Adjuvant Therapy

The main difference between chemotherapy and radiation therapy is the fact that chemotherapy is a systemic treatment and radiation is a local treatment. In this sense radiation is similar to surgery and would only address the area which is receiving radiation. With chemotherapy, once it is injected into your blood stream, it goes everywhere in your system. That is like a double-edge sword though because often it affects organs which do not necessarily need to receive chemotherapy such as your hair, your nails, your bone marrow, or kidney etc. But the fact that it addresses your entire system has the advantage of killing any cancer cell that potentially has cut loose through your system. More and more research is done on creating mechanisms towards targeted therapy that is to direct chemotherapy towards the cancer cells only and avoid side effects of chemotherapy by sparing the normal tissues. The main difference between chemotherapy and radiation therapy is the fact that chemotherapy is a systemic treatment and radiation is a local treatment. In this sense radiation is similar to surgery and would only address the area which is receiving radiation. With chemotherapy, once it is injected into your blood stream, it goes everywhere in your system. That is like a double-edge sword though because often it affects organs which do not necessarily need to receive chemotherapy such as your hair, your nails, your bone marrow, or kidney etc. But the fact that it addresses your entire system has the advantage of killing any cancer cell that potentially has cut loose through your system. More and more research is done on creating mechanisms towards targeted therapy that is to direct chemotherapy towards the cancer cells only and avoid side effects of chemotherapy by sparing the normal tissues.

There is no dosage adjustment of letrozole for patients with normal kidney and liver function. The physician will monitor for kidney and liver function using kidney and liver function tests and change medications if needed.

- With mild to moderate impairment of the liver, the dose of letrozole will not be changed.
- For post menopausal women taking Letrozole with liver problems (cirrhosis and severe hepatic impairment), as determined by liver function tests, the dose recommended for this patient population is 2.5mg every other day.
- There is no change in dosage requirements for patients with a creatinine clearance of the kidneys greater than or equal to 10ml/min.

For more information on this subject, see the following links:
http://www.rxlist.com/femara-drug.htm
http://www.drugs.com/dosage/letrozole.html There is no dosage adjustment of letrozole for patients with normal kidney and liver function. The physician will monitor for kidney and liver function using kidney and liver function tests and change medications if needed.

- With mild to moderate impairment of the liver, the dose of letrozole will not be changed.
- For post menopausal women taking Letrozole with liver problems (cirrhosis and severe hepatic impairment), as determined by liver function tests, the dose recommended for this patient population is 2.5mg every other day.
- There is no change in dosage requirements for patients with a creatinine clearance of the kidneys greater than or equal to 10ml/min.

For more information on this subject, see the following links:
http://www.rxlist.com/femara-drug.htm
http://www.drugs.com/dosage/letrozole.html

Letrozole (Femara) may be employed for breast cancer in these circumstances:
- Early adjuvant treatment for hormone receptor positive (HR+) breast cancer in post-menopausal women. It is unknown how long letrozole should be taken, but the duration of the clinical trial was 5 years. Adjuvant treatment is the administration of letrozole after surgery, radiation, and/or chemotherapy.
- Extended adjuvant treatment for hormone receptor positive (HR+) breast cancer in postmenopausal women who have received 5 years of adjuvant tamoxifen treatment. The ideal length of treatment is not known, as the international study of 5,187 postmenopausal women discovered that when letrozole was taken after completing five years of tamoxifen therapy, there was a decrease in breast cancer recurrences. Treatment may be discontinued if there is a relapse.
- As first or second-line treatment of breast cancer that has advanced in menopausal women after anti-estrogen treatment. Administration may be continued until the breast cancer tumor worsens or metastasizes.
- Locally advanced or metastasized breast cancer with hormone receptor positive or unknown hormone origin.

Here are a couple of other sites to visit for more information.
http://www.ncbi.nlm.nih.gov/pubmed/15161328
http://www.cancer.gov/cancertopics/druginfo/letrozole Letrozole (Femara) may be employed for breast cancer in these circumstances:
- Early adjuvant treatment for hormone receptor positive (HR+) breast cancer in post-menopausal women. It is unknown how long letrozole should be taken, but the duration of the clinical trial was 5 years. Adjuvant treatment is the administration of letrozole after surgery, radiation, and/or chemotherapy.
- Extended adjuvant treatment for hormone receptor positive (HR+) breast cancer in postmenopausal women who have received 5 years of adjuvant tamoxifen treatment. The ideal length of treatment is not known, as the international study of 5,187 postmenopausal women discovered that when letrozole was taken after completing five years of tamoxifen therapy, there was a decrease in breast cancer recurrences. Treatment may be discontinued if there is a relapse.
- As first or second-line treatment of breast cancer that has advanced in menopausal women after anti-estrogen treatment. Administration may be continued until the breast cancer tumor worsens or metastasizes.
- Locally advanced or metastasized breast cancer with hormone receptor positive or unknown hormone origin.

Here are a couple of other sites to visit for more information.
http://www.ncbi.nlm.nih.gov/pubmed/15161328
http://www.cancer.gov/cancertopics/druginfo/letrozole

It is also important to note that new cancer cells develop daily, in everyone, not just in cancer patients. Therefore even if the surgeon was able to remove all visable signs of cancer, addtional treaments may be recommended to prevent recurrence or the spread of cancer. The theory behind TAM is that it prevents estrogen from binding to cancer cells; without estrogen, cancer cells cannot survive. To learn more about Tamoxifen, Pros and Cons, please visit:
http://www.cancer.gov/cancertopics/factsheet/Therapy/tamoxifen

There are those who suggest that freshly ground flax seed and Curcumin eaten on a daily basis produce the same benefits as TAM without the side effects. Please discuss this with an Integrative Oncologist if you wish to explore this route. The first step in treating women with breast cancer is to surgically remove the cancer from the breast. It is difficult to be certain though that every cancer cell has been removed at the time of surgery because some breast cancer cells could have spread to surrounding tissues or other organs prior to the operation. Therefore, women often receive some type of treatment after surgery (adjuvant therapy) to prevent the growth of any cancer cells that might remain in the body. Studies show that when tamoxifen is used for this purpose in Estrogen Receptor positive cancers, the risk of cancer recurrence is reduced.