Hormone Therapy in premenopausal women

Dear Sir,
My sister is suffering from breast cancer since 1996. It was operated and she underwent hormone therapy, radiation and chemo therapy. Cancer cells were slightly receptor positive (about 15%).

Bone metastasis were detected last July, 2001.

Initially, a hormone (tamoxifen) therapy was applied. My sister is 40 year of age and premenopausal. A befriended physician strongly recommended to support the hormone therapy with LR-HR analogs - this recommandation was supported in the literature which we consulted. However, the oncologist does not recommand the application of of LR-HR analogs. His argument is the probably occurrance of side effects like, e.g., depression and a general decrease in the quality of life. Furthermore, he states that the application of LR-HR analogs alongside tamoxifen may be done in Europe but not in the U.S.

I would be interested in learning about your opinion on the application of LR-HR analogs alongside tamoxifen in premenopausal  patients suffering from breast cancer metastasis in the bones (columna vertebrae).

Thank you so much in advanced.

Yours

Karl

[CCF-RN,MSN-JS]

Dear Karl, I ran your question regarding the use of LHRH analogs in combination with Tamoxifen by one of our oncologists to get their opinion.  This is the reply I received:  We do use LHRH analogs in this country.  They are active as a single agent in premenopausal women and can also be used in combination with other agents.  We know that the combination of Tamoxifen and an LHRH analog is superior to LHRH analog alone, but it remains unclear as to whether the LHRH analog adds anything to tamoxifen therapy.  Both are acceptable therapy.  (Also, if an aromatase inhibitor is to be used in a premenopausal woman, it should definitely be combined with a LHRH analog).

[Karl]

Dear CCf-RN,
Dear MNS-RF,

Thank your very much for answering my question. It was very helpful.

Yours

Karl