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    TAMOXIFEN

     

    TAMOXIFEN
    Concerns about long-term use

    A study published in the July 30, 1999, issue of the journal Science revealed that the anti-estrogen drug, tamoxifen, may lose its effectiveness in preventing breast cancer - and may even begin to promote the disease - after 2 to 5 years of use. This study's findings may help researchers to devise ways to restore tamoxifen's effectiveness, but more research is needed.

    How could tamoxifen's effect change over years of use?

    We've known for years that tamoxifen's effect converts over time from that of a cancer inhibitor to a cancer stimulant - in breast cancer cells in the laboratory and in some patients - but we're only beginning to understand why.

    Basically, tamoxifen works by preventing breast cancer cells from interacting with estrogen, which many breast cancers must have in order to grow. But over time in some cases, the drug stops working, and begins to act like estrogen - i.e., to stimulate rather than inhibit cancer cell growth.

    If a woman has been taking tamoxifen for 2 or more years, should she discontinue use until further research has been completed?

    No. There have been many clinical trials on the long-term effectiveness of tamoxifen. The best one compared tamoxifen use for 5 years versus tamoxifen use for 10 years. The results indicated that tamoxifen for 10 years is no better, and may even be worse, than tamoxifen for 5 years. So the current national recommendation is tamoxifen for 5 years.

    Let's take a more detailed look at how this recommendation relates to different women. Tamoxifen is used in two main settings. First, it is used in women who have had breast cancer removed, and have no evidence of existing disease, but are given tamoxifen to reduce the risk of recurrence. It would be wrong for such women to stop using tamoxifen after 2 years - they could lose a lot of the benefits.

    Second, tamoxifen is used in women with metastatic breast cancer. In this group, tamoxifen can be taken for as long as there is no indication of the cancer progressing. Some women do very well on it for a very long time, so unless there is an indication of the disease worsening, there is no reason to stop.

    Are there any treatment options available now to help restore the effectiveness of tamoxifen?

    Currently, there is nothing you can do to restore the effectiveness of tamoxifen, or to prevent tamoxifen resistance from developing. Although the recent Science study brings us closer to understanding the mechanisms by which tamoxifen stops working, we still don't have a clear picture of the process. Because we don't have one specific mechanism to target, we are currently unable to develop a solution to the problem.

    However, much research is being conducted on anti-estrogens and other forms of hormonal therapy. I am confident we will continue to see progress in this area.

     






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