Greater use of key hormone treatments could spare thousands of breast cancer patients the ravages of chemotherapy, new research suggests.
Younger patients in particular stand to benefit if the drugs, LHRH (luteinising hormone-releasing hormone) agonists, were used instead of traditional treatments, say Cancer Research UK scientists in the latest issue of The Lancet.
The team, led by Jack Cuzick of the Wolfson Institute of Preventive Medicine at Queen Mary College, University of London, said the hormone treatments appeared as effective as chemotherapy, but produced fewer side-effects and allowed young women to retain their fertility. LHRH agonists like AstraZeneca's drug Zoladex (goserelin) switch off the ovary and stop the production of the female hormone oestrogen, which can encourage the growth of tumours.
The latest study of around 12,000 pre-menopausal women showed that treatment with an LHRH agonist was as effective a chemotherapy in preventing a recurrence of breast cancer. When the researchers combined LHRH agonists with chemotherapy or tamoxifen, disease recurrence was reduced by a further 13%, and death by 15%.
Prof Cuzick said: “The results mean that pre-menopausal women with hormone receptor positive low risk breast cancer could consider treatment that is as effective as chemotherapy without having to endure unpleasant side effects and risk losing their fertility. For all women aged under 40, this treatment can be added to chemotherapy to improve outcome further. In all cases tamoxifen, a different kind of hormone treatment, would also be usually be used as standard treatment.”
Kate Law, head of clinical trials at Cancer Research UK, said: “Breast cancer is always a shocking diagnosis but it is particularly sad when its treatment results in women being unable to have children. This is a very encouraging finding and suggests breast cancer treatment for some pre-menopausal women could be less devastating while being equally effective as conventional chemotherapy.”
When younger breast cancer patients have chemotherapy the treatment accelerates the menopause and can deny women the chance to have children. In addition, many women suffer from long-term unpleasant post menopausal side effects. About two thirds of pre-menopausal patients have hormone sensitive breast cancer which equates to around 5,500 women being diagnosed in the UK every year.
In an accompanying Lancet editorial, oncologists Dr Nicholas Wilcken and Dr Martin Stockler of the University of Sydney, said: “In women with higher risk disease, chemotherapy followed by tamoxifen should still be the standard approach, with the addition of an LHRH analogue a reasonable consideration for those who remain premenopausal.” By Michael Day