Breast Cancer
Mary J. Marian, Gerard E. Mullin in Integrating Nutrition Into Practice, 2017
Adjuvant endocrine therapy is instituted for breast cancers that are estrogen or progesterone receptor-positive (ER-positive and PR-positive).27 The two SERMs used for treatment of breast cancer, tamoxifen and raloxifene (Evista®), compete with estrogen for receptor sites in target tissues such as the breast. Tamoxifen is used for adjuvant treatment for premenopausal breast cancer. This drug exerts estrogen-like activity on the skeletal and cardiovascular systems, reducing bone loss and improving lipid levels. Side effects of tamoxifen include hot flashes, night sweats, and vaginal dryness. Serious adverse effects include an increased risk of cataracts, endometrial cancer, and pulmonary embolism. The U.S. Food and Drug Administration approved raloxifene for reducing the risk of invasive breast cancer in postmenopausal women with osteoporosis and in postmenopausal women at high risk for invasive breast cancer. The STAR trial that compared Tamoxifen and Raloxifen suggested near equal efficacy supporting a 50% reduction in risk, but with less thrombotic events in the Raloxifen group.28
Pharmacogenomics of Tamoxifen
II-Jin Kim in Cancer Genetics and Genomics for Personalized Medicine, 2017
Tamoxifen is an antagonist of the estrogen receptor in breast tissue via its active metabolite, hydroxytamoxifen or endoxifen. Tamoxifen, which has been clinically used for more than 50 years, is proven to be effective in the adjuvant treatment and metastatic tumor of breast cancer. Tamoxifen is suggested to be used in the treatment of patients with pre- and postmenopausal estrogen receptor (ER)–positive breast cancer. Adjuvant tamoxifen therapy is one of the major endocrine treatment options, especially for women who have ovarian estrogenic activity that cannot be regulated by aromatase inhibitors. Five-year or 10-year adjuvant tamoxifen treatment effectively reduces recurrence of ER-positive tumors [1, 2]. Moreover, tamoxifen is approved for the chemoprevention of breast cancer for women at high risk of developing the disease. Tamoxifen may cause relatively mild adverse effects compared to chemotherapy, but is occasionally (or often) severe requiring to discontinue the treatment. “Hot flash” is the most common adverse event observed in patients treated with tamoxifen.
Integrative hyperthermia treatments for different types of cancer
Clifford L. K. Pang, Kaiman Lee in Hyperthermia in Oncology, 2015
Endocrine therapy is one of the means for breast cancer systemic therapy. Endocrine therapy plays a very important role for hormone-dependent recurrent and metastatic breast cancer, and adjuvant treatment of early breast cancer. It can even be used for high-risk healthy women to prevent breast cancer, which depends on whether patients have entered menopause or not, as well as the condition of ER and PR receptors. For postmenopausal hormone receptor–positive patients, postoperative adjuvant endocrine therapy is optional. Patients after 5 years of surgery can have anastrozole or letrozole; after the use of tamoxifen for 2 to 3 years, sequentially use exemestane or anastrozole for 2 to 3 years. After the use of tamoxifen for 5 years increase the use of letrozole for 5 years, and patients who cannot tolerate aromatase inhibitor treatment due to various reasons can still use tamoxifen for 5 years. Premenopausal patients who are hormone receptor positive have the following options for postoperative adjuvant endocrine therapy. First use tamoxifen for 2 to 3 years, and after menopause patients can switch to an aromatase inhibitor. If patients are still premenopausal after the use of tamoxifen for 2 to 3 years, they can continue to use tamoxifen for 5 years. If patients enter menopause after 5 years, then use letrozole for 5 years as intensive follow-up treatment. Some premenopausal patients who are not suitable for treatment with tamoxifen or who have a high risk of recurrence and metastasis factors can consider using aromatase inhibitors as adjuvant therapy after ovaries are castrated.
Formulation, characterization, and cellular toxicity assessment of tamoxifen-loaded silk fibroin nanoparticles in breast cancer
Published in Drug Delivery, 2021
Afrasim Moin, Shahid Ud Din Wani, Riyaz Ali Osmani, Amr S. Abu Lila, El-Sayed Khafagy, Hany H. Arab, Hosahalli V. Gangadharappa, Ahmed N. Allam
Tamoxifen is a potent hydrophobic endocrine drug commonly used to treat breast cancers and patients at high risk (Day et al., 2020; Abbasalipourkabir et al., 2016). Tamoxifen can act as estrogenic or antiestrogenic, depending on the dosage and the tissues targeted (Figure 1(A)). Nevertheless, tamoxifen therapeutic efficacy is adversely compromised by its poor oral bioavailability, presumably due to extensive hepatic metabolism (Jordan, 2007). In addition, long-term tamoxifen administration can cause adverse side effects, including the development of endometrial cancer, hepatic cancer, increased blood clotting, ocular retinopathy, and corneal opacity (Parkkari et al., 2003; Layek & Mukherjee, 2010). These undesirable side effects of tamoxifen, along with numerous obstacles to the successful delivery of the drug to the tumor site, require the development of a targeted delivery system that grants site-specific delivery of the drug while minimizing the nonspecific off-target effects. Accordingly, an array of nanoparticulate delivery systems have been explored for their efficacy to deliver tamoxifen to the tumor cells, such as nanospheres and nanoparticles comprising poly-caprolactone (Łukasiewicz et al., 2021; Chawla & Amiji, 2002; Villemson et al., 2006). The motive behind the use of such biocompatible and biodegradable polymeric nanocarriers is to augment the selective delivery of drug dose to tumor site while sparing healthy tissues from drug’s off-target effect.
Preventive Effect of Combined Zingiber officinale and Terminalia chebula against DMBA-Induced Breast Cancer Rats via mTOR Inhibition
Published in Nutrition and Cancer, 2022
Jayasindu Mathiyazhagan, Ramamoorthy Siva, Rama Jayaraj, Harishkumar Madhyastha, Gothandam Kodiveri Muthukaliannan
Breast cancer is the most prevalent form of cancer affecting women and is the second most common cause of cancer deaths globally (1). Breast cancer incidence is higher in younger (premenopausal) women (2). Overall mortality and morbidity emphasize the need to prevent breast cancer at its earliest. Tamoxifen is an estrogen receptor modulator that has been used for hormone therapy for the treatment of breast cancer. However, prolonged usage of this drug can cause serious complications such as stroke (3), pulmonary embolism (4), and retinal vein occlusion (5). A myriad of studies have shown the various effects of herbal and dietary compounds in cancer prevention (6). Thus, identifying dietary and herbal products with anticancer potential might provide an alternative for a treatment with significantly lower toxicity and at the same time readily available for all patients. Zingiber officinale (ZO) rhizome is a dietary product used in traditional medicine for diverse ailments such as migraine, arthritis, depression, high cholesterol, diabetes, and cancer (7, 8). Terminalia chebula (TC) fruit is well known in traditional medicine as a cardiotonic, antidiabetic, and anticancer agent (9). Many herbal/ayurvedic formulations (National Library of Ayurved Medicine) use a combination of ZO and TC. However, their combined property is yet to be validated scientifically.
Successful treatment of sclerosing mesenteritis with tamoxifen monotherapy
Published in Baylor University Medical Center Proceedings, 2023
Lauren Zammerilla Westcott, Dallas Wolford, Taylor G. Maloney, Ronald C. Jones
Given the potential for side effects, treatment of sclerosing mesenteritis is recommended only in patients with significant symptoms that affect quality of life.2 Current recommendations for medical treatment include tamoxifen plus corticosteroid as first-line therapy. The largest case series of 92 patients reported the best outcomes in patients who received a corticosteroid taper plus tamoxifen.1 The use of tamoxifen alone is limited to case reports, such as the one presented here, and is an option in those with contraindications to corticosteroids.12 Based on experience in retroperitoneal fibrosis, tamoxifen is recommended indefinitely to prevent relapse.13 Prior to initiation of treatment, patients should be counseled about potential side effects of tamoxifen, including hot flashes, venous thromboembolism, stroke, and endometrial carcinoma.14
Related Knowledge Centers
- Selective Estrogen Receptor Modulator
- Uterine Cancer
- Pulmonary Embolism
- Stroke
- Breast Cancer
- Cancer
- McCune–Albright Syndrome
- Oral Administration
- Irregular Menstruation
- Hot Flash