Side effects of endocrine therapy for breast cancer

In fact, if breast cancer is discovered in time in the early stages of the disease and measures are taken to treat it, there is a high chance that breast cancer can be cured. In the process of treating breast cancer, different treatment methods should be selected for different types, among which endocrine therapy is a more common treatment method. However, patients are more worried about the side effects of endocrine therapy for breast cancer.

1. Side effects of endocrine therapy for breast cancer

The side effects of endocrine therapy are very small, and most patients do not feel obvious discomfort after taking it. The commonly used drug is tamoxifen, and its main side effects are: loss of appetite, nausea, vomiting, diarrhea in a few cases, headache, dizziness, depression, facial flushing, rash, and a very small number of patients may experience leukopenia and thrombocytopenia, but it is generally not serious. Some patients may have abnormal liver function; it is contraindicated for pregnant and lactating women. The side effects of endocrine therapy drugs are relatively rare and generally not serious, and can be tolerated by most patients.

2. Which patients are suitable for endocrine therapy?

It is currently believed that endocrine therapy is suitable for breast cancer patients with ER or PR progesterone receptor-positive, slow tumor growth, long disease-free survival after surgery, or with or without bone and soft tissue metastasis, asymptomatic visceral metastasis, and previous effective endocrine therapy.

3. What are the drugs for endocrine therapy of breast cancer?

Endocrine therapy for postmenopausal patients includes: aromatase inhibitors including non-steroidal (anastrozole and letrozole) and steroidal (exemestane), drugs acting on estrogen receptors (tamoxifen and fulvestrant), progesterone drugs (megestrol acetate), androgens (flumethyltestosterone), and high-dose estrogens (ethinyl estradiol).

Endocrine therapy for premenopausal women includes: tamoxifen, LHRH analogs (goserelin and luprolide), surgical castration (surgical removal of both ovaries), progesterone drugs (megestrol acetate), androgens (flumetholone) and high-dose estrogens (ethinyl estradiol).

How does TCM view the side effects of endocrine therapy for breast cancer?

Traditional Chinese medicine believes that the main reason for the side effects of endocrine treatment of breast cancer is kidney deficiency. After women reach the age of 49, the kidney essence will naturally weaken, and endocrine drugs will further aggravate the deficiency of kidney essence. Because of kidney deficiency, symptoms such as bone pain, hot flashes, and sweating will appear, so treatment should start with tonifying the kidney.

In the process of traditional Chinese medicine treatment, a combination of "internal medication and external treatment" can be adopted. In terms of external treatment, choosing an external wash prescription based on Chinese medicine that promotes blood circulation and unblocks collaterals can significantly relieve the patient's bone pain symptoms. In response to patients' symptoms such as insomnia and excessive sweating, experts recommend the use of traditional Chinese medicine treatments such as navel plasters, foot fumigation with medicine, ear acupuncture, and moxibustion for comprehensive conditioning. However, because everyone's physique is different, the conditioning methods are naturally different, and you must not blindly take supplements.

Principles of endocrine therapy for breast cancer

1. Endocrine therapy and chemotherapy should not be used together in the same period of time. In the past, endocrine therapy has been considered to be "an auxiliary treatment with uncertain efficacy and is dispensable", and most doctors dare not use endocrine therapy alone. It is now confirmed that endocrine therapy can achieve similar therapeutic effects as chemotherapy. Using it alone can not only maximize its effects in different time periods, but also help observe the efficacy and screen out effective therapeutic drugs. If the disease progresses after 1-2 months of endocrine therapy, endocrine therapy should be discontinued and replaced with chemotherapy or other new endocrine drugs.

2. Try to extend the duration of endocrine therapy. During the treatment, there is no need to blindly pursue the CR+PR rate. More attention should be paid to the clinical benefits of CR+PR+≥6 months SD. As long as there is no disease progression (PD), endocrine therapy should be continued, and it is best to continue the medication for 3-5 years.

3. Use endocrine therapy as the first-line treatment as early as possible. According to the clinical research results of letrozole (Fluoron), the efficacy of preoperative neoadjuvant therapy is about 50%, the first-line treatment rescues 30%, and the second-line rescue is about 20%. In addition, although there is a significant difference in the effectiveness of first-line and second-line treatments, second-line treatment for advanced patients cannot be abandoned.

4. There is rarely cross-resistance between endocrine drugs. If one drug becomes resistant, another endocrine drug can be selected. Patients who were once effective in the past may still respond to the new endocrine drug.

5. Pay attention to the impact of Her-2 gene on endocrine therapy resistance.

6. Do not give up the treatment of patients with bone metastasis easily. Bone metastasis is a non-measurable lesion, but it is still an evaluable lesion. The efficacy of letrozole as a first-line treatment for bone metastasis is 22%, and it can still reach 15-16% as a second-line treatment. The median time to lesion progression after first-line treatment is 9-7 months. After 1-2 months of medication, as long as the symptoms improve and X-rays show a few calcification foci in the osteolytic destruction area, it should be considered PR and endocrine therapy should be continued.