Expert Raises QoL Concerns With Adjuvant Hormonal Therapy in ER+ Breast Cancer

Excerpt:

“As research of early-stage estrogen receptor (ER)-positive breast cancer continues, experts are relying more on extended adjuvant hormonal therapy with aromatase inhibitors, but are concerned about patient quality of life (QoL) with such treatment.

” ‘My passion is to really try to figure out how to make the side effects of these therapies more tolerable and how to help women be able to actually have reasonably good and normal QoL while they’re taking these therapies, so that we can increase compliance,’ said Michelle E. Melisko, MD.”

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ESMO 2017 Press Release: Patients with High Risk Prostate Cancer May Benefit “Equally” From Two New Treatments

Excerpt:

“Patients with high risk prostate cancer starting long-term hormone therapy may benefit from two new treatments, according to late-breaking results from the STAMPEDE trial presented at the ESMO 2017 Congress in Madrid.

“Long-term hormone therapy alone has been the standard of care for patients with high risk locally advanced or metastatic prostate cancer since the 1940s.”

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Video: Dr. Matthew Cooperberg on Surgery for Aggressive Prostate Cancer

“Matthew Cooperberg, MD, genitourinary cancer specialist, University of California San Francisco, discusses the rise in aggressive management of men with high-risk prostate cancer. Cooperberg says the proportion of men who are receiving hormonal therapy alone had been rising consistently over the course of a 15 year period, up until 2010, to about 50%. Since then, Cooperberg says that number has dropped to about half of what it was, or 25%, which is attributed to more aggressive treatment.

“Cooperberg says local therapy for men with high-risk prostate cancer was normally radiotherapy, with surgery not being nearly as common. He adds that a growing body of evidence dictates that surgery in prostate cancer may be a more effective local therapy than radiation alone. According to the body of evidence, cancer-related survival and overall survival were normally boosted when surgery was involved for these patients.”

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ASCO Recommends Ovarian Suppression for ER-Positive Breast Cancer

“An American Society of Clinical Oncology (ASCO) expert panel issued an updated guideline recommending that higher-risk premenopausal women with estrogen receptor (ER)-positive breast cancer receive ovarian suppression in addition to adjuvant endocrine therapy. Lower-risk patients, however, should not receive ovarian suppression.

“ ‘In the past year, randomized trials with robust methodological designs have analyzed the effect of ovarian suppression among premenopausal women with ER-positive breast cancers treated with tamoxifen,’ wrote the panel, led by ASCO expert Harold J. Burstein, MD, PhD, of Dana-Farber Cancer Institute in Boston. In the past, studies of this therapy have suffered from problems such as selection criteria confounding.

“The guideline update is based on four randomized controlled trials. These include the Eastern Cooperative Oncology Group 3193 (E-3193) trial, the Suppression of Ovarian Function Trial (SOFT), the Tamoxifen and Exemestane Trial (TEXT), and the Austrian Breast Cancer Study Group (ABCSG)-12 trial. Overall, the studies did not find a significant difference with regard to overall survival between tamoxifen alone, tamoxifen plus ovarian suppression, or aromatase inhibitors (AIs) plus ovarian suppression. The guideline update was published in the Journal of Clinical Oncology.”


New Image Analytics May Offer Quick Guidance for Breast Cancer Treatment

“For women with the most common type of breast cancer, a new way to analyze magnetic resonance images (MRI) data appears to reliably distinguish between patients who would need only hormonal treatment and those who also need chemotherapy, researchers from Case Western Reserve University report.

“The analysis may provide women diagnosed with estrogen positive-receptor (ER-positive)  answers far faster than current tests and, due to its expected low cost, open the door to this kind of testing worldwide.

“The research is published in the journal Nature Scientific Reports.”


Hormonal Therapy May Prevent Ovarian Failure and Preserve Fertility in Breast Cancer

“Young women undergoing chemotherapy for breast cancer may be more likely to remain fertile if they also receive hormonal treatment, according to new research presented to the 2015 European Cancer Congress on Monday and published simultaneously in Annals of Oncology.

“Researchers will tell the Congress that the addition of treatment with a so-called luteinising hormone-releasing hormone analogue, or LHRHa, during , could protect women’s ovaries. The approach may increase the chances of pregnancy after treatment.

“Dr Matteo Lambertini, MD, a medical oncologist at the IRCCS AOU San Martino-IST, Genoa, Italy, will say: ‘Chemotherapy can damage the ovaries and push young women into the menopause. They may experience infertility, sleep disturbance, sexual dysfunction and osteoporosis. It is psychologically distressing, harmful to health, and affects the treatment decisions of many young women.’

” ‘We found that temporary suppression of ovarian function with LHRHa significantly reduces the risk of premature ovarian failure (POF) caused by chemotherapy. It also seems to be associated with a higher pregnancy rate in young breast cancer patients.’ “


Black Women Less Likely to Take Breast Cancer Hormone Therapy

“Among early-stage breast cancer patients in the U.S., black women are less likely than white women to take their prescribed hormone medications, according to a new study that partly – but not entirely – blames economic disparities between races.

“Black women are less likely to be diagnosed with breast cancer than white women, but more likely to die from it, a disparity that emerged in the 1980s and has widened ever since, the authors note in the introduction.

“When it comes to hormone prescriptions, women with fewer financial resources and higher prescription drug co-pays, which are more common for black women, are less likely to stick to the therapy, according to the new study that was led by Dr. Dawn L. Hershman of Herbert Irving Comprehensive Cancer Center at Columbia University in New York.

“For the study, Hershman’s team used an insurance claims database including more than 10,000 women over age 50 who were diagnosed with early-stage breast cancer between 2007 and 2011 and given a prescription for aromatase inhibitors or tamoxifen, both hormonal therapies.”


Strategy Might Thwart Resistance to a Common Prostate Cancer Treatment

“Conventional wisdom has it that high levels of testosterone help prostate cancers grow.”However, a new, small study suggests that a treatment strategy called bipolar androgen therapy—where patients alternate between low and high levels of testosterone—might make prostate tumors more responsive to standard hormonal therapy.

“As the researchers explained, the primary treatment for advanced prostate cancer is hormonal therapy, which lowers levels of testosterone to prevent the tumor from growing. But there’s a problem: Prostate cancer cells inevitably overcome the therapy by increasing their ability to suck up any remaining testosterone in the body.

“The new strategy forces the tumor to respond again to higher testosterone levels, helping to reverse its resistance to standard therapy, the researchers say.

“If confirmed in several ongoing larger trials, ‘this could lead to a new treatment approach’ for prostate cancers that have grown resistant to hormonal therapy, said lead researcher Dr. Michael Schweizer, an assistant professor of oncology at the University of Washington School of Medicine in Seattle.”


Study Discounts Testosterone Therapy for Early Prostate Cancer

“For decades, millions of men with early prostate cancer have been placed on drug therapy to suppress their production of testosterone, despite such significant side effects as impotence, diabetes and bone loss. Now a large new analysis has concluded that so-called androgen deprivation therapy does not extend the lives of these patients.

“ ‘There are so many side effects associated with this therapy, and really little evidence to support its use,’ said Dr. Grace L. Lu-Yao, a researcher at the Rutgers Cancer Institute of New Jersey and the lead author of the report, published on Monday in JAMA Internal Medicine. ‘I would say that for the majority of patients with localized prostate cancer, this is not a good option. ”

“Dr. Lu-Yao and her colleagues followed tens of thousands of men with early prostate cancer for as long as 15 years and found that those who received androgen deprivation therapy lived no longer on average than those who did not. The study joins a growing body of evidence indicating that for many men with early prostate cancer, avoiding testosterone-suppressing drugs altogether may be better than grappling with their potentially devastating toll.”

“One expert who was not involved in the new study, Dr. James M. McKiernan, acting chairman of urology at NewYork-Presbyterian Hospital/Columbia University Medical Center said its findings were ‘eye-opening and even alarming.’ ”

Image: Credit Stuart Bradford