scholarly journals A review of adjuvant hormonal therapy in breast cancer

2004 ◽  
Vol 11 (3) ◽  
pp. 391-406 ◽  
Author(s):  
Kellie L Jones ◽  
Aman U Buzdar
Keyword(s):  
Breast Cancer ◽  
Hormonal Therapy ◽  
Ovarian Function ◽  
Critical Role ◽  
Current Data ◽  
Adjuvant Hormonal Therapy ◽  
Breast Cancer Patients ◽  
Ovarian Suppression ◽  
Receptor Modulator ◽  
Estrogen Production

Breast cancer is the most common carcinoma diagnosed in women today excluding non-melanoma skin cancers. It has been well documented that estrogen plays a critical role in its development and is a major target for treatment. For many years, tamoxifen has been the gold standard for adjuvant hormonal therapy in breast cancer patients. With newer products targeting different mechanisms to suppress estrogen production, patients now have many decisions regarding their care. Agents such as luteinizing hormone releasing hormone (LHRH) agonists can suppress ovarian function in premenopausal patients and have been shown to be as effective and even better than chemotherapy (CMF — cyclophosphamide, methotrexate, fluorouracil-containing regimens) in certain patient populations. Tamoxifen continues to be an option as well as toremifene, a similar selective estrogen receptor modulator. With the advent of newer third generation aromatase inhibitors (anastrozole, letrozole and exemestane) toxicities have been documented to be less and in some cases they are more efficacious than the standard, tamoxifen. This article reviews the current data regarding ovarian suppression, ovarian suppression plus tamoxifen, tamoxifen, toremifene, anastrozole, letrozole, and exemestane in the treatment of adjuvant hormonal-sensitive breast cancer.

scholarly journals Adherence and persistence to adjuvant hormonal therapy in early stage breast cancer patients: A population-based retrospective cohort study in Israel.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12051-e12051
Author(s):  
Tal Sella ◽  
Gabriel Chodick
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Hormonal Therapy ◽  
Breast Cancer Survivors ◽  
Early Stage ◽  
Population Based ◽  
Early Stage Breast Cancer ◽  
Adjuvant Hormonal Therapy ◽  
Breast Cancer Patients ◽  
Suboptimal Adherence

e12051 Background: Adjuvant hormonal therapy has been consistently proven to improve multiple outcomes in early breast cancer. Nonetheless, data on rates of adherence and persistence with therapy outside West Europe and North America are scarce. We assessed the adherence and persistence with adjuvant hormonal in a retrospective population based cohort of breast cancer survivors in Maccabi Health Services (MHS), Israel. Methods: We identified women who were diagnosed with breast cancer and initiated adjuvant hormonal therapy between January 2000 and November 2008. Subjects were followed retrospectively from first dispensed tamoxifen or aromatase inhibitor (AI) and up to the earliest of the following events: disease recurrence (indicated by surgery, radiotherapy, chemotherapy or other related therapies), leaving MHS, death, or completion of 5 years of treatment. Discontinuation of therapy was defined as a 180-day or longer treatment gap. Adherence with therapy was assessed using proportion of days covered (PDC) during follow-up period. Survival analysis was used to determine the effect of adherence on all-cause mortality. Results: A total of 4178 women with breast cancer were followed for a median 7.8 years. Over 90% of patients received tamoxifen as the initial hormonal agent. Mean PDC was 84% with lower rates associated with younger age, smoking status, comorbidities and year of diagnosis. Residential area did not affect adherence. Differences were not found. Discontinuation of therapy occurred in 23% of study patients. Among persistent patients, 70% were optimally adherent with therapy (PDC>=80%). Association between adherence with therapy and survival is investigated. Conclusions: Adherence to adjuvant hormonal therapy among Israeli breast cancer patients with national health insurance is high in comparison to international reports. Nevertheless, suboptimal adherence was identified among younger (<45y) patients. Because of the efficacy of hormonal therapy in preventing recurrence and death in women with early-stage breast cancer, interventions are necessary to identify and prevent suboptimal adherence among high risk subgroups.

scholarly journals Early Discontinuation and Nonadherence to Adjuvant Hormonal Therapy in a Cohort of 8,769 Early-Stage Breast Cancer Patients

2010 ◽  
Vol 28 (27) ◽  
pp. 4120-4128 ◽  
Author(s):  
Dawn L. Hershman ◽  
Lawrence H. Kushi ◽  
Theresa Shao ◽  
Donna Buono ◽  
Aaron Kershenbaum ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Hormonal Therapy ◽  
Early Stage ◽  
Optimal Schedule ◽  
Medication Possession Ratio ◽  
Adjuvant Hormonal Therapy ◽  
Breast Cancer Patients ◽  
Early Discontinuation ◽  
Younger Women ◽  
Hormone Sensitive

Purpose While studies have found that adjuvant hormonal therapy for hormone-sensitive breast cancer (BC) dramatically reduces recurrence and mortality, adherence to medications is suboptimal. We investigated the rates and predictors of early discontinuation and nonadherence to hormonal therapy in patients enrolled in Kaiser Permanente of Northern California health system. Patients and Methods We identified women diagnosed with hormone-sensitive stage I-III BC from 1996 to 2007 and used automated pharmacy records to identify hormonal therapy prescriptions and dates of refill. We used Cox proportional hazards regression models to analyze factors associated with early discontinuation and nonadherence (medication possession ratio < 80%) of hormonal therapy. Results We identified 8,769 patients with BC who met our eligibility criteria and who filled at least one prescription for tamoxifen (43%), aromatase inhibitors (26%), or both (30%) within 1 year of diagnosis. Younger or older age, lumpectomy (v mastectomy), and comorbidities were associated with earlier discontinuation, while Asian race, being married, earlier year at diagnosis, receipt of chemotherapy or radiotherapy, and longer prescription refill interval were associated with completion of 4.5 years of therapy. Of those who continued therapy, similar factors were associated with full adherence. Women age younger than 40 years had the highest risk of discontinuation (hazard ratio, 1.51; 95% CI, 1.23 to 1.85). By 4.5 years, 32% discontinued therapy, and of those who continued, 72% were fully adherent. Conclusion Only 49% of patients with BC took adjuvant hormonal therapy for the full duration at the optimal schedule. Younger women are at high risk of nonadherence. Interventions to improve adherence and continuation of hormonal therapy are needed, especially for younger women.

Hormonal Therapy for the Treatment of Postmenopausal Breast Cancer Patients

2008 ◽  
Vol 21 (1) ◽  
pp. 36-45
Author(s):  
Rebecca E. Greene ◽  
Vivian Tsang
Keyword(s):  
Breast Cancer ◽  
Estrogen Receptor ◽  
Postmenopausal Women ◽  
Hormonal Therapy ◽  
Early Stage ◽  
Postmenopausal Breast Cancer ◽  
Breast Cancers ◽  
Breast Cancer Patients ◽  
Hormone Receptor Positive ◽  
Receptor Modulator

Breast cancer is the most common cancer diagnosed and the second leading cause of cancer-related death in women. The majority of breast cancers diagnosed in postmenopausal women are hormone receptor positive and involve therapy with hormonal agents. Tamoxifen, a selective estrogen-receptor modulator, has been the mainstay of hormonal therapy since the 1970s. The more recent approval and success of aromatase inhibitors, such as anastrozole, letrozole, and exemestane, have seen these agents move to the front line of therapy for postmenopausal women with hormone-positive breast cancer in the adjuvant and metastatic settings. Fulvestrant, a selective estrogen receptor— downregulator, provides an additional hormonal therapy with a novel mechanism of action. This article reviews the current literature available regarding the use of these agents for postmenopausal women with early stage or advanced breast cancer.

scholarly journals Ovarian Function and Fertility Preservation in Breast Cancer: Should Gonadotropin-Releasing Hormone Agonist be administered to All Premenopausal Patients Receiving Chemotherapy?

2019 ◽  
Vol 13 ◽  
pp. 117955811982839 ◽  
Author(s):  
Matteo Lambertini ◽  
François Richard ◽  
Bastien Nguyen ◽  
Giulia Viglietti ◽  
Cynthia Villarreal-Garza
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Fertility Preservation ◽  
Clinical Evidence ◽  
Ovarian Function ◽  
Gonadotropin Releasing Hormone ◽  
Breast Cancer Patients ◽  
Premenopausal Breast Cancer ◽  
Ovarian Suppression ◽  
Gonadotropin Releasing Hormone Agonist

Chemotherapy-induced premature ovarian insufficiency (POI) is one of the potential drawbacks of chemotherapy use of particular concern for newly diagnosed premenopausal breast cancer patients. Temporary ovarian suppression obtained pharmacologically with the administration of a gonadotropin-releasing hormone agonist (GnRHa) during chemotherapy has been specifically developed as a method to counteract chemotherapy-induced gonadotoxicity with the main goal of diminishing the risk of POI. In recent years, important clinical evidence has become available on the efficacy and safety of this strategy that should now be considered a standard option for ovarian function preservation in premenopausal breast cancer patients, including women who are not interested in conceiving after treatment or that would not be candidates for fertility preservation strategies because of their age. Nevertheless, in women interested in fertility preservation, this is not an alternative to gamete cryopreservation, which remains as the first option to be offered. In this setting, temporary ovarian suppression with GnRHa during chemotherapy should be also proposed following gamete cryopreservation or to women who have no access, refuse, or have contraindications to surgical fertility preservation techniques. In this article, we present an overview about the role of temporary ovarian suppression with GnRHa during chemotherapy in breast cancer patients by addressing the available clinical evidence with the aim of identifying both the best candidates for the use of this strategy and the still existing gray zones requiring further investigation.

Temporary Ovarian Suppression in the Prevention of Chemotherapy-induced Premature Menopause in Early-stage Breast Cancer Patients

2013 ◽  
Vol 09 (01) ◽  
pp. 13
Author(s):  
Martina Nunzi ◽  
Silvia Sabatini ◽  
◽  
Keyword(s):  
Breast Cancer ◽  
Ovarian Function ◽  
Early Stage ◽  
Phase Iii ◽  
Premature Menopause ◽  
Gnrh Analogue ◽  
Breast Cancer Patients ◽  
Ovarian Suppression ◽  
Phase Ii Studies ◽  
Randomised Controlled

Infertility and premature menopause are possible side effects of chemotherapy in young women with breast cancer and can affect their compliance to treatment. There is a lot of interest in maintaining ovarian function after chemotherapy in order to ensure fertility and delay the symptoms of early menopause. The use of a gonadotropin-releasing hormone (GnRH) analogue, administered in combination with chemotherapy to protect ovarian reserve against cytotoxic damage, is one of the approaches that has been evaluated, although the rationale for its use is based mainly on hypothesis. Several phase II studies have suggested a decreased incidence of amenorrhoea with the use of GnRH analogue concomitant with chemotherapy. However, the subsequent phase III studies have produced conflicting results. In particular, the temporary ovarian suppression in combination with modern (neo)adjuvant chemotherapy for preventing premature menopause showed no benefit in three studies and an advantage in two studies. This use of a GnRH analogue is appealing but further randomised controlled trials are needed to evaluate its efficacy.

How conversations about adjuvant hormonal therapy differ from ‘typical‘ oncology discussions: Results of an observational linguistic study

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6141-6141
Author(s):  
B. Davidson ◽  
V. Vogel ◽  
L. Wickerham
Keyword(s):  
Breast Cancer ◽  
Hormonal Therapy ◽  
Life Time ◽  
Adjuvant Hormonal Therapy ◽  
Breast Cancer Patients ◽  
Screening Criteria ◽  
Linguistic Study ◽  
Therapeutic Goals ◽  
Oral Medications ◽  
Communication Methods

6141 Background: Adjuvant hormonal therapy in breast cancer presents a conversational challenge for oncologists. Oral medications are a relatively new therapeutic paradigm, and many aspects of typical oncology communication, e.g., risk-benefit presentation, goal of therapy, and the role of patient in selecting/continuing therapy, require a different approach in this setting. An observational linguistic study was undertaken to capture how oncologists and patients discuss adjuvant therapy, and to develop recommendations to improve communication. Methods: Letters of invitation were mailed to 800+ community-based oncologists; of these, 14 met the screening criteria and agreed to participate in this study. 28 postmenopausal, early breast cancer patients on or initiating hormonal therapy were recorded during their regularly scheduled visits. Results: Adjuvant hormonal therapy discussions differ from infusional chemotherapy-focused oncology discussions in several ways: Selection of therapy is based on more than efficacy (e.g., cost, side effects); Chance of recurrence is discussed directly, without significant hedging; Disease name (“cancer”) is discussed openly–the word “cancer” is notably absent from other types of oncology discussions; Visits are routine–patients’ lives are no longer “on hold” (unlike other treatment discussions, where chemotherapy is assumed to be at the center of the patient’s life); Time between visits often moves from every three months to every six months after being on hormonal therapy for a year (unlike other therapies, where patients are seen frequently). Conclusions: Analysis of conversations shows that these patients are seen as, in some way, “cured” (goal of therapy is to prevent recurrence) and that patients are “given their lives back.” The conversational frame displays a lack of urgency and emotion, similar to that of discussions of dyslipidemia management and not like other chemotherapy discussions where the emotional content is very high. New models of therapy require new conversational approaches, e.g., where issues like adherence should be addressed directly, and longer-term therapeutic goals take on primary importance. [Table: see text]

scholarly journals Practical consensus recommendations on duration of adjuvant hormonal therapy in breast cancer

2018 ◽  
Vol 07 (02) ◽  
pp. 142-145 ◽  
Author(s):  
S. Gupta ◽  
M. Singh ◽  
Amish Vora ◽  
G. Babu ◽  
M. Walia ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Hormonal Therapy ◽  
Hormone Receptor ◽  
Early Stage ◽  
Adjuvant Hormonal Therapy ◽  
Breast Cancer Patients ◽  
Term Survival ◽  
Consensus Recommendations ◽  
Hormone Receptor Positive

AbstractOptimization of adjuvant systemic therapy in women with early-stage hormone receptor-positive breast cancer includes the consideration of chemotherapy and duration of hormone therapy. Adjuvant hormonal therapy significantly improves long-term survival of breast cancer patients with hormone receptor-positive disease. Despite the proven clinical efficacy of tamoxifen and aromatase inhibitors, many breast cancer survivors either fail to take the correct dosage at the prescribed frequency (adherence) or discontinue therapy (persistence). Expert oncologist discussed on the duration of adjuvant hormonal therapy for improvement of OS and quality of life of breast cancer patients by providing reduction in recurrence and mortality. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.

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