Article and Video CATEGORIES

Cancer Journey

Search By

Dr. Jack West is a medical oncologist and thoracic oncology specialist who is the Founder and previously served as President & CEO, currently a member of the Board of Directors of the Global Resource for Advancing Cancer Education (GRACE)

 

Concept of Anti-Estrogen Therapy for Lung Cancer Makes International News
Author
Howard (Jack) West, MD

This week, Drs. Bouchardy and colleagues in Geneva published their report of lower rates of lung cancer death in women with breast cancer who received the anti-estrogen therapy tamoxifen compared with women with breast cancer who didn't receive tamoxifen, leading to some debate about whether the commercially available agent tamoxifen should be recommended as a treatment for lung cancer.

This particular study (in it's pre-publication form) was actually discussed by GRACE faculty member Mary Pinder from Moffitt Cancer Center in Tampa just over a year ago. The main concept is that the study reviewed a very large cohort of women in Geneva with breast cancer and compared outcomes in terms of lung cancer development and rates of death from lung cancer as noted in their registry for the group of women who received tamoxifen vs. those who did not. They didn't see a significant reduction in the rate of lung cancers developing, but they did see a much lower rate of lung cancer deaths compared with their calculated expectations in a model in the patients who received tamoxifen (13% of the expected number), compared with 76% of the expected calculation for those women with breast cancer who didn't receive tamoxifen.

As Dr. Pinder appropriately pointed out in her post from a year ago, we need to recognize that this is a retrospective analysis, and I think it's also important to highlight that the numbers of women with lung cancer ended up as pretty small, so it's hard to make too much out of results that would have different conclusion if just 1-2 more patients had a different outcome. Importantly as well, the comparison is to a calculation of expected results that are based on assumptions. Finally, as Dr. Pinder noted as well, there could be some related confounding factor, such as a medication for hot flashes induced by tamoxifen, or something about breast cancer itself that has a protective effect (after all, there was a non-significantly lower than expected rate of lung cancer deaths in the women with breast cancer who didn't receive tamoxifen, and that 24% would be trumpeted if it happened to achieve statistical significance).

On the other hand, these admittedly limited results are consistent with a finding from the Women's Health Initiative that showed a lower lung cancer survival for women who took hormone replacement therapy (HRT) (summarized here by Dr. Heather Wakelee from Stanford), just showing a result in the opposite direction with an anti-estrogen therapy.

So should we be recommending tamoxifen as a treatment for women with lung cancer? I agree with Dr. Pinder's assessment that these results are very intriguing and should lead us to increase our commitment to prospective trials that evaluate agents like tamoxifen or other hormone therapies such as aromatase inhibitors that are routinely used in breast cancer, as they may truly be effective interventions for lung cancer. However, they have their own side effects and costs, and in the absence of a higher level of evidence, I personally feel that the evidence we have now falls well short of what we would need to prescribe one of these agents as a lung cancer treatment. Because these are daily oral therapies, they would have the potential to be used on a longitudinal basis, such as after surgery for early stage disease or after chemo/radiation for locally advanced lung cancer, as well as in the advanced lung cancer setting. I would be very interested in participating in, or at least learning the results of, trials of these hormonal therapies in any of these settings.

The threshold for discussing and perhaps recommending discontinuation of HRT for women with lung cancer who are on it is different from the level of evidence I think you would need to recommend an anti-estrogen therapy. Here, I think the converging evidence, all pretty consistent, would lead me to want to discuss this with women on HRT, or considering HRT; I would say that the level of evidence warrants the potentially detrimental effect on lung cancer survival merits being factored into the equation of pros and cons of this complex question. In fact, I had a conversation with one such patient earlier today.

For now, this remains a murky question, but it's great to see momentum building for research in this field that could lead to better recommendations for our current patients and perhaps a new treatment approach for the future. Of course, what this means in terms of optimizint treatment for he men with lung cancer is still completely unknown. But we're adding pieces to the puzzle.

Next Previous link

Previous PostNext Post

Related Content

Image
Bladder Cancer Video Library 2024
Video
Dr. Petros Grivas discusses intravesical treatment for patients with nonmuscle invasive, or early-stage, bladder cancer, the importance of participating in clinical trials for bladder cancer, combination therapy options for patients with metastatic or incurable bladder cancer, and the importance of family history of cancer and discussing that history with your doctor.
Image
Case Based Panel
Video
The panel discusses treatment options for a patient diagnosed with EGFR Exon 19 Deletion NSCLC and examines data from the Laura Trial, a patient with a smoking history and diagnosis of small cell lung cancer, and how the Adriatic Study factors into decisions, and a patient with NSCLC adenocarcinoma, and a EGFR Exon 21 L858R Alteration, and how data from the Flaura 2 Trial can impact treatment decisions.
Image
Terapias Dirigidas de Cancer de Pulmón 2024
Video
La Dra. Estelamari Rodríguez presenta información básica sobre el NSCLC EGFR+ y analiza la importancia de las pruebas de biomarcadores en el cáncer de pulmón y ofrece una descripción general de las opciones de tratamiento para la enfermedad EGFR+.  Para ver la playlist completa, de click aquí.        

Forum Discussions

Hello Linda, my name is Alexandra Beneke, I'm the Outreach Manager for GRACE. Your willingness to share your experiences and knowledge with the cancer community is truly inspiring. Your dedication to...

Hi Bluebird,  Welcome to GRACE.  I'm sorry you're going through this scare and hope it's just inflammation or from an infection you didn't know you had. 

 

A CT would be...

Radiation + Brain Operation has just been discarded due to high risk. They will double Tagrisso dosis and then wait to see if it works, then try traditional Chemo. I would...

Hi and welcome to GRACE.  I'm sorry to know you are entering a new stage.  I'm not about to comment just now but wanted to let you know I see your...

Edit to say, we can't give advice but we can comment with views and facts.  :)

 

My first thought is to ask if she has been seen at a large...

Hi Barbro, Welcome to GRACE. I'm sorry you're worrying about this. We aren't able to give feedback on scan reports. Interpreting scan reports in this setting is not only unethical but...

Recent Comments

JOIN THE CONVERSATION
Tagrix FDA Approval
By mariachristian on
Hi Judy! It is so good to…
By JanineT GRACE … on
Tagrix vs Tagrisso
By Dipakchavan on
Hello Linda, my name is…
By AlexandraGBeneke on