Hormone Therapy for Cancer Treatment
Using hormone therapy to treat cancer
Some types of cancer may be sensitive to the effects of hormones, and may respond to a type of treatment known as hormone therapy (also called endocrine therapy).
What is hormone therapy?
Hormone therapy is a type of cancer treatment that blocks the effects of hormones on cancer cells. These medications are frequently used in breast and cancer. There are several types of hormone therapy that work in different ways.
Medications that descrease hormones produced by the body or cancer cells
The medications used in breast cancer are called aromatase inhibitors. Examples include:
- Arimidex (anastrozole)
- Aromasin (exemestane)
- Femara (letrozole).
In cancer, this category includes , such as:
- Lupron (leuprolide)
- Zoladex (goserelen)
It also includes Zytiga (), which blocks the body's ability to make testosterone.
Medications that block cancer cells from using hormones made by the body
There are several types of medications used in breast cancer. This includes:
- selective receptor modulators (SERMs), such as tamoxifen or raloxifene,
- selective receptor degraders (SERDs), such as Faslodex (fulvestrant), Oserdu (elacestrant) and Inluriyo (imnulestrant).
In cancer this includes androgen receptor blockers, such as:
- Casodex (bicalutamide)
- Erleada (apalutamide)
- Eulexin (flutamide)
- Nubeqa (darolutamide)
- Xtandi ()
How is hormone therapy selected?
Doctors consider several pieces of information to decide which hormone therapy, if any, is the best therapy for a patient.
Breast cancer treatment
- ER/PR testing: All breast cancers are tested for biomarkers called receptors (ER) and progesterone receptors (PR). Breast cancers with these biomarkers are called ER-positive and PR-positive or just hormone-positive. ER-positive and PR-positive breast cancers tend to respond to hormone therapy.
- Recurrence scores: Special tests measure the risk for recurrence of ER-positive and PR-positive breast cancer. These tests can help to identify which patients may safely avoid chemotherapy and be treated with hormone therapy alone and for how long. OncotypeDX, Mammaprint and Prosigna are examples of these tests.
- Presence or absence of a tumor know as an ESR1 mutation: Newer hormone drugs known as SERDs work best in cancers that have this .
- of disease: Different hormone therapies are approved for different stages of breast cancer. Some are approved for use in combination with other medications or therapies, especially in people with advanced or breast cancer.
- Prior treatment: When breast cancer grows or recurs after hormone therapy, it is considered to be resistant to that therapy. Your doctor may switch you to a different hormone therapy agent or another type of treatment.
Visit this section to learn more about breast cancer treatment using hormone therapy.
cancer treatment
- Risk group: cancers that appear to be contained within the but are considered to be at high risk for spreading outside of the may be treated with hormone therapy with surgery or radiation.
- Prior treatment: When cancer grows or recurs after surgery, doctors may suggest hormone therapy alone or in combination with other types of treatment.
- Hormone sensitivity: Cancers that grow or recur during androgen deprivation therapy are considered castration-resistant. Doctors may recommend a different type of hormone therapy or another type of treatment in this situation.
- and grade of disease: Different hormone therapies are approved for different stages of cancer. Some hormone therapies are used in combination with other medications or therapies, especially in men with advanced or cancer.
Visit this section to learn more about cancer treatment using hormone therapy.
When is hormone therapy given?
After a diagnosis of cancer, hormone therapy may be used at different time points, with different goals:
- hormone therapy is given before surgery to try to shrink a tumor.
- hormone therapy is given to patients with disease after surgery to remove the tumor, when there is no longer evidence of disease. This is done to decrease risk of the cancer coming back.
- Hormone therapy for advanced or cancers may be used to shrink tumors, reduce symptoms, decrease further spread and help people live longer.
Side effects of hormone therapy
Normally, hormones play an important role in a person's health and wellbeing. Blocking the effects of hormones can cause side effects.
Not all people experience side effects, but those who do may have options for minimizing or eliminating some of them. It's important to talk with your doctor about possible treatment for side effects and how they can be managed. Consider participating in a clinical trial that is looking at new ways to manage hormone therapy side effects.
Some of these effects may improve with medication or other medical interventions. It's important that you report any symptoms or changes in your health to your doctor. You may also report any suspected side effects directly to the online or by calling 1-800-FDA-1088. Some of the more common side effects of hormone therapy may include:
Experts use the terms “normal,” “osteopenia,” or “” to describe bone health and weakening. Osteopenia refers to low bone mass or density. is more serious loss of bone density, which weakens the bones. Aromatase inhibitors (used to treat breast cancer), and (used to treat cancer) can weaken the bones.
Guidelines for all patients on aromatase inhibitors recommend:
- assessment for fracture risk
- exercise and calcium/vitamin D supplementation
- treatment for osteopenia or based on bone density test results
- prescribing denosumab or zoledronate while on an aromatase inhibitor
- prescribing bisphosphonates for all postmenopausal women who have significant risk of their cancer coming back
Guidelines for men on (ADT) recommend:
- bone density testing before and during treatment
- calcium/vitamin D supplementation.
- treatment for osteopenia or based on bone density test results
- prescribing denosumab or zoledronate for men who have risk for fractures
Fatigue may be caused by cancer or treatment, including hormone therapy. Fatigue is common in cancer survivors and can persist years after treatment.
It's important to tell your doctor about any changes in your energy level during your regular visits. Your doctor can check and treat you for any underlying causes, including depression, sleep disturbances and medication side effects.
Although no medications can counteract fatigue caused by hormone therapy, you can take steps to try to improve your energy level, including:
- making sure that your diet is balanced and provides you with adequate nutrition. Ask your doctor for a referral to a nutritionist if you need help meeting your nutritional needs.
- making sure that you get adequate sleep.
- trying to stay physically active, which can help improve your energy level.
Hormone therapy can cause hot flashes in both men and women. During a hot flash a person typically experiences mild to extreme heat throughout the body, which may also be accompanied by sweating, flushing, and a rapid heartbeat. Certain antidepressants, called selective serotonin reuptake inhibitors (SSRIs), may relieve hot flashes. Men with cancer may be able to take a type of hormone replacement known as progesterone to treat hot flashes. Progesterone is not safe for women or men with breast cancer.
Supplements do not effectively treat hot flashes, and some supplements may be harmful. Some people who experience hot flashes find handheld fans and "chillows" that reduce body temperature to be helpful. Others have also reported that exercise, hypnosis, yoga or acupuncture relieves their hot flashes.
Some hormone therapy may interfere with the ability to have children in both men and women. This may be temporary or permanent, depending on the medication and the length of time you are on it. If you are interested in having children, speak with your doctor about your fertility options before starting hormone therapy.
Certain hormone therapies—especially aromatase inhibitors—may cause joint pain. Nonsteroidal anti-inflammatories, such as ibuprofen and antidepressants such as duloxetine (Cymbalta) may improve joint pain caused by these therapies. Exercise, yoga and acupuncture may also help relieve joint pain.
Difficulty focusing or changes
Hormone therapy may affect your memory and function. You should report changes to your doctor, so that they can check and treat you for other causes, including depression, sleep disturbance, fatigue and medication side effects. Limiting alcohol and drugs may improve your memory. Some research has shown a benefit from yoga, exercise, mindfulness, meditation, training and a drug called Provigil (modafinil), which is used to treat sleep disorders.
Hormone therapy can lead to sexual side effects due to direct effects on the sexual organs. This may include:
Genito-urinary symptoms
- Vaginal dryness is a common and frustrating side effect that can limit sexual activity. Medications are available to treat vaginal symptoms.
- Erectile dysfunction may be a side effect. Sometimes this can be treated with medications known as PDE5 inhibitors, such as Viagra and Cialis. There are other possible treatments for erection problems if these medications are ineffective.
A special type of physical therapy known as pelvic PT may help alleviate symptoms and improve sexual function.
Loss of libido
Libido refers to a person's level of sexual desire. Hormone therapy can reduce libido. Other factors may contribute to libido loss. Let your doctor know if you are experiencing this symptom, so that you can be evaluated for other possible causes.
- Medications that affect libido or sexual function can sometimes be changed or doses adjusted. Lifestyle changes, such as weight loss, increasing physical activity, smoking cessation and avoiding alcohol can improve libido. Integrative therapies, such as yoga or meditation, may also help. Healthcare providers who are trained in couples counseling, intimacy or sexuality may help you work through some of these challenges.
- In women, medications such as bupropion or flibanserin may improve libido.
Both and testosterone help support muscle mass and metabolism. Blocking these hormones can lead to weight gain.
To maintain an ideal body weight, experts recommend:
- Balance what you eat with your physical activity to avoid unwanted weight gain.
- Consult with a registered dietitian to assure that you are receiving the right amount of nutrients in your diet.
For weight loss, experts recommend:
- Replace foods that are high in calories with low-calorie, nutritious foods.
- Practice portion control by using smaller plates and avoiding extra servings.
- Track diet, calories and physical activity routines.
Weight loss drugs known as GLP-1 inhibitors may help with weight loss after breast cancer treatment. These drugs include:
- Zepbound (tirzepatide)
- Wegovy (semaglutide)
Early research suggests that people on hormone therapy for breast cancer may not lose as much weight on these drugs as people who are not receiving hormonal therapies for cancer. More research is needed to understand the safety of these agents for cancer survivors and people in treatment.
Questions for your doctor
Below are some questions to ask your doctor about hormone therapy as part of your treatment plan.
- What is the name of the hormone therapy that I am taking?
- Are there any tests that can predict if hormone therapy will work for me?
- What is the goal of hormone therapy?
- How long will I be on hormone therapy?
- What are some of the side effects I may experience while I'm on hormone therapy? When am I most likely to experience them?
- If I experience side effects that I cannot tolerate, can I stop the medication, reduce the dose or switch to another medication?
- What are the serious side effects I should look for? Who should I contact if I experience them?
- Are there any medications or steps that I can take to avoid or lessen side effects?
- How will you monitor me while I'm on this medication?
- What are my options if my cancer comes back while on or after taking this hormone therapy?
- What are the long-term effects that I should look for? Who will monitor me for these effects? Should I be requesting regular tests to check my bone density?
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