[hutchibk]

Kykeon and Debbie,

I posted my experience based on being a metastatic patient (as Debbie described in her excellent explanation) and because Ha's signature also indicates she is a metastatic patient...

[AlaskaAngel]

This may SOUND like I'm digressing from the question asked, but I'll raise this question so that we don't miss the boat by asking the wrong questions.

This is where the need seems so obvious to me that we need a much better understanding of endocrinology FIRST, to be able to understand how best to use whatever medical weapons there might be.

Is chemotherapy's real purpose to just kill whatever cancer cells there are? Or is its main effect that of changing one's endocrine status, with that then leading to the production of fewer cancer cells?

If oncologists had been more focused on using ovarian ablation through other means than chemotherapy as the primary tool in the first place, we might not be putting so many people through chemotherapy (AND all the other problems that go with chemotherapy).

AlaskaAngel

[Debbie L.]

I cannot even find the articles that I had in hand (on screen), just a few months ago. It's a hard topic for the inexperienced to search. Maybe some of you more-skilled sleuths would help teach us how you do this? In this instance, "concurrent" seems an important word to use. But then will there be more hits with "endocrine" or with "hormonal", or by mentioning Tamoxifen, Arimidex, etc. by name? I get a LOT of non-relevant things, especially with "concurrent" as it brings in all the trials that exclude concurrent whatever.

And I should have included a disclaimer in my previous post, especially to Son of Ha, who is looking for expert help. I am NOT an expert and particularly my paragraph musing about the way the two (chemo and endocrine) therapies, given together, MIGHT work was pure speculation on my part -- based on no evidence nor confirmation from an expert.

So AA, are you saying that for ER+ disease we should be looking harder at how to overcome resistance? Or are you saying that all breast cancer might be tweaked so that it would respond to endocrine therapy?

Debbie Laxague

[AlaskaAngel]

I'm no expert either. I do suspect the answer to most if not all breast cancer (and other cancers such as prostate cancer and pancreatic cancer) is an endocrine one. Breasts are endocrine glands.

Why else is it that breast cancer is so much harder to deal with effectively for younger people? Is it because their endocrine system is so much more indomitable (for lack of a better word) that even chemotherapy isn't effective enough to provide a knockout punch? Why else are so many triple negatives young, and so many HR+ older? Why else are full-term pregnancies, lactating, and menopause often factors?

To me it is as if, by creating specialists that deal with cancer, we allowed them to avoid acknowledging the background basis for all metabolism, which is key in the entire process of all cell development, cancer and otherwise.

[AlaskaAngel]

In terms of responding to the original question, for example:

Theoretically at least, the metabolic response to chemotherapy should not be uniformly spread out across its administration, if normally the repeated application of it acts to bring about menopause (with the slowing of metabolism/metabolic rate for ALL cells, that so annoyingly also causes my midriff bulge at age 60). So perhaps the slowing of cell development and division occurs more and more completely toward the last treatment cycles with chemotherapy, in which case, if the chemotherapy acts primarily on fast-dividing cells, there is less and less "kill" effect with each successive treatment. Older, more menopausal, HR+ patients would get less and less from its application, which may be why HR-'s tend to have better response to chemotherapy. With one-size-fits-all dosing and treatment schedules, how hard has oncology looked at metabolism as being a variant, due to the differences in our endocrine processes?

Is there ever much discussion about any of this in terms of the endocrine system and cellular metabolism?