[MOL] Re: tamoxifin [01267] Medicine On Line


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[MOL] Re: tamoxifin



mmm, sorry i don't have the book handy, but just read a book about differing
treatments and tamoxifin seems to be the most effective against recurrence of
estroen sensitive cancers.

i will get back with the name and the author.

also, there is a newer alternative to tamoxifin without as many negative side
effects. i can't remember what that is, either. saw it on the news a few times
while i was busy with other treatments.

good luck!

   -sharon

deb grodin wrote:

> And I wonder why I can't decide to take tamoxifen or not.
> Finally finished 28 regular radiation treatments!!! Begin first of 5
> boosts tomorrow and then I am done!!!!!! Wanted to celebrate today and
> did - fell asleep outside under a tree. Do I know how to party or
> what!!! Next week for a real celebration my husband is going with me and
> then it's lunch in Princeton.
> As for the channel 7 special report on Stacey Sagers breast cancer, part
> two is on tonight. I did not watch it yet, however if you wish to view
> it just go to the web site - www.7online.com. Tonight at 7:00 she will
> be on line -  www.7online.com  to answer questions as to how she made
> her decisions, and to answer questions. I think it runs for one hour.
> I need to revisit my tree, I am so tired.
> Debby G.
> Becker, Joyce wrote:
> >
> > Round 3 in Cancer Battle: A 5-Year Drug Regimen
> >     [05/11/99; New York Times (Free Registration Required)]
> >
> >                     Having completed the first two phases of treatment for an
> > early breast cancer -- a
> >                     lumpectomy and six weeks of radiation therapy -- I have
> > now begun the third and, in
> >                     a way, the most exciting phase: five years of daily
> > treatment with the drug
> >               tamoxifen.
> >
> >               Unlike traditional cancer chemotherapy, tamoxifen does not kill
> > cells and does not cause
> >               nausea and hair loss. Tamoxifen is more like a growth
> > regulator. It is an estrogen-like
> >               compound that acts in the breast as an antiestrogen, preventing
> > the natural hormone from
> >               stimulating the growth of breast cancer cells.
> >
> >               Tamoxifen has been around for about 20 years. It was first used
> > to treat advanced breast
> >               cancer, then to prevent recurrence of less advanced disease.
> > Now it is being used to prevent
> >               breast cancer from occurring in the first place in women at
> > high risk of developing the
> >               disease.
> >
> >               Factors that contribute to a woman's risk of developing breast
> > cancer include being over 60,
> >               having a family history of breast cancer, having had a
> > noninvasive breast cancer or
> >               precancerous breast abnormalities, having begun to menstruate
> > before the age of 12 and
> >               having had no children or a first child after age 30.
> >
> >               The First Cancer Preventive
> >
> >               I admit to being confused and disappointed when my surgeon
> > announced gleefully that my
> >               cancer was highly sensitive to hormone stimulation, as
> > indicated by a test for estrogen and
> >               progesterone receptors on the cancer cells. To me that meant I
> > would probably never again be
> >               able to take postmenopausal hormones, which could protect my
> > heart, bones and brain from
> >               premature deterioration and which prevented hot flashes and
> > vaginal dryness.
> >
> >               The surgeon was pleased because being
> > estrogen-receptor-positive meant that my tumor was
> >               slower growing, and that I could reap the maximum protection
> > from tamoxifen, which has
> >               been shown to cut in half the risk of recurrence of the
> > original breast cancer as well as the
> >               development of a second cancer in the opposite breast.
> >
> >               Estrogen receptors are found in about 65 percent to 80 percent
> > of breast cancers in
> >               postmenopausal women and 45 percent to 60 percent of cancers in
> > premenopausal women.
> >
> >               The higher the level of estrogen receptors in a woman's tumor,
> > the greater the survival
> >               benefit associated with taking the drug. Women whose cancers
> > are
> >               estrogen-receptor-negative reap some benefit from tamoxifen as
> > well, suggesting that the
> >               drug has other as-yet undiscovered actions.
> >
> >               Studies have indicated that five years of daily tamoxifen is
> > more protective than one or two
> >               years and as good or better than taking the drug for 10 years.
> > Its protective effects have been
> >               shown to persist for at least five years after the drug is
> > stopped.
> >
> >               Most exciting, last year tamoxifen was shown in a study of more
> > than 13,000 women to
> >               reduce by 50 percent the development of a first cancer in women
> > considered at high risk for
> >               the disease. This made tamoxifen the first drug found to
> > prevent cancer, although it is still
> >               not known for sure whether the protection is permanent. But
> > tamoxifen may not be helpful in
> >               women who carry cancer-promoting mutations of the genes BrCa1
> > and BrCa2.
> >
> >               Dr. D. Lawrence Wickerham, an oncologist at Allegheny
> > University in Pittsburgh and a
> >               co-leader of national tamoxifen studies, said, "The cancers
> > that developed in
> >               tamoxifen-treated women tended to be smaller and were found at
> > an earlier stage," meaning
> >               they were more readily cured. Describing other benefits found
> > in the studies, Dr. Wickerham
> >               said: "Women taking tamoxifen suffered fewer bone fractures of
> > the wrist, hip and spine and
> >               their cholesterol level dropped by 12 to 20 percent.
> > Furthermore, there is no evidence that
> >               tamoxifen is associated with weight gain, depression, nausea or
> > cancers of the ovary, liver
> >               and gastrointestinal tract."
> >
> >               The effects of tamoxifen on the brain are unknown, though there
> > is no evidence of any ill
> >               effect, like memory impairment.
> >
> >               Unwanted Effects, Too
> >
> >               But for all the good tamoxifen does, it has certain major and
> > minor disadvantages. Like
> >               estrogen, it raises the risk of developing a relatively
> > uncommon cancer of the uterus,
> >               endometrial cancer, a disease that can be detected early
> > through routine monitoring and cured
> >               by surgery and, if needed, radiation therapy. Its other serious
> > side effect -- one that is shared
> >               by estrogen as well -- is an increased risk of blood clots,
> > which are occasionally fatal.
> >               Nonetheless, Dr. V. Craig Jordan of Northwestern University's
> > cancer center, who did
> >               pioneering research on tamoxifen, said the survival benefit
> > from the drug for a woman like
> >               me who has had breast cancer outweighs the risk of death from
> > its effects on the uterus and
> >               blood by about 30 times.
> >
> >               Stimulation of the growth of the endometrium, or uterine
> > lining, which could increase the
> >               risk of cancer, occurs in a small percentage of women who take
> > tamoxifen. Nonetheless,
> >               women may be advised to have a baseline uterine examination
> > before starting tamoxifen,
> >               followed by annual checkups to see if the drug is stimulating
> > growth of the endometrium.
> >               This examination can be done in a doctor's office as an
> > endometrial biopsy or painlessly by
> >               transvaginal ultrasound. A woman who experiences an unusual
> > vaginal discharge or bleeding
> >               while on tamoxifen should report that to her gynecologist
> > without delay.
> >
> >               On a less serious note, tamoxifen also causes hot flashes in a
> > quarter to a third of users and
> >               an annoying vaginal discharge in about 5 percent to 10 percent
> > of women. The hot flashes
> >               may seriously disrupt a woman's life. But they usually diminish
> > with time, and their
> >               intensity may be diminished by daily consumption of soy
> > products like tofu and ground
> >               flaxseed.
> >
> >               A New Class of Drugs
> >
> >               Tamoxifen, sold as Nolvadex, is the first of a new class of
> > drugs called SERM's, for
> >               selective estrogen receptor modulators. These compounds compete
> > with natural estrogen for
> >               a docking site on cells throughout the body. When these sites,
> > called receptors, are occupied
> >               by tamoxifen, estrogen cannot hook on properly and exert its
> > usual effects.
> >
> >               A more recent addition to this class is raloxifene, sold as
> > Evista, which seems to share most
> >               of the characteristics, good and bad, of tamoxifen, and several
> > other such drugs are in
> >               various stages of development. The ultimate goal is to find a
> > compound that does all the good
> >               that estrogen does, including reducing the risk of heart
> > disease and osteoporosis, stimulating
> >               brain cells and preventing menopausal symptoms, but that has
> > none of estrogen's bad
> >               effects, especially raising the risk of cancers of the breast
> > and uterus and causing blood clots.
> >
> >               Raloxifene, which is approved for the prevention of bone loss,
> > also appears to protect the
> >               breast and heart but without stimulating cell growth and cancer
> > in the uterus. But like
> >               tamoxifen, it can increase clotting and induce hot flashes, and
> > it is not yet known whether it
> >               is as good as or better than tamoxifen in preventing breast
> > cancer.
> >
> >               A study to determine this, called STAR (for Study of Tamoxifen
> > and Raloxifene), is just
> >               getting under way. The study, sponsored by the National Cancer
> > Institute, will involve
> >               22,000 women and is expected to last 5 to 10 years.
> >
> >               "At the moment, it's too early to use raloxifene to prevent
> > breast cancer outside of a clinical
> >               trial," Dr. Wickerham said during a teleconference sponsored by
> > Cancer Care Inc.
> >
> >               "We don't yet know raloxifene's long-term benefits or risks."
> >
> >               He suggested that women interested in possibly participating in
> > the STAR trial call the
> >               National Cancer Institute's hot line, (800) 4-CANCER, or sign
> > on to the Web site of the
> >               National Surgical Adjuvant Breast and Bowel Project.
> >
> >               More information on tamoxifen can be found in a new paperback
> > book, "Tamoxifen," by Dr.
> >               John F. Kessler and Greg A. Annussek (Avon, $5.99).
> > ------------------------------------------------------------------------
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