Any radiotherapy-risk factors with Systemic Lupus and MCTD? - 1245194

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kristina
Any radiotherapy-risk factors with Systemic Lupus and MCTD? - 1245194

Hallo,

I would like to know how I can prevent any risk-factors
in my future treatment of radiotherapy/hormone tharapy?

The reason why I am asking is because I do suffer from Systemic Lupus (SLE)
and Mixed Connective Tissue Disease (MCTD), Sjoegren's, Sicca and drug-intolerance,
and during puberty & menopause I suffered SLE/MCTD flare-ups
because of the hormonal changes which caused me to suffer
kidney failure each time, but I did succeed to keep my kidneys.
After puberty my kidney function recovered to GFR 40% again
and after menopause they stayed between GFR 10-12% (no dialysis).
I wonder if the hormonal cancer treatment might cause another flare-up?
Are there any precautions for SLE/MCTD sufferers
with drug-intolerance and over-sensitivity to hormonal changes?

Thank you once again from Kristina.

Dr West
Reply To: Any radiotherapy-risk factors with Systemic Lupus and

Here's a post about what is known about risks from radiation in people with collagen vascular disease, like what you're describing:

http://cancergrace.org/radiation/2011/03/13/rt-in-collagen-vasc-disease/

I don't know about hormone therapies, such as those used for breast cancer, but I'll see if Dr. Walko, an expert in cancer pharmacology, has any insight on this question.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

catdander
Reply To: Any radiotherapy-risk factors with Systemic Lupus and

kristina, In case an email hasn't been sent out to Dr. Walko, I sent one. Dr. Walko, I hope I'm not slamming you with requests.
Janine

dr walko
Reply To: Any radiotherapy-risk factors with Systemic Lupus and

Kristina,
It would be helpful to know exactly which hormonal therapy will be used. I'm assuming, since you have said that you are postmenopausal, that an aromatase inhibitor (Femara/letrozole, Arimadex/anastrozole, or Aromasin/exemestane) will be used. These drugs work by blocking the enzyme that activates estrogen so there is even less estrogen in your body (and with less estrogen, the tumor cannot feed off of it). This is in contrast to the drug tamoxifen that works by blocking estrogen receptors, so there is still estrogen in the body, it just cannot bind to the receptor on the tumor.

In terms of your specific case, it would be hard to predict what would happen or which drug would be optimal. I would recommend making sure your kidney function is very closely watched and then perhaps changing to a drug that works differently (i.e tamoxifen) if worsening starts to happen. Neither class of drugs needs to be adjusted for people with lower kidney function and the rates of "kidney problems" for both were very low (about 1% higher compared with placebo pills).

Best wishes,
Dr. Walko

Christine M. Walko, PharmD, BCOP, FCCP
Personalized Medicine Specialist
Moffitt Cancer Center, Tampa, FL

kristina
Reply To: Any radiotherapy-risk factors with Systemic Lupus and

Thank you for your kind answers, Dr. West, catdander (Janine) and Dr. Walko,
it is very much appreciated and does help me a lot.

It does appear that I now need very close monitoring
because of my MCTD and very low GFR kidney function.

I have been told by the surgeon that a test revealed
a hormone-sensitivity of 8/8 (I am sure you know what this might mean)
and I was told this was ideal for Tamoxifen, but I don’t know yet
which route of medication he will take.

It is interesting that I have been told the plan for my radiotherapy
may be smaller doses given over a longer period of time
to offset adverse reaction in my case.

I am very grateful for you time and your advice
because my medical history is extremely complicated.

Kind regards and many thanks again from Kristina.