In this section, we try and answer three questions in the expectations during hormonal therapy:
Hormonal therapy regimen differs from person to person depending upon the clinical condition of the patient. There are seven hormonal therapies available and different therapy is given for different reason. Some are administered post menopausal, some pre menopausal.
Factors like the menopausal status, stage of breast cancer, medical history of blood clots, arthritis, personal risk of uterine and ovarian cancer, also side effects from one particular hormonal therapy helps decide any one treatment regime.
Early stage breast cancer and postmenopausal: in hormonal therapy, aromatase is recommended as the initial first medication for early-stage, hormone-receptor-positive breast cancer in postmenopausal women. Commonly after a 2 -3 year curse of tamoxifen, women may be switched on to aromatase inhibitors. For further reduction in recurrence risk, at times aromatase inhibitors are used for another 5 years following tamoxifen.
Early-stage Breast Cancer and Premenopausal: Tamoxifen is recommended for early-stage hormone-receptor-positive breast cancer in premenopausal women.
Advanced Breast Cancer: for advanced (metastatic) hormone-receptor-positive breast cancer in women, it is recommended that post a 2 – 5 years course of tamoxifen, an aromatase inhibitor should be started. Also if and when the cancer cells stop reacting nd responding to tamoxifen, the aromatase inhibitor can be started. After some time if it is observed that the cancer cells are not responding to either aromatase inhibitors and neither tamoxifen, the patient can be put on faslodex.
The duration of the hormonal therapy is dependent on the stage of cancer when the medicine intake was initiated. Also other factors like the intake of medicine, if it is pre or post surgery and the side effects of a particular regimen may decide the duration of the hormonal therapy.
Post surgery, commonly hormonal therapy is taken for pre menopausal women for women with early stage hormone receptor positive breast cancer. This therapy is taken for usually a period of five years and is termed as adjuvant hormonal therapy.
Also in certain cases on the completion of a 5 year course of one hormonal therapy medicine, doctors recommend taking a different hormonal therapy medicine. This is called extended adjuvant hormonal therapy. For instance post surgery after a 5 year course of tamoxifen, patient may be put on aromatase inhibitor for additional time period.
Pre surgery, commonly hormonal therapy is taken for 3 – 6 months ( to shrink cancer) before surgery in post menopausal women with an early stage hormone receptor positive breast cancer. This is termed as neoadjuvant hormonal therapy. This may be recommended in large cancers before surgery to shrink the size of the cancer.
Hormonal therapy is administered for as long as it is required in treatment of advanced (metastatic) hormone receptor positive breast cancer in Pre- or postmenopausal women. It is continued in such cases as long as the breast cancer is responding to the hormonal therapy, later the doctor may recommend a different hormonal therapy if the initial one stops working.
Except one hormonal therapy medicine which is Faslodex all the other hormonal therapy medicines are available as pills and be taken orally. It is advisable to take the pills at the same time everyday for easy remembrance. These hormonal therapy medicines need not be taken with food necessarily. Faslodex is the only hormonal therapy medicine which is available as an injection and is given usually at the doctor’s office/clinical setting once a month. It is injected into the muscle.