Anti-hormone therapy for breast cancer

If your tumour is one of the hormone-sensitive forms If you are a woman with a hormonal imbalance - and this is the case for most patients - anti-hormone therapy could be a treatment option for you.

At the Breast Centre am Englischen Garten, we start where every good treatment should start: with you. We analyse your tumour, understand your life situation and find out together, whether the anti-hormone therapy is right for you - and if so, which medication can best accompany you over the coming years. Because this therapy is a marathon, not a sprint. And you deserve a partner who will run the entire distance with you.

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What are the advantages of anti-hormone therapy?

Suitable for the majority of patients - 70-80% of all breast cancers are hormone-sensitive and can benefit from this form of therapy

Targeted instead of blanket coverage - The therapy specifically blocks the hormones' growth signals to cancer cells, leaving healthy cells largely unaffected

Proven long-term effect - Taken over 5-10 years, anti-hormone therapy has been shown to reduce the risk of relapse and significantly improve the long-term prognosis

Usually taken as a tablet - No regular visits to the clinic for infusions, you can carry out the therapy at home

Less acute stress than chemotherapy alone - No hair loss, no severe nausea - the side effects are different, but often easier to cope with in everyday life

Individual choice of medication - Depending on your menopause status, age and tolerance, we will select the optimum preparation for you

Flexible therapy duration - We regularly check whether the therapy is still appropriate and adjust the duration and dosage individually if necessary

Can be combined with other treatments - If the risk is higher, we can reinforce the anti-hormone therapy with targeted drugs such as CDK4/6 inhibitors

Long-term support - Throughout the entire treatment period of 5-10 years, we are at your side if you have any questions, side effects or uncertainties

Also effective for metastases - Even in advanced breast cancer, anti-hormone therapy is often the first choice and can control progression for years

What is anti-hormone therapy for breast cancer?

This is how anti-hormone therapy works:

Anti-hormone therapy (also called endocrine therapy) is an important treatment method for many women with breast cancer. Unlike chemotherapy, which generally targets fast-growing cells, anti-hormone therapy has a more targeted effect: it specifically targets the effect of hormones on the tumour.

In around 70 to 80 per cent of all breast cancers in women, the tumour is hormone-sensitive or hormone receptor-positive. This means that the growth of the cancer cells is promoted by natural hormones in the body - mainly oestrogen and sometimes progesterone. Anti-hormone therapy can be very effective for these types of tumours, as it slows down the growth of the cancer cells and can significantly reduce the risk of recurrence.

The Anti-hormone therapy is one of the targeted therapies, as it acts specifically on a certain growth mechanism of the cancer cells. It is often seen as a „gentler“ alternative to chemotherapy, as it usually causes fewer acute side effects. However, it is only effective in so-called hormone-sensitive tumours. At our breast centre, we use this modern form of therapy on an individual and patient-oriented basis.

How long does anti-hormone therapy last?

The optimal duration of anti-hormone therapy has changed over the years as a result of new research findings:

Standard duration of 5 years

Traditionally, anti-hormone therapy was carried out over a period of 5 years. This duration has been shown in numerous studies to be effective in significantly reducing the risk of relapse.

Special situations

In certain situations, the duration of therapy can be adjusted:

• Metastasised breast cancer: therapy is often continued as long as it is effective and well tolerated
• Younger patients: Due to the higher risk of relapse, longer treatment is often recommended
• Serious side effects: In the event of intolerable additional adverse effects, a change of medication or a shortening of therapy may be considered

The optimum duration should always be determined individually and checked regularly.

How are hormones and breast cancer linked?

In order to understand how anti-hormone therapy works, it is important to know how hormones and breast cancer are linked:

The role of hormones in the body

Hormones are messenger substances that are produced in the body and control various processes - from growth and development to metabolism and reproduction. The female sex hormones oestrogen and progesterone are mainly produced in the ovaries, but also in smaller quantities in other tissues such as fatty tissue and the adrenal glands.

These hormones have many important functions in the body:

• They control the menstrual cycle
• They promote the development of female sexual characteristics
• They influence bone formation and preservation
• They act on the breast tissue and promote its growth

Hormone receptors on cells

Hormones can only exert their effect if they bind to special docking sites, the so-called hormone receptors. These receptors act like keyholes into which only certain „keys“ (in this case the hormones) fit.

There are two main types of hormone receptors in breast cancer cells:

• Oestrogen receptors (ER): These bind the hormone oestrogen.
• Progesterone receptors (PR): These bind the hormone progesterone.

If a tumour has one or both of these receptors, it is described as „hormone receptor-positive“. More precisely, it can be ER-positive, PR-positive or both.

How hormones promote tumour growth

In the case of hormone receptor-positive breast cancer, oestrogen and/or progesterone can dock onto the receptors on the cancer cells. This process triggers a chain of biochemical reactions that:

• Stimulates the growth and proliferation of cancer cells
• Inhibits the natural cell death programming (apoptosis) of cancer cells
• Promotes the formation of new blood vessels to supply the tumour

These processes lead to the tumour growing and spreading under the influence of hormones.

How does anti-hormone therapy for cancer work?

Anti-hormone therapy intervenes in this process and suppresses the growth-promoting effect of the hormones on the cancer cells. This is done in two basic ways:

Blocking the hormone receptors

Some drugs bind to the binding sites of the hormones on the cancer cells and block them. As a result, the body's own hormones can no longer dock and develop their growth-promoting effect. These drugs are known as „selective oestrogen receptor modulators“ (SERMs) or „selective oestrogen receptor downregulators“ (SERDs).

The principle can be compared to a lock and key: The medication is inserted into the lock (the receptor) like a false key and blocks it so that the correct key (the hormone) no longer fits in.

Reduction in hormone production

Other medications aim to reduce the amount of hormones in the body. This can be achieved in various ways:

• Inhibition of oestrogen production in tissue outside the ovaries (by aromatase inhibitors)
• Suppression of ovarian function (by GnRH analogues or surgical removal of the ovaries)

These measures reduce the amount of hormones in the body so that fewer hormones are available to stimulate tumour growth.

Who can benefit from anti-hormone therapy?

Anti-hormone therapy is not suitable for every affected woman. The decision is mainly based on the hormone receptor status of the tumour, which is determined in pathology after the operation or biopsy.

Hormone receptor status determination

The tumour tissue is examined to determine whether and to what extent hormone receptors are present. The result is given as a percentage or as a score:

• ER-positive/PR-positive: If more than 1 per cent of the cancer cells have oestrogen receptors or progesterone receptors
• ER-negative/PR-negative: If less than 1 per cent of cancer cells have these receptors

The more hormone receptors are present, the more likely a good response to anti-hormone therapy is.

Other factors for the treatment decision

In addition to the hormone receptor status, other factors play a role in the decision in favour of or against anti-hormone therapy:

• Menopause status: before or after the menopause - this influences the choice of medication
• Age of the patient: Younger and older patients may respond differently to the therapy
• Tumour stage and risk: If there is a higher risk of recurrence, more intensive or longer therapy may be advisable
• Concomitant diseases: Existing health problems can influence tolerance
• Desire to have children: Special aspects must be taken into account for young women who wish to have children

When is anti-hormone therapy used?

Anti-hormone therapy can be used in various phases of breast cancer treatment:

Adjuvant (supportive) therapy after surgery

The most common application is adjuvant therapy, which begins after surgery. The aim is to combat any cancer cells that may remain in the body and reduce the risk of recurrence. This preventive treatment is also carried out when there are no visible tumour foci left.

Adjuvant anti-hormone therapy is typically given for several years (usually 5-10 years) and has been shown to be very effective in improving long-term survival.

Neoadjuvant therapy before surgery

In some cases, anti-hormone therapy can also be used before surgery to shrink the tumour. This can be:

• Enable breast-conserving surgery where a complete breast removal would otherwise be necessary
• Reduce the scope of the operation
• Valuable information about the tumour's response to hormone therapy is provided by

Neoadjuvant anti-hormone therapy typically lasts 4-6 months before surgery.

Metastasised disease

Anti-hormone therapy can be used to treat breast cancer that has already spread to other parts of the body (so-called metastases):

• Slowing down the progression of the disease
• Alleviate symptoms
• Improving the quality of life

In metastasised hormone receptor-positive breast cancer, anti-hormone therapy is often the first treatment option before chemotherapy is considered.

Risk reduction in high-risk patients

In rare cases, anti-hormone therapy (usually tamoxifen) can also be used for prevention in women with a very high risk of breast cancer, e.g. in the case of certain genetic predispositions or precursors of breast cancer.

Communication with the treatment team at the Breast Centre at Englischer Garten

Open communication with the treatment team is crucial for the success of the therapy:

During the therapy

• Document side effects: Write down the type, frequency and intensity of the symptoms
• Attend regular check-ups: Keep agreed follow-up appointments
• Address problems: Don't wait until side effects become unbearable
• Enquiries: If anything is unclear or new symptoms occur, contact us promptly

In case of problems

• Discuss adherence to treatment: Talk openly about difficulties with regular intake
• Discuss alternatives: If side effects are intolerable, ask about other medications or dosages
• Enquire about support options: Ask about accompanying therapies or offers of help

Long-term therapy requires a long-term partnership. We are at your side - for years to come.

Contact the case management of the Breast Centre at the English Garden

We will be happy to advise you personally at the Geisenhofer Clinic in Munich.

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