Cancere hormonale. Cum ajuta tratamentul cu hormoni (hormonoterapia) in cancerul mamar

Actualizări în tratamentul hormonal al cancerului de sân

Actualizări în tratamentul hormonal al cancerului de sân

It is applied in patients expressing tumoral hormone receptors ER - estrogen receptor and PGR - progesteron receptor. It is possible that HER2 human epitelial growth factor receptor 2 to have an influence on the response or resistance to hormonal treatment.

This article presents the main cancere hormonale of drugs used cancere hormonale hormonal treatment and their indication, improvements obtained and future perspectives of research. El este aplicat la pacientele la care se identifică în ţesutul tumoral prezenţa receptorilor hormonali ER - receptor estrogen şi PGR - receptor progesteron. Este posibil ca şi statusul HER2 receptorul 2 al factorului de creştere epidermal uman să aibă influenţă asupra răspunsului şi rezistenţei la tratamentul hormonal.

Articolul are drept scop prezentarea principalelor clase de medicamente folosite în tratamentul hormonal şi a prinicipalelor indicaţii, progrese înregistrate şi perspective cancere hormonale viitor.

Tratamentul hormonal în cancer

Cuvinte cheie tratament hormonal cancer de sân modulatori selectivi ai receptorului de estrogen inhibitori de aromatază Introduction Hormones are molecules that act like chemical messengers cancere hormonale the human body.

Their main circulating path is cancere hormonale the blood stream. Estrogen and progesteron are made in the ovaries in premenopausal women, and in other tissues including fat in postmenopausal women. Apart from their classic role female sex characteristics, pregnancy etc.

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To determine the hormonal status, tissue from the tumour is needed. It can be obtained either by biopsy, or by surgery.

cancere hormonale

Main hormone therapy classes Blocking ovarian function - ovaries are the main production site of estrogen in premenopausal women. Blocking of their function can be achieved by cancere hormonale removing ovaries surgically, or by radiation both being definitive methods or, most frequently cancere hormonale today, inhibiting their function temporarily by using  gonadotropin releasing hormone GnRH agonists or luteinizing hormone releasing hormone LH-RH agonists.

Cum ajuta tratamentul cu hormoni (hormonoterapia) in cancerul mamar

Examples: goserelin and leuprolide. The main side effects of these therapies are bone loss, mood swings, depression, and loss of libido. Blocking estrogen production - aromatase inhibitors AI are used to cancere hormonale the production of estrogens from fat and other tissues. They cancere hormonale be given alone in postmenopausal women or in association with ovarian suppression in premenopausal setting. Examples: anastrozole, letrozole cancere hormonale both inactivate temporarily the aromatase enzyme non-steroidal AI - or exemestane, which inactivates the enzyme permanently steroidal AI.

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The main side effects are: cancere hormonale of heart attack, angina, heart failure, and hypercholesterolemia, bone loss, joint pain, mood swings and depression.

Blocking estrogens effects - two drugs block the action of estrogen on the breast tumour cells.

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Selective estrogen receptor modulating agents SERMs : they bind to the receptor, blocking it, thus preventing the binding of estrogen. Examples: tamoxifen and toremifen.

They act like antagonists in some tissues tumour cells and agonists in other uterus, boneinfluencing their safety profile. Common adverse reactions: risk of blood clots, especially in the lungs and legs, stroke, cataract, endometrial cancer, bone loss in premenopausal cancere hormonale.

Other antiestrogen drugs, like fulvestrant: they act similarly to tamoxifen, but without the agonist effect. Furthermore, after binding to the estrogen receptor, they programme it for destruction. This explains the better safety profile and side effects: gastrointestinal symptoms, elevated liver functional tests, loss of strength and pain Taking into account the medical history of patients and other treatments they are undergoing, we must be careful for interactions. For tamoxifen, caution must be taken for patients in treatment with antidepressants from the class of selective cancere hormonale reuptake inhibitors SSRI like paroxetine, which inhibits enzyme CYP2D6.

They slow down tamoxifen metabolization and reduce its effects. Safer alternatives are available, like sertraline, venlafaxine or even considering changing tamoxifen with AI.

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Treatment protocols Prevention. The same cancere hormonale for AI is still under investigation 8. There have been several studies investigating this option, mainly using AI. The purpose is to ob­tain tumour shrinkage in order to allow breast conserving surgery.

Tratamentul hormonal in cancer | adventube.ro

Although there are promising results, currently such therapies are not approved for this indication 9. Some studies show cancere hormonale patients with positive ER levels even with low count benefit from at least 5 years of therapy. Newer studies extend this period to 7 or even 10 years. In premenopausal patients at high risk young age, high grade tumour, lymph node involvmentaromatase inhibitor with associated ovarian suppression or tamoxifen for 5 years can be considered based on SOFT and TEXT trials results.

There are different strategies, involving either starting with tamoxifen for years, then switching to AI or tamoxifen for 5 years and switching afterwards, or starting with AI plus ovarian suppression. Also, we must bear in mind the adverse reactions profile.

For tamoxifen, the cardiovascular risk and of uterine cancer requiring anual echographic monitoringand for AI, mainly the risk for bone health annual DEXA and supplements of calcium, vitamin D and even agents like zoledronic acid or denosumab Endocrine therapy is fairly well supported, with tolerable side effects, and should be given in patients with non-visceral or asymptomatic, and with not high-volume visceral tumours, especially in patients with suggestive factors cancere hormonale good response indolent cancere hormonale, old age, long disease free interval.

There is also the option of fulvestrant, after progression after antiestrogen therapy.

There is a benefit to switch non-steroidal AI like anastrozole with steroidal AI like exemestane after disease progression, cancere hormonale not facing visceral crisis The results of PALOMA-2 trial published in November showed a significant longer progression-free survival in patients on palociclib in combination with letrozole compared to patients on letrozole alone.

However, the addition papilloma della tiroide palciclib caused higher rates of myelotoxic events in the study along with fatigue, nausea, mouth sores, hair loss, and diarrhea. For patients who already progressed on an AI, palbociclib can be given along with fulvestrant Resistance to hormonal treatment Despite good tolerance and response obtained, primary and secondary resistance to hormonal treatment is a concerning reality; phase III studies show that in metastatic breast cancer with positive hormone receptors, only one third of patients have radiological cancere hormonale after IA.

And even in the patients cancere hormonale initially respond, at some point they all develop resistance to treatment, progression, and finally death 18, There are several hypotheses for acquired hormonal resistance: altered expression of ER coregulators, downregulation of ER expression, ER mutations and ligand-independent activation of ER - probably, in real life situations experiencing a combination of all above.

It is well known that tumours exhibiting HER2 human epidermal growth factor receptor 2 are cancer laringian sanse de supravietuire aggressive and have the worst prognostic.

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cancere hormonale There is evidence suggesting that Cancere hormonale family like HERand especially overexpression of HER 2, offers intrinsec resistance to hormonal treatment, thus sustaining the rationale of using also targeted treatment for this case Also, there seems to be a place for liquid biopsies in monitoring response to hormonal treatment and prognosis worse for patients identified with ER mutations by this method Further studies cancere hormonale needed for identifing and characterizing mechanisms cancere hormonale resistance and methods to overcome them.

Conclusions In treating breast cancer, every treatment has its use and rationale.

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Cancere hormonale is obvious that a hormonal treatment with low adverse reaction is preferred for most cancere hormonale the patients, even in the presence of visceral metastasis asymptomatic. The further development of molecular profiling some already available in certain areas - MammaPrint, Oncotype Dxbiomarkers and techniques involving circulating tumour cells seem to bring us cancerul vindecat to the ideal of personalized medicine, where patients receive the treatment that yields the best results for cancere hormonale.

Bibliografie 1. Hormone receptor status, tumor characteristics, and prognosis: a prospective cohort of breast cancer patients. Breast Cancer Research ; 9 1 :R6. Okumura Y, Nishimura R. Lajos Pusztai, Giuseppe Viale. Published online Nov 1. Cancer Prevention Research ; 3 6 — Long-term tamoxifen citrate use and potential ocular toxicity.

American Journal of Ophthalmology ; 4 — Toxicity of adjuvant endocrine therapy in postmenopausal breast cancer patients: a systematic review and meta-analysis. Journal of the National Cancer Institute ; 17 — Double-blind, randomized trial comparing the efficacy and tolerability of cancere hormonale versus anastrozole in postmenopausal women with advanced breast cancer cancere hormonale on prior endocrine therapy: results of a North American trial.

JAMA Neoadjuvant endocrine therapy in primary breast cancer: indications and use as a research tool.

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British Journal of Cancer ; 6 — Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials.

Lancet ; — Untch M, Thomssen C. Clinical practice decisions in endocrine therapy. Cancer Investigation ; 28 Suppl — Assessment of letrozole and tamoxifen alone and in sequence for postmenopausal women with steroid hormone receptor-positive breast cancere hormonale the BIG cancere hormonale randomised clinical trial at 8.

Cum ajuta tratamentul cu hormoni (hormonoterapia) in cancerul mamar

Lancet Oncology ; 12 12 — Adjuvant hormonal therapy for early-stage breast cancer. Surgical Cancere hormonale Clinics of North America ; 19 3 — Prudence A. Francis MD. Bertelli G. Sequential treatment with exemestane and non-steroidal aromatase inhibitors in advanced breast cancer.

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Terapie hormonală

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Nat Rev Cancer 2: — Yarden Y et al. Nat Rev Mol Cell Biol 2: — Nat Rev Cancer 5: — Memorial Sloan Kettering Cancer Center. Potential of liquid biopsy for breast cancer patients: Cancere hormonale blood test could help tailor treatments for advanced breast cancer patients.

ScienceDaily, 11 Decemberwww.

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