Hormone Therapy
Certain forms of Breast Cancer are hormone dependant. They carry receptors on their cells and such types of cancer are identified by tests called ER & PR.
Hormone therapy, also called endocrine therapy, is a treatment used to block or reduce the effects of hormones, particularly estrogen, on breast cancer cells.
At Hyderabad Breast Clinics, all patients who are diagnosed with Breast Cancer undergo Receptor status tests as well as Her 2Neu testing and based on these results treatment to the patient is personalised ensuring higher response rates and reduced toxicity.
Types of Hormone Therapy
Hormone therapy works by either lowering the levels of estrogen in the body or by blocking estrogen from attaching to the receptors on cancer cells. There are several approaches to hormone therapy for breast cancer:
Selective Estrogen Receptor Modulators (SERMs)
These drugs block estrogen from binding to its receptor on breast cancer cells, which helps stop tumor growth.
- Tamoxifen is the most commonly used SERM, effective in both premenopausal and postmenopausal women. It can be used to treat early-stage breast cancer, reduce the risk of recurrence, or as a treatment for advanced breast cancer.
Aromatase Inhibitors (AIs)
These drugs block the enzyme aromatase, which is responsible for converting androgens into estrogen in postmenopausal women. By reducing estrogen production, AIs lower estrogen levels and slow cancer growth.
- Common AIs include Anastrozole, Letrozole, and Exemestane. They are typically used for postmenopausal women with hormone receptor-positive breast cancer.
Estrogen Receptor Downregulators (ERDs)
These drugs block the estrogen receptor and also reduce the number of estrogen receptors on cancer cells.
- Fulvestrant is an example of an ERD, usually used in advanced breast cancer, particularly when other hormone therapies are no longer effective.
Ovarian Suppression or Ablation
For premenopausal women, reducing estrogen production from the ovaries can be an effective treatment.
- Ovarian suppression can be achieved with drugs such as Goserelin or Leuprolide (, which stop the ovaries from producing estrogen.
- Oophorectomy, the surgical removal of the ovaries, is another permanent option for ovarian ablation.
When is Hormone Therapy Used?
Hormone therapy is usually recommended in the following situations:
Adjuvant Therapy (After Surgery)
To lower the risk of recurrence in hormone receptor-positive breast cancers. It is often given for 5 to 10 years after surgery.
Neoadjuvant Therapy (Before Surgery)
To shrink the tumor before surgery.
Metastatic Breast Cancer
To control the growth and spread of cancer in advanced or metastatic cases, particularly in hormone receptor-positive cancers.
Duration of Treatment
Hormone therapy is typically taken for 5 to 10 years. The duration depends on the patient's risk factors, menopausal status, and how well they tolerate the therapy.
Common Side Effects
The side effects of hormone therapy vary depending on the specific treatment used but may include:
Hot flashes
Vaginal dryness or discharge
Decreased libido
Fatigue
Bone thinning (osteoporosis), particularly with aromatase inhibitors
Mood swings or depression
Increased risk of blood clots (with tamoxifen)
Joint and muscle pain (especially with aromatase inhibitors)
Benefits of Hormone Therapy
Prevents Recurrence
In hormone receptor-positive breast cancers, hormone therapy significantly reduces the risk of cancer returning after surgery.
Helps in Advanced Cancer
In metastatic breast cancer, it can control disease progression for months or even years.
Non-Chemotherapy Option
Hormone therapy offers a less toxic treatment option than chemotherapy, with different side effects.
Who is a Candidate for Hormone Therapy?
Hormone therapy is effective only in patients with hormone receptor-positive (ER+/PR+) breast cancer.
It is typically not used for hormone receptor-negative (ER-/PR-) cancers, as these cancers do not rely on hormones to grow.
Monitoring and Follow-Up
Patients on hormone therapy are regularly monitored through:
Bone density scans
- To check for osteoporosis, especially in postmenopausal women using aromatase inhibitors.
Blood tests
- To monitor for any adverse effects on liver function or other organ systems.
Physical exams and mammograms
- To track any signs of cancer recurrence.