Hormone Therapy Has A Stronger Impact On A Woman’s Quality Of Life Than Chemo, Study Finds

A French study has found that hormone therapy has a greater impact on a woman’s quality of life than chemotherapy two years after a breast cancer diagnosis.

Hormone therapy (also called endocrine therapy) is given to breast cancer patients whose cancer is fueled be either estrogen or progesterone, or both. Roughly two out of every three breast cancers is hormone-positive. Hormone therapy is systemic — meaning that it targets cancer cells throughout the body, not just in the breast. It is typically taken for five to ten years.

Chemotherapy can be given before or after breast cancer surgery, and is the primary treatment for metastatic breast cancer. It is given in cycles, which can least weeks to months at a time. Chemo attacks fast-growing cells like cancer cells, but also the quick-growing cells in your bone marrow, hair follicles, and digestive tract.

Side effects for both treatments can range from mild to severe. Yet a common perception is that chemotherapy has worse side effects and more negatively impacts a woman’s quality of life. This study found that perception to be wrong.

The study was published in the Annals of Oncology and was conducted by Institut Gustave Roussy. The data was pulled from patients who were part of the CANTO cohort (“CANcer TOxicities”). This cohort is a group of 20,000 breast cancer patients who will be studied over a period of ten years, with the specific goal of quantifying and preventing chronic toxicities related to treatment.

Researchers measured quality of life in 4,262 breast cancer patients from the CANTO cohort, using two different tools: one which assessed general quality of life in patients with all types of cancer (EORTC QLQ-C30), and a tool that specifically assessed quality of life in breast cancer patients (QLQ-BR23).

All the patients in the study had localized breast cancer that was stage I, II, or III. Quality of life was measured at the time of diagnosis, one year after the diagnosis, and two years after the diagnosis.

For all of the women in this study, the primary treatment method was surgery. Some of them also had chemotherapy and/or radiation. About 75-80% of them had to take hormone therapy for a minimum of 5 years. Roughly one-third of the women were premenopausal, with the other two-thirds being postmenopausal.

Researchers found that, overall, quality of life was worse two years after diagnosis for patients who were taking hormone therapy, especially patients who were menopausal. Quality of life was also worse for a longer period of time compared to chemo. Hormone therapy had a detrimental effect on a variety of areas and symptoms, including role and social function, pain, insomnia, systemic therapy side-effects, breast symptoms, emotional function, and future perspective recovery.

Chemo had a negative impact on physical and cognitive function, dyspnea, financial difficulties, body image, and breast symptoms. But, while rough at the onset, chemo lasts only a short time in comparison to hormone therapy, and was not shown to have a persistent negative impact on quality of life at two years post-diagnosis.

The effects of each treatment were different for premenopausal and postmenopausal women. Chemo had a stronger negative effect on quality of life for premenopausal women at first — especially on cognitive function. But for postmenopausal patients, hormone therapy was more frequently associated with lowered quality of life.


The findings of the study suggest a significant downside to hormone therapy, and this is something patients need to be made aware of. However, the benefits can certainly outweigh the risks in many situations. Additional support for patients undergoing hormone therapy should be considered.

“It is important in the future that we are able to predict which women are going to develop severe symptoms with anti-hormonal treatment so that we can support them,” said Dr. Inès Vaz-Luis, a specialist breast cancer oncologist and researcher who directed the study. “It will also be important in the future to differentiate prior to treatment patients who are at high risk of relapse from those at lower risk in order to tailor hormone treatment. This may be done to avoid escalation of anti-hormonal treatment in certain patients.

“Hormone therapy is extremely effective in treating breast cancer, resulting in a reduction by approximately 50% in the risk of relapse. The finding of adverse effects does not in any way put into question the excellent risk/benefit ratio of this treatment.”

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8 Ways Metastatic Breast Cancer Is Different from Stages I-III

Metastatic breast cancer, also referred to as stage IV breast cancer, is the most advanced type of the disease. It occurs when tumors spread to other parts of the body. Unfortunately, it is incurable, and means that a woman who is diagnosed with it must live with cancer for the rest of her life. 

Being diagnosed with stage IV breast cancer can be overwhelming, and yet while there is no cure, many people with metastatic breast cancer can still lead full, rewarding lives and do amazing things. Of course, with the diagnosis comes many changes. Here are some of the ways metastatic breast cancer is different from the other stages of the disease.

8. You’re No Longer Looking for a Cure

As previously mentioned, the unfortunate reality of a stage IV breast cancer diagnosis is that you’ll be living with cancer for the rest of your life, which means your treatment will continue just as long. This will affect every treatment you decide to undergo and what you’re willing to experience. You’re no longer looking for a cure, but you are looking for more time.

7. Other People Will Still Think You’re Curable

The average person doesn’t understand that metastatic breast cancer is incurable — they may be under the assumption that your treatment will end during your lifetime. While you know better, do your best to deal with this. Be clear with your friends and family about your situation.

6. You Have More to Learn About This Type of Cancer

Many people, including those who have metastatic breast cancer, don’t fully understand the disease. Dedicate yourself to learning everything you can. This will not only keep you aware of your options, it will also empower you as you work to manage your care.

5. The Goal of Treatment Becomes to Prolong Life

With each treatment you undergo, you know the objective is now to stay as healthy as you can for as long as possible. Some women with metastatic breast cancer can live several years after a diagnosis with proper treatment and care.

4. Quality of Life Becomes More Important

After your stage IV diagnosis, time becomes much more valuable. A good quality of life is what matters, and you have to decide what treatments are worth it and which ones aren’t. Some treatments may be effective, but may also come with side effects you simply don’t want to deal with. Be honest with your medical team about how you feel to ensure you’re spending your time the way you want to.

3. Palliative Care Becomes Part of Your Treatment Plan

Palliative care deals with treating pain and symptoms related to your disease. It is also referred to as “comfort care” or “supportive care,” as the goal is not to cure, but to manage your symptoms and alleviate any emotional issues. It might include endocrine therapy to relieve pain, or medication to deal with nausea or insomnia. The primary objective is to help improve your quality of life.

2. You Get a Different Group of Breast Cancer “Sisters”

One of the silver linings of your diagnosis is that now, you’re part of an exclusive sisterhood, made up of women who are battling the same cancer as you. Like you, their disease is not curable and their time has become more valuable. Make the most of those sisters you have around you. Maybe you can draw strength from each other.

1. You Learn to Live in the Present

You may have received a tough diagnosis, but now you realize that this moment is yours. Make the most of it and appreciate the small things while they’re happening. Spend time with family, check items off your bucket list, and take each day as it comes.
Learning to live with cancer may be difficult, but you still have life to live. This is YOUR time, and it’s up to you how you’d like to make the most of it.

Breast cancer can turn your world upside down, but as draining as it is, good things can come out of your experience, too.

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New antibody-drug conjugate shows promising activity in salivary gland tumors

The antibody-drug conjugate ado-trastuzumab emtansine (T-DM1) has promising activity in HER2 amplified salivary gland tumors, according to data published in the Annals of Oncology.

The publication is for 'Arm Q,' which is one of nearly 40 single-arm phase two treatments in the NCI-Molecular Analysis for Therapy Choice (NCI-MATCH or EAY131) trial. NCI-MATCH is being co-led by the ECOG-ACRIN Cancer Research Group (ECOG-ACRIN) and the National Cancer Institute (NCI), part of the National Institutes of Health.

We saw that two of the three NCI-MATCH patients with salivary gland tumors had significant tumor shrinkage by at least 30% with T-DM1 treatment, and this benefit lasted. The benefit lasted two years in the patient with squamous cell cancer of the parotid gland, and nine months in the case of mucoepidermoid carcinoma of the parotid gland."

Komal Jhaveri, MD, FACP, lead researcher

Jhaveri is a medical oncologist and early-phase clinical trials specialist at Memorial Sloan Kettering Cancer Center in New York.

"This is a hint of activity that needs to become the focus of a larger trial," said Dr. Jhaveri.

Another recent T-DM1 trial (not part of the NCI-MATCH trial) reported interim results at the 2019 annual meeting of the American Society of Clinical Oncology.

In that trial (NCT02675829), nine of the 10 patients with salivary gland cancers treated with T-DM1 responded either with tumor shrinkage by computed tomography (CT) scan or as assessed by positron emission tomography (PET). As a result, that trial has since been expanded to enroll additional patients.

T-DM1 is a targeted therapy that contains the monoclonal antibody trastuzumab, which binds to the HER2 protein found on some cancer cells. It also contains the cytotoxic drug DM1, which inhibits tumor cell division.

Unlike chemotherapy, antibody-drug conjugates like T-DM1 are intended to target and kill tumor cells while sparing healthy cells. T-DM1 has improved overall survival and led to a new standard of care in HER2-positive metastatic breast cancer  previously treated with trastuzumab and a taxane.

The primary objective of each arm in NCI-MATCH is to estimate the proportion of patients who had an objective response (OR). Under predefined criteria, an OR rate greater than 16% in a given NCI-MATCH arm would warrant further study of the agent(s).

Although the results from Arm Q did not meet these criteria, the signal in salivary gland tumors is important.

"We are excited about the prospect of this and other upcoming MATCH arms to shed new light on responsive tumor types, as there is far less data available in rare and uncommon disease types from previously conducted trials," said Keith T. Flaherty, MD, a medical oncologist at Massachusetts General Hospital Cancer Center in Boston and ECOG-ACRIN study chair for the overall NCI-MATCH trial.

"Salivary cancer is a particularly understudied area and seeing evidence of benefit for a molecularly targeted approach strongly supports further focus on this cancer type."

Patients received T-DM1 at 3.6 mg/kg intravenously every three weeks until toxicity or disease progression.

Of the 38 patients enrolled in Arm Q, 36 were included in the efficacy analysis. Overall, this was a heavily pretreated group of patients with multiple unique histologies (excluding breast and gastric). Seventeen patients (47%) had stable disease with median duration of 4.6 months, including eight of 10 patients with ovarian and uterine carcinomas.

The six-month progression-free survival rate was 23.6%. Common toxicities were fatigue, anemia, fever and thrombocytopenia. However, this arm did not find any new toxicities for T-DM1.

There was a trend for tumor shrinkage with higher levels of gene copy number as determined by the tumor sequencing assay. The median HER2 copy number was 17 (range: seven-139). Notably, the patient with squamous cell cancer of the parotid gland had a HER2 gene copy number of 129 and the patient with mucoepidermoid carcinoma of the parotid gland had a copy number of 21.

"NCI-MATCH seeks to determine whether matching certain drugs or drug combinations in adults whose tumors have specific gene abnormalities will effectively treat their cancer, regardless of their cancer type," said Lyndsay Harris, MD, Associate Director, Cancer Diagnosis Program, NCI, and co-PI of the NCI-MATCH trial.

"In certain studies, such as this, we also saw benefit in rare tumor types. Such discoveries could be eligible to move on to larger, more definitive trials."

The publication (Annals of Oncology, Volume 30, Issue 11, November 2019) marks a milestone for the NCI-MATCH trial, being the first results manuscript to appear in print.

Genentech Inc. provided ado-trastuzumab emtansine for Arm Q under a Clinical Trial Participation Agreement between NCI and Genentech.

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Source:medical newsnet.