Entries in Tamoxifen (5)


Woman Takes Tamoxifen to Prevent Breast Cancer, Loses Ovaries

Courtesy Viv Robins(NEW YORK) -- Viv Robins became part of a clinical trial for tamoxifen, an estrogen blocker used to treat and prevent breast cancer, because her mother had died of the disease at age 54.  But the only cancer Robins said she knows she can now avoid for sure is ovarian cancer.

Two years into the tamoxifen trial, when Robins was 46, her ovarian cyst burst, she developed peritonitis and doctors had to remove her uterus and both ovaries to save her life.

"I felt immediately extremely ill," Robins, now 65, who lives in London, told ABC News, recalling the flashing lights in the ambulance as she was rushed into surgery for an emergency 3 a.m. hysterectomy at the Royal Marsden hospital.  "The surgeon opened me up and found a stomach full of blood.  He didn't know what was going on."

Now, nearly two decades later, as the United Kingdom's National Institute of Health and Clinical Excellence is drafting guidelines that would recommend tamoxifen as a preventive drug for women at high risk for breast cancer -- the U.S. Food and Drug Administration approved tamoxifen for women at high risk in 1998 -- Robins said she can't help but wonder whether it was the drug that prompted her cyst to burst.  She'd had benign ovarian cysts since she was 19, she said, and they had never given her problems until she started taking tamoxifen.

"Occasionally, larger ovarian cysts may rupture spontaneously and cause significant bleeding," said Dr. Jennifer Ashton, a senior medical contributor at ABC News.

Dr. Len Lichtenfeld, the deputy chief medical officer at the American Cancer Society, said, "Tamoxifen has been used for such a long time by so many women around the world that, were this a serious complication, it should have shown up.  It's not one that rises to common knowledge."

In the years that followed the clinical trial, Robins said she continued to keep a watchful eye on documents mailed to all trial participants.  Several studies about cyst development in some post-menopausal patients caught her eye, but no findings linked tamoxifen to the rupturing of ovarian cysts.

More common adverse effects have included blood clots and endometrial cancer, but Dr. Kimberly Blackwell, a breast cancer specialist at Duke University Medical Center, said these risks were on par with those associated with taking birth control pills.

The U.S. Preventive Services Task Force recommends that clinicians discuss tamoxifen with their high-risk patients who are at low risk of developing side effects, though it is not a sweeping recommendation like the one that may come to pass in the U.K.  The task force also recommends not prescribing tamoxifen to patients with a low or average risk of developing breast cancer.

"I wish the drug was more widely emphasized," said Blackwell, "because it's a known way of preventing breast cancer for women at high risk of developing it."

Tamoxifen reduces the likelihood that high-risk women will develop breast cancer by about half, she said, referring to findings from the Breast Cancer Prevention Trial, which led to tamoxifen's FDA approval.

Factors that increase the risk of blood clots include smoking and being overweight, so those patients would not be ideal candidates for tamoxifen.

"If the risk [of developing breast cancer] is high enough, doubling the risk of blood clots, many times, is worth trying to take the medication," Blackwell said.  "It should be a discussion between every woman and her physician, and every woman should know her own individual risk factors for breast cancer."

Copyright 2013 ABC News Radio


Breast Cancer Study: Extending Tamoxifen Use Saves Lives

Comstock/Thinkstock(SAN ANTONIO) -- In a study that many breast cancer experts say may change practice, researchers have reported that extending the use of the drug tamoxifen to 10 years -- rather than the currently recommended five years -- could save lives by thwarting cancer's return.

Breast cancer can recur even years after treatment.  For the three quarters of breast cancers that are estrogen receptor (ER) positive, tamoxifen and other hormone therapy drugs have lowered the risk of cancer coming back.

Long awaited data on the breast cancer drug tamoxifen from a large clinical trial was released Wednesday at the San Antonio Breast Cancer Symposium and published in the medical journal The Lancet.  

The Adjuvant Tamoxifen: Longer Against Shorter, or ATLAS, trial began in 1996 and is one of the largest breast cancer trials of its type.  It is a large multi-center study involving more than 12,000 women with early breast cancer.  Unlike earlier studies, which did not show a clear benefit of taking tamoxifen for longer than five years, this trial reports that lives are saved by taking tamoxifen for longer as time progresses.

"Five years of adjuvant tamoxifen is already an excellent treatment that substantially reduces the 15-year risk for recurrence and death," study author Dr. Christina Davies said in a statement.  "We now know that 10 years of tamoxifen is even better, approximately halving breast cancer mortality during the second decade after diagnosis"

In the ATLAS study, 6,846 women with ER positive breast cancer, who had already completed five years of tamoxifen therapy, were randomized to either stop the drug or continue taking it for five more years.  Recruitment began in 1996.  Participants were followed yearly for breast cancer recurrence, death and serious side effects.

Over the studied period, both breast cancer recurrences and deaths were lower among those who took tamoxifen for 10 years rather than just five years.  Fifty-six fewer women were observed to die of breast cancer during follow-up among the group who continued tamoxifen than among the group who stopped.  This was a 2.8 percent reduction in breast cancer mortality during the 10 years of the trial.

However, experts say more tamoxifen could have consequences, including a higher risk of uterine cancer and blood clots.

"The data may push more patients to consider longer durations of anti-estrogen therapy," said Dr. Harold Burstein, an oncologist at the Harvard Medical School and Dana-Farber Cancer Institute.  "Patients will also need to be aware of the trade-offs, including mild side effects and more serious but rare cancer risks."

But Dr. Larry Norton of Memoral Sloan Kettering Cancer Center said benefits appear to outweigh the risks.

"The fact that overall survival is improved suggests that whatever the 'cost' from any and all toxicities, they are outweighed by the improvement in breast cancer outcomes," he said.

Copyright 2012 ABC News Radio


Researchers Examine Toxicity of Breast Cancer Drugs

Photodisc/Thinkstock(NEW YORK) -- Drugs called aromatase inhibitors are used to treat breast cancer in post-menopausal women.  They work by inhibiting the production of estrogen which stimulates the growth of breast cancer cells.

A study in the Journal of the National Cancer Institute looks at why the drugs, called AIs, are associated with a reduction in breast cancer recurrence but not in improved survival.

Researchers found that, compared with Tamoxifen -- another breast cancer drug -- longer use of AIs was associated with a number of adverse toxic effects -- among them, increased heart disease and bone fractures.

The authors conclude that the toxicity of AIs over long periods of treatment may explain the lack of overall survival benefit despite a positive effect on breast cancer recurrence.

Copyright 2011 ABC News Radio


Breast Cancer: Tamoxifen Saves Lives but Some Women Go Without It

Photodisc/Thinkstock(WASHINGTON) -- For women diagnosed with hormone-sensitive breast cancer -- more than 150,000 in the U.S. each year -- five years of tamoxifen treatment can dramatically cut the risk of death or recurrence of the cancer, according to a study published Thursday in the medical journal The Lancet.

Tamoxifen, a mainstay in breast cancer therapy since the early 1980s, blocks estrogen receptors to thwart the sex hormone's tumor-feeding effects. Doctors always knew it worked, but the Lancet study -- which included data from 20 trials and 21,000 women -- confirmed the drug's effects are both profound and long-lasting.

"It is an extraordinary drug in terms of the protection it offers women in the decade after treatment," said Christina Davies, a senior research scientist at the Clinical Trial Service Unit at Oxford University and the study's lead author. "It's off-patent, it's cheap and it's available to women worldwide."

Taking a pill a day for five years reduced annual breast-cancer mortality by 30 percent for 15 years, the study found. And recurrence rates fell 47 percent in the first four years after treatment, and 32 percent over the next five years, according to the study.

But tamoxifen does come with its share of side effects, and some are even life-threatening, such as an increased risk of uterine cancer and blood clots forming in the lungs. In the Lancet study, there were nine deaths from uterine cancer and six deaths from lung blood clots among women taking tamoxifen compared with one death from uterine cancer and no deaths from lung blood clots in women taking a placebo. However, the overall risk of death was small -- 0.1 percent in younger women and 0.6 percent in older women.

Less severe but no less significant for premenopausal women on the fence about tamoxifen is the drug's potential to trigger symptoms of menopause -- hot flashes, mood swings, dryness, leg cramps and joint pain.

Studies have found that even two years on tamoxifen can bring benefits, and ongoing studies are investigating whether a 10-year treatment course is even better than a five-year course.

The study also confirms that women whose tumors are even mildly hormone-sensitive -- as low as 1 percent positive for estrogen receptors in standard lab tests -- can benefit from tamoxifen.

"Recently, we started calling these low-level-expressing tumors positive and have been offering these women tamoxifen," said Dr. Banu Arun, co-director of Clinical Cancer Genetics at the University of Texas MD Anderson Cancer Center in Houston. "This further supports that what we've been doing was correct."

The new study also found that tamoxifen extends survival, even in women who've had chemotherapy, debunking a common misconception that one or the other would do, Arun said.

Tamoxifen is also used to prevent breast cancer in women at high risk for the disease because of their genetic makeup. But only 30 percent of these women opt to take the drug, said Arun, with 70 percent opting for regular screenings instead.

Copyright 2011 ABC News Radio


Anti-Estrogen Medication Could Improve Lung Cancer Diagnosis

Photo Courtesy - Getty Images(GENEVA, Switzerland) – A drug used to battle breast cancer may help reduce the risk of dying from lung cancer, according to a new study.

The study, published in Cancer, claims that the anti-estrogen medication tamoxifen can help control hormonal levels in lung cancer patients that are critical to survival.

Researchers at the Geneva Cancer Registry examined the effect of anti-estrogen therapy in patients with lung cancer. They found that fewer women who had taken anti-estrogens died from lung cancer than expected.

"Our results support the hypothesis that there is a hormonal influence on lung cancer which has been suggested by findings such as the presence of estrogen and progesterone receptors in a substantial proportion of lung cancers," said Elisabetta Rapiti, M.D., of the Geneva Cancer Registry. "If prospective studies confirm our results and find that anti-estrogen agents improve lung cancer outcomes, this could have substantial implications for clinical practice.”

Copyright 2011 ABC News Radio

ABC News Radio