Hormonal Therapy for Breast C... Video Transcript

Participants

Lodovico Balducci MD, Cathy Conley , Joanne E. Mortimer MD

Summary

As with virtually any medication, the benefits of hormonal therapy for breast cancer always come with the risk of side effects. At this year's 24th Annual San Antonio Breast Cancer Symposium, presentations addressed the relative benefits and side effects of various hormonal therapies, and implications for treatment. Join us as we talk to two experts from the conference about this important issue.

Webcast Transcript

CATHY CONLEY: Hi I'm Cathy Conley. I'm here at the 24th annual San Antonio Breast Cancer Symposium, where the top researchers and clinicians have gathered to discuss the latest advances in the fight against breast cancer.

One of the main issues on the table is hormonal therapy. This treatment has proven to be effective in preventing the spread, growth, and recurrence of breast cancer, but it's also known to have side effects. I met with the experts to assess hormonal therapy.

LODOVICO BALDUCCI, MD: Hormonal treatment is really the mainstay of cancer treatment in postmenopausal woman. That is because the majority of postmenopausal women have a cancer that is rich in hormone receptors, estrogen and/or progesterone receptors. This makes the cancer susceptible to hormonal therapy.

JOANNE E. MORTIMER, MD: In treating spread of breast cancer, there are a number of different hormonal agents that we use. The class of drugs which are used in first line treatment in the spread of breast cancer are aromatase inhibitors, of which there are three generally used. Arimidex or anastrozole, Femara or letrozole, exemestane or Aromasin, are the three used as first line treatment in the spread of breast cancer.

The drug that is used most often in prevention of breast cancer in treating newly diagnosed breast cancer is tamoxifen. The brand name is Nolvadex.

CATHY CONLEY: The main hormonal agents are all beneficial, but they vary in their benefits and side effects.

LODOVICO BALDUCCI, MD: One major benefit of the hormonal therapies, not only that it is so active, but also it is much less toxic than chemotherapy. This SERM, the selective estrogen receptor modulators, include Tamoxifen, which is a time-honored drug, Toremifene, which is practically equivalent with Tamoxifen, may have some minor benefit. The use of Tamoxifen in the adjuvant setting is associated with a decrement of 30% in the mortality rate of breast cancer.

So they were very safe and very effective medications. They have some problems, however. They are associated with increased risk of blood clot, with an increased risk of strokes, with an increased risk of cancer of the endometrium, of the uterus. It's a very small risk.

Now there is this new generation of product called aromatase inhibitors. The way that these compounds work is by depriving completely the tissues of estrogen. That gives them some edge over estrogen antagonists. In that way, they really eliminate the source of fuel that stimulate the growth of the tumor.

How are we going to choose which one is the best? The best way, of course, would be a side-to-side comparison. On the basis of the information that we have, the effectiveness of Aromasin seems to be a little better than the effectiveness of the other drugs. It was shown that it still has about a 25% response rate in people who progress while receiving letrozole or receiving anastrozole. It looks like Aromasin may have a mild androgenic effect. That may be very instrumental in reducing the risk of hot flashes.

CATHY CONLEY: Dr. Mortimer, you presented data on the effects of tamoxifen on sexuality and cognition. Tell us about that.

JOANNE E. MORTIMER, MD: What it does on sexuality is not actually favorable. It seems as though tamoxifen is actually associated with a decrease in libido, a decreased ability to become aroused sexually, and a decreased ability to have orgasm. Most women don't complain about that, but I think that it is an issue that we need to consider as long as we keep women on hormones like tamoxifen for long periods of time.

CATHY CONLEY: Tell us about the implications of these results.

JOANNE E.