Hormonal Therapy

Hi Brandi, I did not take this, but I took Arimidex and had such severe side effects that I had to stop. Reactions to these meds vary; some women do fine on one drug and have reactions to others. I told my doctor right away, she had me stop for a while, tried again, but was always immobilized with pain. It can be dangerous to stop a drug without supervision, as some meds can cause a rebound effect, so check with your doctor. You can look up side effects of fareston here, and search for any other med: www.rxlist.com/fareston-drug.htm
Good luck! Hi Brandi, I did not take this, but I took Arimidex and had such severe side effects that I had to stop. Reactions to these meds vary; some women do fine on one drug and have reactions to others. I told my doctor right away, she had me stop for a while, tried again, but was always immobilized with pain. It can be dangerous to stop a drug without supervision, as some meds can cause a rebound effect, so check with your doctor. You can look up side effects of fareston here, and search for any other med: www.rxlist.com/fareston-drug.htm
Good luck!

The standard recommendation is for five years of aromatase therapy based on our present knowledge and the results of numerous large clinical trials that compared aromatase inhibitors to tamoxifen. It is also an acceptable strategy to initiate therapy with tamoxifen and switch to an aromatase inhibitor after 2 to 3 years to complete a total of five years of therapy. Based on evidence from a large clinical trial, it is also acceptable to switch to tamoxifen from an aromatase inhibitor; this is an option for individuals who are experiencing difficult side effects with aromatase inhibitors. The standard recommendation is for five years of aromatase therapy based on our present knowledge and the results of numerous large clinical trials that compared aromatase inhibitors to tamoxifen. It is also an acceptable strategy to initiate therapy with tamoxifen and switch to an aromatase inhibitor after 2 to 3 years to complete a total of five years of therapy. Based on evidence from a large clinical trial, it is also acceptable to switch to tamoxifen from an aromatase inhibitor; this is an option for individuals who are experiencing difficult side effects with aromatase inhibitors.

This may vary depending on the individual and their risk for bone density loss or fracture. It is important when starting an aromatase inhibitor that you have a baseline bone mineral density study (referred to as a DEXA scan) and a clinical assessment for other potential risk factors for osteoporosis (defined as a T score < 2.5 on a DEXA scan by the World Health Organization). These risks include older age, previous fracture, low body weight, current tobacco use, and excessive alcohol consumption, among others. I encourage all women starting an aromatase inhibitor to adopt lifestyle changes that promote not only bone health but overall health as well. These include increasing physical activity (including weight bearing exercise), stopping smoking, and taking calcium and vitamin D supplements. Some individuals starting an aromatase inhibitor may be advised to take drug therapy with bisphosphonates if they have osteoporosis or a history of a fracture or osteopenia (http://www.medterms.com/script/main/art.asp?articlekey=8048)(T-score between -1 and -2.5 on a DEXA scan) with other risk factors. There is no consensus on the optimal strategy for monitoring but every two years is a common strategy. This may vary depending on the individual and their risk for bone density loss or fracture. It is important when starting an aromatase inhibitor that you have a baseline bone mineral density study (referred to as a DEXA scan) and a clinical assessment for other potential risk factors for osteoporosis (defined as a T score < 2.5 on a DEXA scan by the World Health Organization). These risks include older age, previous fracture, low body weight, current tobacco use, and excessive alcohol consumption, among others. I encourage all women starting an aromatase inhibitor to adopt lifestyle changes that promote not only bone health but overall health as well. These include increasing physical activity (including weight bearing exercise), stopping smoking, and taking calcium and vitamin D supplements. Some individuals starting an aromatase inhibitor may be advised to take drug therapy with bisphosphonates if they have osteoporosis or a history of a fracture or osteopenia (http://www.medterms.com/script/main/art.asp?articlekey=8048)(T-score between -1 and -2.5 on a DEXA scan) with other risk factors. There is no consensus on the optimal strategy for monitoring but every two years is a common strategy.

The role of hormonal therapy for risk reduction should be carefully considered and discussed with experts in breast cancer risk assessment and management in a shared decision-making environment. Guidelines from expert groups recommend that the risks and benefits of breast cancer prevention be discussed with premenopausal and postmenopausal women who are at high risk for the disease.

Women at high risk may include some women over the age of 60; women with certain high-risk conditions found on breast biopsy, such as lobular carcinoma in situ (LCIS) or atypical ductal or lobular hyperplasia; women between the ages of 35 and 59 years who have a calculated five-year risk of developing breast cancer of 1.7 percent or higher, according to a system called the Gail model. The Gail model uses a woman's current age, age at first menstrual period, age at first live birth, the number of first-degree relatives with breast cancer, and the number and pathologic findings of any breast biopsies to estimate the probability of breast cancer over time. This model, and others, is used by health professionals to calculate an individual’s risk and the results should be interpreted with an expert in breast cancer risk assessment. It is also important to remember that the presence of breast cancer risk factors does not mean that cancer is inevitable as many women with risk factors never develop breast cancer.

Another very important issue is that the Gail model does not consider the risk of cancer associated with inherited breast cancer-predisposing genes such as BRCA1 and BRCA2. If an individual has a strong family history that suggests the possibility of an inherited predisposition to breast cancer, then that individual should be referred for genetic counseling. Other components of a risk/benefit assessment and counseling include a careful discussion of the side effects of hormonal therapy, options for participation in clinical research and healthy lifestyle changes. The role of hormonal therapy for risk reduction should be carefully considered and discussed with experts in breast cancer risk assessment and management in a shared decision-making environment. Guidelines from expert groups recommend that the risks and benefits of breast cancer prevention be discussed with premenopausal and postmenopausal women who are at high risk for the disease.

Women at high risk may include some women over the age of 60; women with certain high-risk conditions found on breast biopsy, such as lobular carcinoma in situ (LCIS) or atypical ductal or lobular hyperplasia; women between the ages of 35 and 59 years who have a calculated five-year risk of developing breast cancer of 1.7 percent or higher, according to a system called the Gail model. The Gail model uses a woman's current age, age at first menstrual period, age at first live birth, the number of first-degree relatives with breast cancer, and the number and pathologic findings of any breast biopsies to estimate the probability of breast cancer over time. This model, and others, is used by health professionals to calculate an individual’s risk and the results should be interpreted with an expert in breast cancer risk assessment. It is also important to remember that the presence of breast cancer risk factors does not mean that cancer is inevitable as many women with risk factors never develop breast cancer.

Another very important issue is that the Gail model does not consider the risk of cancer associated with inherited breast cancer-predisposing genes such as BRCA1 and BRCA2. If an individual has a strong family history that suggests the possibility of an inherited predisposition to breast cancer, then that individual should be referred for genetic counseling. Other components of a risk/benefit assessment and counseling include a careful discussion of the side effects of hormonal therapy, options for participation in clinical research and healthy lifestyle changes.

Initiation of hormonal therapy is commonly begun after the completion of chemotherapy (and after completion of radiation therapy if you receive both). In terms of actual timing, hormonal therapy will typically begin approximately four to six weeks following completion of chemotherapy. A preference for sequential timing of chemotherapy and hormonal therapy, i.e., adjuvant chemotherapy followed by hormonal therapy, was suggested by a clinical trial, in which sequential versus concurrent chemo/hormonal therapy were directly compared and sequential treatment had superior outcomes for disease free and overall survival.

I would add that there are limited clinical data and no consensus on the use of concurrent hormonal therapy and radiation therapy, thus some medical oncologists advise overlap of hormonal therapy with radiation and others advise waiting until radiation is complete. I generally advise waiting until radiation is complete. Initiation of hormonal therapy is commonly begun after the completion of chemotherapy (and after completion of radiation therapy if you receive both). In terms of actual timing, hormonal therapy will typically begin approximately four to six weeks following completion of chemotherapy. A preference for sequential timing of chemotherapy and hormonal therapy, i.e., adjuvant chemotherapy followed by hormonal therapy, was suggested by a clinical trial, in which sequential versus concurrent chemo/hormonal therapy were directly compared and sequential treatment had superior outcomes for disease free and overall survival.

I would add that there are limited clinical data and no consensus on the use of concurrent hormonal therapy and radiation therapy, thus some medical oncologists advise overlap of hormonal therapy with radiation and others advise waiting until radiation is complete. I generally advise waiting until radiation is complete.

Assuming you are talking about adjuvant therapy here, the answer is split into pre and post menopausal women. Most premenopausal women are asked to start on Tamoxifen but some may get an AI plus a zoladex shot (to make them postmenopausal). In that case, the advice is 5 years. If you are premenopausal and start on Tamoxifen but then become postmenopausal, you may be switched to an AI for 5 years after 5 years of tamoxifen.

For postmenopausal women, it is typically 5 years of an AI only OR it could be 5 years of an AI AFTER 5 years of tamoxifen.
Assuming you are talking about adjuvant therapy here, the answer is split into pre and post menopausal women. Most premenopausal women are asked to start on Tamoxifen but some may get an AI plus a zoladex shot (to make them postmenopausal). In that case, the advice is 5 years. If you are premenopausal and start on Tamoxifen but then become postmenopausal, you may be switched to an AI for 5 years after 5 years of tamoxifen.

For postmenopausal women, it is typically 5 years of an AI only OR it could be 5 years of an AI AFTER 5 years of tamoxifen.

There were some early reports in the literature that soy foods may reduce the effectiveness of Tamoxifen in animal studies, but at least one study from the Univ of So Cal (wu, JCO, 2007) showed that soy food consumption had no effect on the active metabolites of Tamoxifen in Asian American breast cancer survivors. There were some early reports in the literature that soy foods may reduce the effectiveness of Tamoxifen in animal studies, but at least one study from the Univ of So Cal (wu, JCO, 2007) showed that soy food consumption had no effect on the active metabolites of Tamoxifen in Asian American breast cancer survivors.

The answer is no. There are no specific hormonal therapy to be used after completing all the treatment for hormone positive primary inflammatory breast cancer. This is a rare and an aggressive disease. The rareness unfortunately does not allow to study the role of the hormone therapy in inflammatory breast cancer. The answer is no. There are no specific hormonal therapy to be used after completing all the treatment for hormone positive primary inflammatory breast cancer. This is a rare and an aggressive disease. The rareness unfortunately does not allow to study the role of the hormone therapy in inflammatory breast cancer.

I took a three-pronged approach to managing my estrogen. First, I decided to have my ovaries removed about a year after I finished treatment. I had had a simply hysterectomy a decade ago, so I still was ovulating even though I wasn't menstruating. Second, once I went through surgical menopause, I started taking Arimidex. It effectively knocks out estrogen produced by the adrenals. Finally, I have studied all of the dietary sources and tried to make sense of the research. The plant sources of estrogen are many, and the research on its effects for breast cancer is contradictory. I have decided to be very moderate in my consumption of soybeans, for eaxmple. I took a three-pronged approach to managing my estrogen. First, I decided to have my ovaries removed about a year after I finished treatment. I had had a simply hysterectomy a decade ago, so I still was ovulating even though I wasn't menstruating. Second, once I went through surgical menopause, I started taking Arimidex. It effectively knocks out estrogen produced by the adrenals. Finally, I have studied all of the dietary sources and tried to make sense of the research. The plant sources of estrogen are many, and the research on its effects for breast cancer is contradictory. I have decided to be very moderate in my consumption of soybeans, for eaxmple.

Deciding to take any medication is a personal decision and the benefits and risks specific to you should be taken into consideration.

Some of the factors that should be considered are:
- specifics of the diagnosis - hormone receptor status, stage of disease, etc.
- family history and hereditary risk of breast cancer
- specifics of the prognosis
- risk of recurrence
- treatment and surgery history
- personal risk tolerance
- potential benefits and risks of tamoxifen

Potential benefits of tamoxifen for hormone receptor positive breast cancer:
- helps to prevent growth of cancer in the breast
- reduces the risk of cancer recurrence in the breast
- reduces the risk of new cancer in the breast

Potential risks of tamoxifen:
- increases the risk of blood clots, strokes, uterine cancer, and cataracts
- less serious side effects are similar to menopause, such as: hot flashes and vaginal discharge

High benefit of tamoxifen example:
Someone who has had a lumpectomy for an invasive cancer and positive lymph nodes is probably a high risk of recurrence and the benefits of tamoxifen likely outweigh the risks. Unless this person has a high risk of blood clots, in which case they should consider other hormonal treatment options.

Low benefit of tamoxifen example:
Someone who has had a bilateral mastectomy for a non-invasive cancer (DCIS) is probably a low risk for recurrence and the risks of tamoxifen would likely outweigh the benefits. Deciding to take any medication is a personal decision and the benefits and risks specific to you should be taken into consideration.

Some of the factors that should be considered are:
- specifics of the diagnosis - hormone receptor status, stage of disease, etc.
- family history and hereditary risk of breast cancer
- specifics of the prognosis
- risk of recurrence
- treatment and surgery history
- personal risk tolerance
- potential benefits and risks of tamoxifen

Potential benefits of tamoxifen for hormone receptor positive breast cancer:
- helps to prevent growth of cancer in the breast
- reduces the risk of cancer recurrence in the breast
- reduces the risk of new cancer in the breast

Potential risks of tamoxifen:
- increases the risk of blood clots, strokes, uterine cancer, and cataracts
- less serious side effects are similar to menopause, such as: hot flashes and vaginal discharge

High benefit of tamoxifen example:
Someone who has had a lumpectomy for an invasive cancer and positive lymph nodes is probably a high risk of recurrence and the benefits of tamoxifen likely outweigh the risks. Unless this person has a high risk of blood clots, in which case they should consider other hormonal treatment options.

Low benefit of tamoxifen example:
Someone who has had a bilateral mastectomy for a non-invasive cancer (DCIS) is probably a low risk for recurrence and the risks of tamoxifen would likely outweigh the benefits.

There are three different types of hormonal therapy medicines:

- AIs (Aromatase Inhibitors):
- Arimidex (anastrozole)
- Aromasin (exemestane)
- Femara (letrozole)

- SERMs (Selective Estrogen Receptor Modulators):
- tamoxifen
- Evista (raloxifene)
- Fareston (toremifene)

- ERDs (Estrogen Receptor Down Regulators):
- Faslodex (fulvestrant) There are three different types of hormonal therapy medicines:

- AIs (Aromatase Inhibitors):
- Arimidex (anastrozole)
- Aromasin (exemestane)
- Femara (letrozole)

- SERMs (Selective Estrogen Receptor Modulators):
- tamoxifen
- Evista (raloxifene)
- Fareston (toremifene)

- ERDs (Estrogen Receptor Down Regulators):
- Faslodex (fulvestrant)

First of all, your physician should test to make sure that you are post-menopausal.

Aromatase inhibitors are the most common hormonal treatment for post-menopausal women. The three most prescribed are:
- Arimidex (chemical name: anastrozole)
- Femara (chemical name: letrozole)
- Aromasin (chemical name: exemestane)

Alternative treatments are:
- tamoxifen
- Faslodex (fulvestrant)
- Fareston (toremifene)
- Megace (megestrol)
- Halotestin (fluoxymesterone)

A combination of the above therapies might be considered in some cases.

If the side effects are too severe, you might consider changing treatments.

Sometimes though, the cancer changes and the hormonal treatment is ineffective or might even fuel the cancer. In these cases, the treatments should stop and potentially another hormonal therapy can be tried. First of all, your physician should test to make sure that you are post-menopausal.

Aromatase inhibitors are the most common hormonal treatment for post-menopausal women. The three most prescribed are:
- Arimidex (chemical name: anastrozole)
- Femara (chemical name: letrozole)
- Aromasin (chemical name: exemestane)

Alternative treatments are:
- tamoxifen
- Faslodex (fulvestrant)
- Fareston (toremifene)
- Megace (megestrol)
- Halotestin (fluoxymesterone)

A combination of the above therapies might be considered in some cases.

If the side effects are too severe, you might consider changing treatments.

Sometimes though, the cancer changes and the hormonal treatment is ineffective or might even fuel the cancer. In these cases, the treatments should stop and potentially another hormonal therapy can be tried.

Potential benefits of tamoxifen for hormone receptor positive breast cancer:
- helps to prevent growth of cancer in the breast
- reduces the risk of cancer recurrence in the breast
- reduces the risk of new cancer in the breast

Potential risks of tamoxifen:
- increases the risk of blood clots, strokes, uterine cancer, and cataracts
- less serious side effects are similar to menopause, such as: hot flashes and vaginal discharge

Research thus far has not shown that tamoxifen and other anti-estrogen medications are effective for hormone (estrogen and progesterone) receptor negative breast cancer tumors. Potential benefits of tamoxifen for hormone receptor positive breast cancer:
- helps to prevent growth of cancer in the breast
- reduces the risk of cancer recurrence in the breast
- reduces the risk of new cancer in the breast

Potential risks of tamoxifen:
- increases the risk of blood clots, strokes, uterine cancer, and cataracts
- less serious side effects are similar to menopause, such as: hot flashes and vaginal discharge

Research thus far has not shown that tamoxifen and other anti-estrogen medications are effective for hormone (estrogen and progesterone) receptor negative breast cancer tumors.

Tamoxifen may be considered as a potential treatment for hormone receptor positive breast cancers in the following situations:
- to prevent growth of early-stage breast cancer (i.e. DCIS - ductal carcinoma in situ)
- to prevent growth of metastatic breast cancer
- as adjuvant therapy (treatment after the primary treatment to reduce chance of recurrence or continued growth)
- to prevent development of breast cancer in high risk women
- adjunctive and palliative treatment of advanced breast cancer

Research thus far has not shown that tamoxifen and other anti-estrogen medications are effective for hormone (estrogen and progesterone) receptor negative breast cancer tumors. Tamoxifen may be considered as a potential treatment for hormone receptor positive breast cancers in the following situations:
- to prevent growth of early-stage breast cancer (i.e. DCIS - ductal carcinoma in situ)
- to prevent growth of metastatic breast cancer
- as adjuvant therapy (treatment after the primary treatment to reduce chance of recurrence or continued growth)
- to prevent development of breast cancer in high risk women
- adjunctive and palliative treatment of advanced breast cancer

Research thus far has not shown that tamoxifen and other anti-estrogen medications are effective for hormone (estrogen and progesterone) receptor negative breast cancer tumors.

For pre-menopausal women with estrogen positive breast cancer, the hormonal treatment options are:
- tamoxifen is the most common treatment
- medications that temporarily stop the ovaries from producing estrogen are: Zoladex (goserelin acetate), Lupron (leuprolide), or Trelstar (triptorelin)
- surgical removal of ovaries
- radiation treatment to stop ovaries from working

A couple of less common treatments are Megace (megestrol) and Halotestin (fluoxymesterone). These treatments are used in specific cases. For pre-menopausal women with estrogen positive breast cancer, the hormonal treatment options are:
- tamoxifen is the most common treatment
- medications that temporarily stop the ovaries from producing estrogen are: Zoladex (goserelin acetate), Lupron (leuprolide), or Trelstar (triptorelin)
- surgical removal of ovaries
- radiation treatment to stop ovaries from working

A couple of less common treatments are Megace (megestrol) and Halotestin (fluoxymesterone). These treatments are used in specific cases.

For women, reduced estrogen levels sometimes confuses the part of your brain (hypothalamus) that controls your body temperature, appetite, sleep cycles, and appetite. When this happens, the brain will send messages to the heart, blood vessels, and nervous system to increase blood flow, thus causing hot flashes and increased body temperature.

Hot flashes are common with women going through menopause. During menopause, a woman's ovaries produce less estrogen. This is a natural process for women as they age.

Hot flashes may also be caused medically through medications (ovarian shutdown medications and hormonal medications) or removal of ovaries.

Ovarian shutdown medications include: Zoladex (goserelin acetate), Lupron (leuprolide), and Trelstar (triptorelin)
Hormonal medications include: Arimidex (anastrozole), Aromasin (exemestane), Femara (letrozole), Tamoxifen, Evista (raloxifene), Fareston (toremifene), and Faslodex (fulvestrant). For women, reduced estrogen levels sometimes confuses the part of your brain (hypothalamus) that controls your body temperature, appetite, sleep cycles, and appetite. When this happens, the brain will send messages to the heart, blood vessels, and nervous system to increase blood flow, thus causing hot flashes and increased body temperature.

Hot flashes are common with women going through menopause. During menopause, a woman's ovaries produce less estrogen. This is a natural process for women as they age.

Hot flashes may also be caused medically through medications (ovarian shutdown medications and hormonal medications) or removal of ovaries.

Ovarian shutdown medications include: Zoladex (goserelin acetate), Lupron (leuprolide), and Trelstar (triptorelin)
Hormonal medications include: Arimidex (anastrozole), Aromasin (exemestane), Femara (letrozole), Tamoxifen, Evista (raloxifene), Fareston (toremifene), and Faslodex (fulvestrant).

A flare reaction is a temporary worsening in the symptoms. Hormonal therapies can cause a "flare" reaction shortly after they are started. Although uncomfortable, a tumor flare reaction can be a sign that the hormonal treatment is working and is often followed by a positive response. Patients should be monitored closely the first few weeks after beginning treatment. If needed, side effects can be treated.

The worsening symptoms could be an increase in pain, tumor size, redness around the tumor, or new lesions. A flare reaction is a temporary worsening in the symptoms. Hormonal therapies can cause a "flare" reaction shortly after they are started. Although uncomfortable, a tumor flare reaction can be a sign that the hormonal treatment is working and is often followed by a positive response. Patients should be monitored closely the first few weeks after beginning treatment. If needed, side effects can be treated.

The worsening symptoms could be an increase in pain, tumor size, redness around the tumor, or new lesions.