It Will Also Be Important In The Future To Differentiate Prior To Treatment Patients Who Are At High Risk Of Relapse From Those At Lower Risk In Order To Tailor Hormone Treatment This May Be Done To Avoid Escalation Of Anti
The CANTO cohort comprises 12,000 women with breast cancer treated in 26 French centres. It is sponsored by Unicancer and directed by Professor Fabrice André, specialist breast cancer oncologist at Gustave Roussy, Inserm research director and responsible of the lab Predictive Biomarkers and Novel Therapeutic Strategies in Oncology . Its objective is to describe adverse effects associated with treatment, to identify the populations at risk of developing them and to adjust therapy accordingly, so as to afford a better quality of life following cancer.
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J Clin Oncol. 2019 Feb 10 37:423-438 : https://doi.org/10.1200/JCO.18.01160
TO CITE THIS POST :
1INSERM Unit 981, Gustave Roussy, Cancer Campus, Villejuif, France
2Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
3Medical Oncology, Gustave Roussy, Cancer Campus, Villejuif
4Department of Supportive Care, Gustave Roussy, Cancer Campus, Villejuif
5Medical Oncology, Centre François Baclesse Caen, Caen
6Unicancer, Paris, France
7Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova
8Department of Internal Medicine and Medical Specialties , School of Medicine, University of Genova, Genova, Italy
9Surgical Oncology, Centre Georges-François Leclerc, Dijon
10Medical Oncology, Institut Curie, Paris
14Surgical Oncology, C.R.L.C Val dAurelle, Montpellier
Radiation Therapy After Radical Prostatectomy: What Has Changed Over Time
- 1Urology Unit, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
- 2Department of Urology, Medical University Innsbruck, Innsbruck, Austria
- 3Division of Surgery and Interventional Science, University College London, London, United Kingdom
- 4Department of Urology, University College London Hospital, London, United Kingdom
- 5Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
- 6Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
- 7Department of Radiation Oncology, Udine General Hospital, Udine, Italy
- 8Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
- 9Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- 10Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- 11Department of Urology and Pediatric Urology, Mainz University Medicine, Mainz, Germany
- 12Department of Urology, CHUV Lausanne, Lausanne, Switzerland
- 13Department of Urology, Antonius Hospital, Utrecht, Netherlands
- 14Department of Urology, University Hospital Essen, Essen, Germany
- 15Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, Milan, Italy
- 16University Hospital ZÃ¼rich, Zurich, Switzerland
- 17Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
When Should I Call My Doctor Or Oncologist
- You have a fever of 100.5Â°F or higher or chills.
- You have bleeding from your gums.
- You have nausea or vomiting and cannot take your chemo.
- You vomit after you take your oral chemo.
- You miss a dose of chemo.
- You have sores or white spots in your mouth.
- You have constipation or diarrhea for more than 1 day.
- You feel depressed.
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Side Effects Of Tamoxifen And Toremifene
The most common side effects of tamoxifen and toremifene are:
- Vaginal dryness or discharge
- Changes in the menstrual cycle
When tamoxifen treatment starts, a small number of women with cancer that has spread to the bones might have a tumor flare which can cause bone pain. This usually decreases quickly, but in some rare cases a woman may also develop a high calcium level in the blood that is hard to control. If this happens, the treatment may need to be stopped for a time.
Rare, but more serious side effects are also possible:
Is There A Xeloda Generic
Yes, Xeloda is the brand name for capecitabine. The Food and Drug Administration approved the Xeloda generic in 2013. Its made the drug more widely available. The generic cost is typically lower, but it will vary widely depending on factors like your insurance coverage or how you buy it. The cost per month of capecitabine was $1,518 in 2014, according to data published through 2019 by the Memorial Sloan Kettering Cancer Center. The drug company that makes the Xenoda brand also has a financial aid program.
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How Is Hormone Therapy Used To Treat Breast Cancer
There are three main ways that hormone therapy is used to treat hormone-sensitive breast cancer:
Adjuvant therapy for early-stage breast cancer:Tamoxifen is FDA approved for adjuvant hormone treatment of premenopausal and postmenopausal women with ER-positive early-stage breast cancer, and the aromatase inhibitorsanastrozole, letrozole, and exemestane are approved for this use in postmenopausal women.
Research has shown that women who receive at least 5 years of adjuvant therapy with tamoxifen after having surgery for early-stage ER-positive breast cancer have reduced risks of breast cancer recurrence, including a new breast cancer in the other breast, and reduced risk of death at 15 years .
Until recently, most women who received adjuvant hormone therapy to reduce the chance of a breast cancer recurrence took tamoxifen every day for 5 years. However, with the introduction of newer hormone therapies , some of which have been compared with tamoxifen in clinical trials, additional approaches to hormone therapy have become common .
Some premenopausal women with early-stage ER-positive breast cancer may have ovarian suppression plus an aromatase inhibitor, which was found to have higher rates of freedom from recurrence than ovarian suppression plus tamoxifen or tamoxifen alone .
Men with early-stage ER-positive breast cancer who receive adjuvant therapy are usually treated first with tamoxifen. Those treated with an aromatase inhibitor usually also take a GnRH agonist.
Persistent Psa After Radical Prostatectomy How To Interpret The Data
Although PSA should be 0 after surgery, some patients are faced with one of two scenarios: PSA recurrence or PSA persistence.
Since other cells in the body can produce small quantities of PSA, the test would raise no concerns if the PSA is 0.1 after prostatectomy. However, any results higher than this can lead to one of the aforementioned scenarios.
Persistent PSA after radical prostatectomy is the detection of a PSA higher than 0.1 nanograms of PSA per milliliter of blood . The distinction is that the PSA has not recurred, but rather persisted after surgery.
The key difference this small distinction makes is the prediction of the course the disease will take. A persistent PSA after radical prostatectomy or other forms of treatment can, unfortunately, mean cancer has progressed and metastasized. In many cases, the best course of secondary treatment is hormone therapy with the purpose of shrinking the size of cancer tumors.
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Estrogen Receptor Blockers Estrogen Receptor Blocker Drugs Attach Directly To And Block The Estrogen Receptors On Cancer Cells So That The Cancer Cells Cant Use Estrogen They Do Not Affect The Level Of Estrogen In The Body Estrogen Receptor Blockers Are Also Called Selective Estrogen Receptor Modulators
Tamoxifen is the most commonly used anti-estrogen drug. It is used in post-menopausal and premenopausal women. Tamoxifen is given by mouth as a pill.
Tamoxifen is the hormonal therapy drug used most often to lower the risk that DCIS or LCIS will lead to an invasive breast cancer.
Tamoxifen very slightly increases the risk for uterine cancer, deep vein thrombosis and stroke. Doctors will carefully weigh these risks against the benefits of giving this drug before they offer it to women who have a personal or a strong family history of these conditions. Usually the benefits of taking tamoxifen outweigh these risks.
Fulvestrant is an anti-estrogen drug that reduces the number of estrogen receptors on breast cancer cells. It is given as an injection into the muscles of the buttocks.
Fulvestrant is used in post-menopausal women if the breast cancer has grown after they were treated with tamoxifen. It is also used in postmenopausal women with locally advanced or metastatic breast cancer that have never been treated with hormonal therapy.
Possible Side Effects Of External Beam Radiation
The main short-term side effects of external beam radiation therapy to the breast are:
- Swelling in the breast
- Skin changes in the treated area similar to a sunburn
Your health care team may advise you to avoid exposing the treated skin to the sun because it could make the skin changes worse. Most skin changes get better within a few months. Changes to the breast tissue usually go away in 6 to 12 months, but it can take longer.
External beam radiation therapy can also cause side effects later on:
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Psa Levels 5 Years After Radiation Therapy Predict Survival From Prostate Cancer
The level of prostate-specific antigen in the blood of prostate cancer patients five years after radiation treatment can help predict their disease-free survival for the next several years, according to the October 2002 issue of the International Journal of Radiation Oncology, Biology and Physics, the official journal of ASTRO, the American Society for Therapeutic Radiology and Oncology.
Researchers have discovered that patients who maintain very low five-year PSA levels have a very low probability of relapse at 10 years and beyond.
The study identified 328 men treated with external beam radiation therapy to the prostate who were biochemically disease-free five years after treatment. The median follow-up was 7.4 years. The patients were divided into four groups according to their PSA values five years after treatment: PSA less than or equal to 0.5, 0.5 to 1.0, 1.0 to 2.0 and 2.0 to 4.0 ng/mL. PSA progression-free rates were calculated in each subgroup at 10 years after treatment.
Researchers concluded that when PSA levels remain low five years after external beam radiation therapy, the great majority of patients will be biochemically disease-free at 10 years. The hazard rates of biochemical progression in the 6 to 10 years after treatment are low and are comparable to rates seen when prostatectomy is the chosen treatment modality.
Hormones And Breast Cancer
The hormones estrogen and progesterone make some breast cancers grow. They are called hormone-sensitive breast cancers. Most breast cancers are sensitive to hormones.
Estrogen and progesterone are produced in the ovaries and other tissues such as fat and skin. After menopause, the ovaries stop producing these hormones. But the body continues to make a small amount.
Hormone therapy only works on hormone-sensitive cancers. To see if hormone therapy may work, doctors test a sample of the tumor that has been removed during surgery to see if the cancer might be sensitive to hormones.
Hormone therapy can work in two ways:
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If Cancer Comes Back Or Has Spread
AIs, tamoxifen, and fulvestrant can be used to treat more advanced hormone-positive breast cancers, especially in post-menopausal women. They are often continued for as long as they are helpful. Pre-menopausal women might be offered tamoxifen alone or an AI in combination with an LHRH agonist for advanced disease.
What Are The Side Effects Of Hormone Therapy For Prostate Cancer
Because androgens affect many other organs besides the prostate, ADT can have a wide range of side effects , including:
- loss of interest in sex
Studer UE, Whelan P, Albrecht W, et al. Immediate or deferred androgen deprivation for patients with prostate cancer not suitable for local treatment with curative intent: European Organisation for Research and Treatment of Cancer Trial 30891. Journal of Clinical Oncology 2006 24:18681876.
Zelefsky MJ, Eastham JA, Sartor AO. Castration-Resistant Prostate Cancer. In: Vincent T. DeVita J, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenbergs Cancer: Principles & Practice of Oncology, 9e. Philadelphia, PA: Lippincott Williams & Wilkins 2011.
Smith MR, Saad F, Chowdhury S, et al. Apalutamide and overall survival in prostate cancer. European Urology 2021 79:150158.
Larry B. Levy, MSOncology
- Biochemical failure is not justificationper se to initiate additionaltreatment. It is not equivalent to clinicalfailure. It is, however, an appropriateearly end point for clinical trials.
- No definition of PSA failurehas, as yet, been shown to be a surrogatefor clinical progression or survival and
Deficiencies in theASTRO Definition
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What If My Psa Rises While Im On Hormone Therapy
When the PSA is rising or cancer is spreading despite a low level of testosterone, prostate cancer is called castration-resistant, or hormone-refractory. Despite this name, some hormonal therapies may still work. But prostate cancer in this setting may progress and become more aggressive and resistant, and you should be prepared to discuss additional treatment strategies with your doctor. This is the time when a medical oncologist, if not already involved in your care, gets involved. These doctors specialize in medical, systemic treatments for prostate cancer, which is useful at this time given that your disease is typically metastatic, meaning that it is not confined to only one location. Cancer cells in this situation have typically spread through the blood stream or lymphatics to other places in the body, and localized treatments are rarely helpful except in circumstances where where you are having symptoms, such as problems with urination.
Fortunately, more and more treatments for metastatic castration-resistant prostate cancer have become available in recent years, including certain newer androgen directed therapies, taxane chemotherapy, immunotherapy, PARP inhibitors, and, in 2022, lutetium-PSMA radionuclide therapy. Additional tests are required for some of these treatments to see if your particular type of prostate cancer is likely to respond. See Chapter 5 in PCFs Prostate Cancer Patient Guide for more details.
Common Thoughts And Feelings
You may feel all sorts of things after you finish treatment. Some men are relieved and feel ready to put the cancer behind them and get back to normal life. But others find it difficult to move on. Adjusting to life after cancer can take time.
For some men, the emotional impact of what they have been through only hits them after they have finished treatment. You might feel angry for example, angry at what you have been through, or about the side effects of treatment. Or you might feel sad or worried about the future.
Follow-up appointments can also cause different emotions. You might find it reassuring to see the doctor or nurse, or you may find it stressful, particularly in the few days before your appointments.
Worries about your cancer coming back
You may worry about your cancer coming back. This is natural, and will often improve with time. There are things you can do to help manage your concerns, such as finding ways to reduce stress. Breathing exercises and listening to music can help you relax and manage stress. Some people find that it helps to share what theyre thinking with somebody else, like a friend. If you are still struggling, you can get help for stress or anxiety on the NHS you can refer yourself directly to a psychological therapies service or ask your GP.
If youre worried about your PSA level or have any new symptoms, speak to your doctor or nurse. If your cancer does come back, youâll be offered further treatment.
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What Types Of Hormone Therapy Are Used For Breast Cancer
Several strategies are used to treat hormone-sensitive breast cancer:
Blocking ovarian function: Because the ovaries are the main source of estrogen in premenopausal women, estrogen levels in these women can be reduced by eliminating or suppressing ovarian function. Blocking ovarian function is called ovarian ablation.
Ovarian ablation can be done surgically in an operation to remove the ovaries or by treatment with radiation. This type of ovarian ablation is usually permanent.
Alternatively, ovarian function can be suppressed temporarily by treatment with drugs called gonadotropin-releasing hormone agonists, which are also known as luteinizing hormone-releasing hormone agonists. By mimicking GnRH, these medicines interfere with signals that stimulate the ovaries to produce estrogen.
Estrogen and progesterone production in premenopausal women. Drawing shows that in premenopausal women, estrogen and progesterone production by the ovaries is regulated by luteinizing hormone and luteinizing hormone-releasing hormone . The hypothalamus releases LHRH, which then causes the pituitary gland to make and secrete LH and follicle-stimulating hormone . LH and FSH cause the ovaries to make estrogen and progesterone, which act on the endometrium .
Blocking estrogens effects: Several types of drugs interfere with estrogens ability to stimulate the growth of breast cancer cells:
Types Of Hormone Therapy For Prostate Cancer
Hormone therapy may be part of prostate cancer treatment if the cancer has spread and cant be cured by surgery or radiation therapyor if the patient isnt a candidate for these other types of treatment. It may also be recommended if cancer remains or returns after surgery or radiation therapy, or to shrink the cancer before radiation therapy.
Additionally, hormone therapy may be combined with radiation therapy initially if theres a high risk of cancer recurrence. It can also be given before radiation therapy to shrink the cancer and make other treatments more effective. Other types of hormone therapy for prostate cancer include:
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Will I Be Able To Work While I Am Having Treatment
Most women are able to continue working during chemotherapy if they wish to. If you plan to keep working, it helps to have a supportive work place that gives you flexible work hours. You may need to have a few days off after each cycle of chemotherapy and when you get back to work you may find it difficult to work long hours. Your doctor can provide a medical certificate for time off this can be just a few days or a few months depending on your individual situation.
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What Is Hormone Therapy For Cancer
Also referred to as hormonal or endocrine therapy, this cancer treatment is different from menopausal hormone replacement therapy , which refers to the prescription of supplemental hormones to help relieve the symptoms of menopause.
Certain cancers rely on hormones to grow. In these cases, hormone therapy may slow or stop their spread by blocking the bodys ability to produce these particular hormones or changing how hormone receptors behave in the body.
Breast and prostate cancers are the two types most commonly treated with hormone therapy. Most breast cancers have either estrogen or progesterone receptors, or both, which means they need these hormones to grow and spread. By contrast, prostate cancer needs testosterone and other male sex hormones, such as dihydrotestosterone , to grow and spread. Hormone therapy may help make these hormones less available to growing cancer cells.
Hormone therapy is available via pills, injection or surgery that removes hormone-producing organs, namely the ovaries in women and the testicles in men. Its typically recommended along with other cancer treatments.
If hormone therapy is part of your treatment plan, discuss potential risks or side effects with your care team so that you know what to expect and can take steps to reduce them. Let doctors know about all your other medications to avoid interactions.
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