Hormone Therapy in Breast Cancer

The Role of Hormone Therapy in Breast Cancer Treatment

Hormone Therapy in Breast Cancer Treatment

Introduction

Breast cancer is a type of carcinoma, which is cancer that begins in the cells of the breast. This is one cancer that has been known to affect many women all over the world. Hormone receptor-positive (HR+) is the most common form of breast cancer and accounts for about 70% of all breast cancer cases. Endocrine therapy is central to the management of patients with HR+ breast cancer. By outlining the mechanisms of hormone therapy, the different types of hormone treatments, the benefits, the disadvantages, and further developments of hormone therapy, this information will give a detailed insight into how hormone treatments work for breast cancer.

Hormone Therapy in Breast Cancer
Credit: rockymountaincancercenters

Estrogen Receptor Modulation Mechanism of Breast Cancer Hormone Therapy

Hormone therapy is a type of treatment that is used in the management of breast cancer and is aimed at preventing the growth of cancer cells, which are hormone-dependent and are commonly fed by estrogen hormone. Estrogen stimulates the growth of hormone-responsive cancer cells by attaching to estrogen receptors (ERs) located on the cell surface of these cells. These ERs are targeted by hormone therapy, decreasing estrogen synthesis or its impact on the cancer cells.

There are two primary mechanisms by which hormone therapy inhibits estrogen:

  1. Aromatase inhibitors (AIs) are drugs that can lower the amount of estrogen by inhibiting the aromatase enzyme. Aromatase is responsible for transforming androgens to estrogen in postmenopausal women. Several AIs, including anastrozole, letrozole, and exemestane, are applied in the adjuvant (early-stage) and metastatic (advanced) stages of HR+ breast cancer.
  2. Selective estrogen receptor degraders (SERDs) are newer drugs that can interact with the human ER and degrade it so that the number of ERs on cancer cells decreases. Elagolixisib is the first SERD to be approved for the treatment of HR-positive breast cancer.

In addition to AIs and SERDs, other types of hormone therapy include:

  1. Aromatase inhibitors for premenopausal women: Aromatase inhibitors can be used in conjunction with other ovarian suppression therapies such as GnRH agonists for premenopausal patients for lowering estrogen levels. The approach is commonly referred to as ovarian suppression with aromatase inhibitors, or OSAI for short.
  2. Estrogen receptor blockers: These drugs, for example, fulvestrants, work as estrogen antagonists; they bind to the same receptors as estrogen, ER, and thus deprive estrogen of the possibility to stimulate further cancer cell division.
  3. Aromatase inhibitors and estrogen receptor blockers: The two classes of drugs can be taken by some patients in combination, and this may enhance the improvement of the condition.

Benefits of Hormone Therapy in the Treatment of Breast Cancer

Hormone therapy has several advantages in treating breast cancer:

  1. Improved survival rates: Hormone therapy has been recognized to reduce the overall mortality of patients diagnosed with HR+ breast cancer. In the early-stage setting, hormone therapy lowers the risks of recurrence and mortality.
  2. Targeted therapy: The specificity of hormone receptors on the cancer cells mentioned above makes hormone therapy selective, which does not have side effects on other non-targeted healthy tissues.
  3. Fewer side effects: Hormone therapy is considered less toxic to the patient as compared to other treatments such as chemotherapy or radiotherapy. Side effects include mild to moderate symptoms like hot flashes, dryness of the vagina, arthralgia, and others.

Disadvantages of hormone therapy in the treatment of breast cancer

While hormone therapy offers several advantages, it also has some disadvantages:

  1. Limited efficacy: The use of hormone therapy may not be prominent to all patients, especially those with advanced metastatic HR+ breast cancer that has shown resistance to the hormone therapy.
  2. Acquired resistance: Sometimes the cancer cells may adapt to the environment and hormonal treatment that was initially useful and develop some form of resistance known as acquired resistance. This can make hormonal treatment less effective, and the patient may need other forms of treatment.
  3. Treatment duration: It may be prescribed for 5 years or longer in some cases, and this is a disadvantage because some side effects result from long-term use of this therapy, and some patients may not be compliant due to the long time when they are being treated.

Development in Hormone Receptor Therapy for Breast Cancer Management

Efforts are still being made to improve the use and efficiency of estrogen-selective receptor modules for breast cancer treatment. Some potential future advancements include:

  1. Combination therapies: Integrating hormone therapy with other directed therapies, including PARP inhibitors, may enhance efficacy and overcome resistance.
  2. Novel hormone therapies: Novel classes of hormonal therapy, including SERDs, are still under investigation in an attempt to enhance the effectiveness of hormone therapy and avoid resistance.
  3. Personalized medicine: Such biomarkers can assist clinicians in selecting the correct treatment mode that would be effective in the individual case and within the minimum risk of developing other side effects.
  4. Immunotherapy: Adding hormone treatment to immunotherapy could enhance the body’s immune response to the cancer cells, improving results.

Conclusion

Hormone therapy is widely used in the treatment of hormone receptor-positive breast cancer. Because it aims at cancer cells that depend on hormones for their growth, hormone therapy can enhance the lifespan of the patient as well as the length of the recovery period. Although the applicability of hormone therapy is somewhat limited by the problems of acquired resistance and long treatment periods, further research continues to be directed toward the development of more efficient selective methods. With these advancements, hormone therapy remains an essential part of the treatment for HR+ breast cancer.

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