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Breast Cancer (Expert Forum)
Adjuvant, tamoxifen or other chemotherapy for ER/PR negative cancer??
Questions posted in the Breast Cancer Forum are answered by medical professionals from The Cleveland Clinic. Topics include Breast Biopsy, Chemotherapy, Hormone Therapy, Lumps, Lumpectomy, Lymph node dissection, Lymphedema, Mammograms, Mastectomy, Radiation Therapy, Reconstruction, Self Breast Exam, and Surgery.
Adjuvant, tamoxifen or other chemotherapy for ER/PR negative cancer??
by Hari2, Jul 02, 2002 12:00AM
Hi,
My mom-in-law (73 years) underwent mastectomy a month & half back. Her ER/PR tests were negative. Chemotherapy (epirubrin + cyclophosphamide) was adviced. A second opinion is to forego chemotherapy (due to her age) altogether and go for tamoxifen treatment for the required duration. We're still debating and discussing the options. To help us make an informed decision we'd like inputs from all with respect to (a) relative merits / demerits (in terms of efficacy, short/long term side-effects etc) of the two treatment regimens suggested, (b) quality of life with the two treatments and (c) her longevity.
We may have to decide fast one way or the other. I, therefore, request an early response. Would be much obliged.
My mom-in-law (73 years) underwent mastectomy a month & half back. Her ER/PR tests were negative. Chemotherapy (epirubrin + cyclophosphamide) was adviced. A second opinion is to forego chemotherapy (due to her age) altogether and go for tamoxifen treatment for the required duration. We're still debating and discussing the options. To help us make an informed decision we'd like inputs from all with respect to (a) relative merits / demerits (in terms of efficacy, short/long term side-effects etc) of the two treatment regimens suggested, (b) quality of life with the two treatments and (c) her longevity.
We may have to decide fast one way or the other. I, therefore, request an early response. Would be much obliged.
Doctor's Answer
by CCF-RN,MSN-JS, Jul 02, 2002 12:00AM
Dear Hari2, Decisions regarding adjuvant treatment (treatment given after surgery to try to prevent or minimize the growth of microscopic deposits of tumor cells that might grow into a recurrent tumor)for breast cancer are based on a number of factors. Information regarding the stage of the disease, particularly tumor size and lymph node status, help to determine the possibility of cancer spread, and need for adjuvant treatment. The hormone receptor status helps to determine whether adjuvant hormone treatment may be beneficial.
The goal of homonal therapy is to prevent breast cancer cells from receiving stimulation from estrogen. In general, hormonal adjuvant therapy is not recommended to women whose breast cancers do not express hormone receptor protein. In other words, randomized clinical trials have not shown substantial benefit of tamoxifen in cancers that are ER/PR negative.
In regard to side effects of treatment, with the chemotherapy the short term side effects (nausea,vomiting, mouth sores, hair loss, low blood counts) occur in varying degrees depending on treatments, doses etc. and resolve after treatment is completed (adjuvant chemotherapy programs are usually given once a month, for 4 to 6 months). This also seems to be true for psychological distress. Several small studies have documented mild cognitive problems, such as those in memory. The occurence of these effects on memory and the severity has yet to be determined. There is also a very small increase in the risk of treatment-related second cancers and cardiac disease.
As to side effects with tamoxifen, hot flashes and vaginal discharge have been the most common side effects attributed to tamoxifen. Tamoxifen is associated with a small, increased risk of uterine cancer, and blood clots, particularly for women 50 years old or older. The benefits, however, far outweigh the risks.
Age is less of a factor than overall health. There are 73 year olds that are very active/healthy etc. and there are 73 year olds that have other health problems, or are very frail. Quality of life considerations are also a very individual thing. Available resources during treatment such as, rides to and from treatment, someone to be available just after treatments if she is not feeling well to help out, should be considered in making the decision.
Whether to proceed with chemotherapy in consideration of her age, health status, and quality of life would need to be up to her. This, of course, after discussion of all of the risks (potential side effects of the treatment taking into account her overall health), and benefits (prevention or minimization of the growth of possible microscopic deposits of tumor cells that may grow into a recurrent tumor). Each person differs in terms of the importance they might place on the risks and benefits of treatment.
The goal of homonal therapy is to prevent breast cancer cells from receiving stimulation from estrogen. In general, hormonal adjuvant therapy is not recommended to women whose breast cancers do not express hormone receptor protein. In other words, randomized clinical trials have not shown substantial benefit of tamoxifen in cancers that are ER/PR negative.
In regard to side effects of treatment, with the chemotherapy the short term side effects (nausea,vomiting, mouth sores, hair loss, low blood counts) occur in varying degrees depending on treatments, doses etc. and resolve after treatment is completed (adjuvant chemotherapy programs are usually given once a month, for 4 to 6 months). This also seems to be true for psychological distress. Several small studies have documented mild cognitive problems, such as those in memory. The occurence of these effects on memory and the severity has yet to be determined. There is also a very small increase in the risk of treatment-related second cancers and cardiac disease.
As to side effects with tamoxifen, hot flashes and vaginal discharge have been the most common side effects attributed to tamoxifen. Tamoxifen is associated with a small, increased risk of uterine cancer, and blood clots, particularly for women 50 years old or older. The benefits, however, far outweigh the risks.
Age is less of a factor than overall health. There are 73 year olds that are very active/healthy etc. and there are 73 year olds that have other health problems, or are very frail. Quality of life considerations are also a very individual thing. Available resources during treatment such as, rides to and from treatment, someone to be available just after treatments if she is not feeling well to help out, should be considered in making the decision.
Whether to proceed with chemotherapy in consideration of her age, health status, and quality of life would need to be up to her. This, of course, after discussion of all of the risks (potential side effects of the treatment taking into account her overall health), and benefits (prevention or minimization of the growth of possible microscopic deposits of tumor cells that may grow into a recurrent tumor). Each person differs in terms of the importance they might place on the risks and benefits of treatment.
