Alternatives to Taking Tamoxifen for Breast Cancer
Many cases of breast cancer are estrogen-responsive, which means the tumor grows in response to estrogen. Tamoxifen is a therapeutic agent designed to block the effects of estrogen. It can be used to prevent the development of cancer in high-risk patients, such as those with a family history of breast cancer, or to treat existing breast cancer. Tamoxifen, however, can lead to a number of side effects, and cancers treated with Tamoxifen can eventually become resistant to the drug. A number of alternative treatments are available to patients who respond poorly to Tamoxifen.
Raloxifene
Raloxifene, trade name Evista, is an estrogen-blocking drug that can serve as an alternative to Tamoxifen. It belongs to a class of estrogen inhibitors called selective estrogen response modulators. Evista works by blocking the activation of estrogen receptors on breast cells to prevent estrogen signaling. Prescribing Evista to patients with a high risk of developing breast cancer may prevent cancer development by disrupting estrogen signaling in the breast.
Evista is only prescribed to post-menopausal women, according to Lilly, the drug's manufacturer. It is prescribed for the treatment of breast cancer or as a treatment for osteoporosis with the additional function of protecting against breast cancer development. Women taking Evista are at an increased risk of developing blood clots.
- Raloxifene, trade name Evista, is an estrogen-blocking drug that can serve as an alternative to Tamoxifen.
- Evista works by blocking the activation of estrogen receptors on breast cells to prevent estrogen signaling.
Anastrozole
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Anastrozole, trade name Arimidex, is another alternative to Tamoxifen therapy. Arimidex belongs to a class of drugs called aromatase inhibitors, which work to prevent estrogen production. The molecular structure of estrogen is based on existing cholesterol-like chemicals in cells and specific proteins are responsible for generating estrogen. Anastrozole works by inhibiting key proteins involved in estrogen synthesis, stopping the production of estrogen and lowering estrogen levels.
Arimidex is approved to treat initial cases of metastatic breast cancer in post-menopausal women, and can also be taken to prevent breast cancer recurrence. AstraZeneca Pharmaceuticals, Arimidex's manufacturer, reports that taking Arimidex may worsen existing cardiovascular conditions, as well as cause bone weakness, nausea or allergic reactions.
- Anastrozole, trade name Arimidex, is another alternative to Tamoxifen therapy.
- Anastrozole works by inhibiting key proteins involved in estrogen synthesis, stopping the production of estrogen and lowering estrogen levels.
Medroxyprogesterone Acetate
Medroxyprogesterone, trade name Provera, is another hormone-based cancer therapy that may serve as an alternative to Tamoxifen 1. Provera is a synthetic chemical that acts similarly to progesterone, another hormone responsible for signaling in breast cells. The exact mechanism by which Provera works to fight cancer is not yet known, but it may disrupt estrogen signaling or directly kill cancer cells, according to MacMillan Cancer Support 1.
Provera is prescribed for breast cancer cases that have become resistant to Tamoxifen or other hormone therapy. MacMillan reports that Provera can lead to increased appetite, fluid retention, irregular vaginal bleeding and mood changes.
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References
- MacMillan Cancer Support: Medroxyprogesterone acetate
- Breastcancer.org. Tamoxifen (Brand Names: Nolvadex, Soltamox). Revised April 17, 2019.
- Hassett MJ, Somerfield MR, Baker ER, et al. Management of male breast cancer: ASCO guideline. Journal of Clinical Oncology. 2020;38(16):1849-1863. doi:10.1200/JCO.19.03120
- Yu NY, Iftimi A, Yau C, et al. Assessment of Long-term Distant Recurrence-Free Survival Associated With Tamoxifen Therapy in Postmenopausal Patients With Luminal A or Luminal B Breast Cancer. JAMA Oncology. 2019. doi:10.1001/jamaoncol.2019.1856
- Sanchez-spitman AB, Swen JJ, Dezentje VO, Moes DJAR, Gelderblom H, Guchelaar HJ. Clinical pharmacokinetics and pharmacogenetics of tamoxifen and endoxifen. Expert Rev Clin Pharmacol. 2019;12(6):523-536. doi:10.1080/17512433.2019.1610390
- Fleeman N, Martin saborido C, Payne K, et al. The clinical effectiveness and cost-effectiveness of genotyping for CYP2D6 for the management of women with breast cancer treated with tamoxifen: a systematic review. Health Technol Assess. 2011;15(33):1-102. doi:10.3310/hta15330
- Sanchez-spitman A, Dezentjé V, Swen J, et al. Tamoxifen Pharmacogenetics and Metabolism: Results From the Prospective CYPTAM Study. J Clin Oncol. 2019;37(8):636-646. doi:10.1200/JCO.18.00307
- Breastcancer.org. Aromatase Inhibitors. Revised October 21, 2019.
- American College of Obstetricians and Gynecologists. Committe Opinion. Tamoxifen and Uterine Cancer. Reaffirmed 2019.
- Fleeman, N, et al. The clinical effectiveness and cost-effectiveness of genotyping for CYP2D6 for the management of women with breast cancer treated with tamoxifen: a systematic review. Health Technol Assess. 2011 Sep;15(33):1-102. doi: 10.3310/hta15330
- Sahebkar, A., Serban, M., Penson, P. et al. The Effects of Tamoxifen on Plasma Lipoprotein(a) Concentrations: Systematic Review and Meta-Analysis. Drugs. 2017. 77(11):1187-1197. doi: 10.1007/s40265-017-0767-4
- Sanchez-Spitman, A., Dezentje, V., Swen, J. et al. Tamoxifen Pharmacogenetics and Metabolism: Results From the Prospective CYPTAM Study. Journal of Clinical Oncology. Published January 24, 2019. doi: 10.1200/JCO.18.00307
- Yu NY, Iftimi A, Yau C, et al. Assessment of Long-term Distant Recurrence-Free Survival Associated With Tamoxifen Therapy in Postmenopausal Patients With Luminal A or Luminal B Breast Cancer. JAMA Oncology. 2019. doi:10.1001/jamaoncol.2019.1856
- National Cancer Institute. Breast Cancer Treatment (PDQ)—Health Professional Version.
Writer Bio
Sylvie Tremblay holds a Master of Science in molecular and cellular biology and has years of experience as a cancer researcher and neuroscientist. Based in Ontario, Canada, Tremblay is an experienced journalist and blogger specializing in nutrition, fitness, lifestyle, health and biotechnology, as well as real estate, agriculture and clean tech.