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Hormone Therapies

  

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Hormone Therapy
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Breast Cancer 101 (Interactive Multimedia) - Tamoxifen
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When are hormone therapies used?

Some breast cancer cells need estrogen and/or progesterone (female hormones that are produced in the body) to grow. When these hormones attach to special proteins called hormone receptors, the cancer cells with these receptors grow.

  • Breast cancers that have many cells with hormone receptors are hormone receptor-positive (estrogen receptor-positive (ER-positive) and/or progesterone receptor-positive (PR-positive)).
     
  • Breast cancers that have few or no cells with hormone receptors are hormone receptor-negative (estrogen receptor-negative (ER-negative) and/or progesterone receptor-negative (PR-negative)).

All tumors are checked for hormone receptors. A pathologist determines the receptor status by testing the tumor tissue removed during a biopsy.  

Most breast cancers are hormone-receptor positive. Hormone therapies are only used to treat hormone receptor-positive breast cancers.  

Learn more about hormone receptor status.

How do hormone therapies work?

Hormone therapies slow or stop the growth of hormone receptor-positive tumors by preventing the cancer cells from getting the hormones they need to grow. They do this in a few ways. Some hormone therapies, like the drug tamoxifen, attach to the receptor in the cancer cell and block estrogen from attaching to the receptor. Other therapies, like aromatase inhibitors, lower the level of estrogen in the body so the cancer cells cannot get the estrogen they need to grow.  

Treatment with the hormone therapies tamoxifen and/or aromatase inhibitors lowers the risk of [56-57]:

Hormone therapy versus menopausal hormone therapy

Hormone therapy for breast cancer treatment is different from menopausal hormone therapy (MHT). MHT may also be called postmenopausal hormone use or hormone replacement therapy.  

Hormone therapies used in breast cancer treatment block hormone actions or lower hormone levels in the body. So, although these drugs are called hormone therapies, they act as “anti-hormone” therapies. By contrast, MHT is meant to increase hormone levels in the body to treat menopausal symptoms. MHT increases the risk of breast cancer (learn more) and is only recommended for short-term use to ease menopausal symptoms.

Hormone therapy drugs

Figures 5.7 and 5.8 list the common hormone therapies  for early, locally advanced and metastatic breast cancer. These figures do not include rarely used drugs or drugs no longer in use. 

Figure 5.7: Hormone therapies commonly used to treat early and locally advanced breast cancer  

Drug 

Brand name 

Used in pre- or postmenopausal women? 

Injection or pill? 

Tamoxifen

Nolvadex

Pre- and postmenopausal

Pill

Anastrozole

Arimidex

Postmenopausal

Pill

Letrozole

Femara

Postmenopausal

Pill

Exemestane

Aromasin

Postmenopausal

Pill

Goserelin

Zoladex

Premenopausal

Injection

Leuprolide

Lupron

Premenopausal

Injection

Adapted from Murphy et al. [58].

To learn more about a specific hormone therapy, visit the National Institutes of Health’s Medline Plus website.    

Figure 5.8: Hormone therapies commonly used to treat metastatic breast cancer 

Drug 

Brand name 

Used in pre- or postmenopausal women? 

Injection or pill? 

Anastrozole

Arimidex

Postmenopausal

Pill

Exemestane

Aromasin

Postmenopausal

Pill

Fulvestrant

Faslodex

Postmenopausal

Injection

Goserelin

Zoladex

Premenopausal

Injection

Letrozole

Femara

Postmenopausal

Pill

Leuprolide

Lupron

Premenopausal

Injection

Megestrol acetate

Megace

Pre- and postmenopausal

Pill

Tamoxifen

Nolvadex

Pre- and postmenopausal

Pill

Toremifene

Fareston

Postmenopausal

Pill

To learn more about a specific hormone therapy, visit the National Institutes of Health’s Medline Plus website.  

Hormone therapy guidelines

Although the exact treatment for breast cancer varies from person to person, treatment guidelines help ensure quality care. These guidelines are based on the latest research and the consensus of experts. The National Comprehensive Care Network (NCCN) and American Society of Clinical Oncology (ASCO) are two respected organizations that regularly update and post their guidelines online. The National Cancer Institute (NCI) also has overviews of treatment options.

Importance of following your breast cancer treatment plan

Breast cancer treatment is most effective when all parts of the treatment plan are followed. So, it is important to follow your treatment plan (for medications and other therapies) prescribed by your health care provider in terms of:

  • Timing
  • Dose
  • Frequency

Completing hormone therapy

Hormone therapy with tamoxifen and/or aromatase inhibitors is typically prescribed for at least five years (up to 10 years of treatment). The length of treatment coupled with side effects can make it difficult to complete hormone therapy.  

Although the menopausal symptoms related to hormone therapy can be hard to deal with, there are treatments that may ease these side effects. If you have side effects, talk to your health care provider about ways to treat them.  

To get the most benefit out of hormone therapy, you need to take the full course of treatment. Women who complete the full course have higher rates of survival [59].  

If you have trouble remembering to take your hormone therapy, a daily pillbox or setting an alarm on your watch or mobile device (you may be able to download a mobile app) may help [3]. However, you do not need to panic if you miss a day or two.  

Learn more about the importance of following your breast cancer treatment plan.

Prescription drug assistance

Hormone therapy drug costs can quickly become a financial burden for you and your family. Medicare and many insurance providers offer prescription drug plans. One may already be included in your policy or you may be able to buy an extra plan for prescriptions.  

Tamoxifen and aromatase inhibitors (anastrozole, exemestane and letrozole) are off-patent and available in a generic form. Generics are cheaper than name brand drugs, but are just as effective. You may also qualify for assistance from programs that help with drug costs or offer low-cost or free prescriptions.  

Learn more about insurance plans and prescription drug assistance programs.  

Susan G. Komen® position on fairness in breast cancer medication coverage 

Medications taken by mouth (oral) are usually covered under a health insurance plan’s prescription drug benefit rather than the plan’s medical benefit. As a result, people often find themselves facing high out-of-pocket costs when filling their prescriptions (sometimes costing thousands of dollars per month). High prescription drug costs are a barrier to care. High costs can prevent people from getting the medications prescribed by their health care provider.  

Komen supports efforts at the state and federal level to require insurers to provide equal (or better) coverage for oral breast cancer medications as they provide for IV medications to ensure people have access to affordable, appropriate treatment for their cancer.

 

 Komen Support Resources  

 

 

Clinical trials

Research is ongoing to improve all areas of treatment for breast cancer. New therapies are being studied in clinical trials. The results of these studies will decide whether these therapies will become part of standard care. After discussing the benefits and risks with your health care provider, we encourage you to consider joining a clinical trial.  

BreastCancerTrials.org in collaboration with Susan G. Komen® offers a custom matching service that can help you find a clinical trial that fits your health needs. Search BreastCancerTrials.org for clinical trials on hormone therapies.

Learn more about clinical trials.

 Komen Perspectives  

Read our perspective on clinical trials (July 2012).* 

* Please note, the information provided within Komen Perspectives articles is only current as of the date of posting. Therefore, some information may be out of date at this time.  

Updated 05/02/14

   

Tamoxifen 

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    Side Effects of Tamoxifen  

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Aromatase Inhibitors 

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    Side Effects of Aromatase Inhibitors  

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    Ovarian Suppression (Therapies that Stop the Ovaries from Producing Hormones) 

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    Emerging Areas in Chemotherapy, Hormone Therapy and Targeted Therapy  

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    Questions for Your Provider - Hormone Therapy 

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