Hormone Therapy for Prostate Cancer Tied to Depression

Excerpt:

“Hormone therapy for prostate cancer may increase the risk for depression, a new analysis has found.

“Hormone therapy, or androgen deprivation therapy, a widely used prostate cancer treatment, aims to reduce levels of testosterone and other male hormones, which helps limit the spread of prostate cancer cells.

“From 1992 to 2006, researchers studied 78,552 prostate cancer patients older than 65, of whom 33,382 had hormone therapy.”

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Intermittent Hormonal Therapy Proves to be Viable in Prostate Cancer

“With no significant difference between intermittent and continuous androgen-deprivation therapy, patients with prostate cancer may experience an improvement in their quality of life with the former.

“Androgen-deprivation therapy may be an effective treatment in prostate cancer, though its side effects may result in a loss of quality of life for patients. Allowing low-risk patients to take breaks between treatments—a practice known as intermittent hormonal therapy, or a ‘hormone holiday’—may combat these challenges without impacting survival.

” ‘Intermittent hormonal therapy has been growing in popularity over the years. Patients who receive hormone therapy often have side effects, and giving them so-called “hormone holidays” may improve quality of life. Over the years, there has really been a lot of trials and experimental work that laid the groundwork for this going back 20 years,’ said Leonard G. Gomella, MD, in an interview with Targeted Oncology.”


“Hormone Holiday” Can Improve QoL for Select Patients With Prostate Cancer

“Androgen-deprivation therapy, while an effective treatment for prostate cancer, can result in side effects and a reduced quality of life. Allowing low-risk patients to take breaks between treatments—a practice known as intermittent hormonal therapy, or a ‘hormone holiday’—may combat these challenges without impacting survival.

“A recent systematic review and meta-analysis conducted by JAMA Oncology found no significant difference between intermittent and continuous therapy for overall survival (HR, 1.02; 95% CI, 0.93-1.11; 8 trials, 5352 patients), cancer-specific survival (HR, 1.02; 95% CI, 0.87-1.19; 5 trials, 3613 patients), and progression-free survival (HR, 0.94; 95% CI, 0.84-1.05; 4 trials, 1774 patients).”


Early Chemotherapy Improves Survival for Men with Prostate Cancer

“Two papers from UCL show that having early chemotherapy improves survival for men with prostate cancer. The papers, published in the Lancet and Lancet Oncology, report the results from the STAMPEDE clinical trial and a meta-analysis.

“Both papers looked at the use of a chemotherapy drug called docetaxel. Docetaxel is already used for men with prostate cancer once hormone therapy has stopped working. In STAMPEDE and the meta-analysis, the researchers looked at using it earlier, when men are starting long-term hormone therapy. Both studies found that adding docetaxel improved survival for these men.

“The studies also looked at whether the drug zoledronic acid improves survival. Zoledronic acid is used to reduce the risk of bone problems in men whose cancer has spread to their bones, and whose hormone therapy has stopped working. The new studies looked at using it earlier, when men are starting long-term hormone therapy. Both studies found that adding zoledronic acid did not improve survival for these men.”


ESMO Asia 2015 Press Release: Asian Women with Endocrine-Resistant Breast Cancer Benefit from Combination Therapy

“Data collected in Japanese and Korean patients included in the global PALOMA3 trial provides evidence that combining palbociclib with fulvestrant is an effective strategy to overcome endocrine resistance in women with hormone receptor positive (HR+), HER2 negative (HER2-) advanced breast cancer. The analysis of efficacy and safety of the combined therapy in an Asian population will be presented (1) at the first ESMO Asia 2015 Congress in Singapore, and results are in line with those reported in all patients (both Asian and non-Asian) earlier this year.

“Endocrine resistance is a major clinical issue that makes advanced breast cancer more difficult to treat. Hormone therapy is generally well tolerated and an easy-to-administer option for breast cancer, with demonstrated benefits in patients whose tumours express hormone receptors (HR), particularly the HR+/HER2- subgroup. The ideal option for patients is to be on one endocrine therapy after another, as long as the disease responds or remains unchanged. ‘However, unavoidably, resistance develops in almost all advanced patients a median ten months after the first-line hormonal agent is administered, and a much shorter median time after the second- or third-line hormonal agents, eventually driving patients to switch to the more toxic chemotherapy,’ one of the study authors, Dr. Jungsil Ro, Center for Breast Cancer at the National Cancer Center, Goyang, Korea, said.”


Hormone Therapy for Prostate Cancer Tied to Possible Alzheimer's Risk

“Hormone therapy for prostate cancer might dramatically increase a man’s risk of developing Alzheimer’s disease, a large-scale analysis of health data suggests.

“Men who underwent  (ADT) for their prostate cancer had nearly twice the risk of Alzheimer’s, when compared to prostate cancer patients who didn’t receive hormone therapy, researchers found.

“The risk increased even more if men received hormone therapy for longer than a year, said study lead author Dr. Kevin Nead, a radiation oncology resident at the University of Pennsylvania’s Perelman School of Medicine in Philadelphia.”


Radiotherapy May Help in Node-Positive Prostate Cancer

“Adding prostate and pelvic radiotherapy (RT) to hormone therapy appears to cut relapse rates in men newly diagnosed with high-risk nonmetastatic (M0) node-positive prostate cancer, according to an exploratory analysis by European investigators.

“In a November 25 online paper in JAMA Oncology, Dr. Nicholas D. James of the University of Warwick, Coventry, UK, and colleagues note that they came to this conclusion using data collected between 2005 and 2014 in 721 patients allocated to the control arm (standard-of-care only) of the STAMPEDE Trial.

“Dr. James told Reuters Health by email that these data ‘form part of a pair of publications detailing outcomes in the control arm of STAMPEDE and help to make sense of the forthcoming paper on the randomized comparisons currently in press at The Lancet.’ “


New Study Could Save Breast Cancer Patients Time, Money and Side Effects

“Most breast cancer patients with invasive lobular carcinoma could be treated with hormones alone and not with chemotherapy, according to a study by Virginia Piper Cancer Institute at Abbott Northwestern Hospital, part of Allina Health.

“Researchers reviewed all consecutive cases of invasive lobular carcinoma  diagnosed at the Allina Health Laboratory from the past eight years. Included were 158 patients with invasive lobular carcinoma breast cancer who also had molecular testing with the Oncotype DX gene expression test.

“With Allina Health pathologists, researchers defined a model that included characteristics of a tumor most predictive of the recurrence risk identified on the Oncotype DX gene expression test: progesterone receptor expression, Ki-67 (proliferation index), estrogen receptor expression, patient age and tumor size.”


Early Stage Breast Cancer May Not Require Chemo

“Researchers report in the New England Journal of Medicine (NEJM) the strongest evidence yet that some women with early stage breast tumors may not need chemotherapy to effectively treat their cancer. For some women, hormone-based anti-tumor drugs may be all they need to enjoy 98% survival at five years and a 93.8% chance of being free of invasive breast cancer in that time as well.

“The key to identifying these women lies with a gene-based test called Oncotype Dx, which scans 21 genes in the tumor to create a dossier of the tumor’s strengths and weaknesses. The information helps doctors to determine how potentially aggressive, or not, a tumor might be. Allowed on the market as a clinical laboratory test in 2004, it produces a recurrence score from 0 to 100 and helps doctors determine whether women should be treated with chemotherapy. Lower scores generally indicate that hormone-based drug therapies are enough, while higher recurrence scores push physicians to consider chemotherapy to lower the risk of the cancer returning.”