Tamoxifen dose for breast cancer

Discussion in 'Canadian Meds' started by 777, 25-Aug-2019.

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    Tamoxifen dose for breast cancer


    Of tamoxifen—5 mg/d, given for 3 years rather than 5 years—halved the risk of breast cancer recurrence or new lesions over placebo in women with breast intraepithelial neoplasia, without producing the usual toxicities seen with the standard dose, Italian researchers reported at the 2018 San Antonio Breast Cancer Symposium. “We believe our results have external validity and—given their pragmatic nature and the easy accessibility of tamoxifen—are generalizable,” said Andrea De Censi, MD, of the National Hospital E. Ospedali Galliera–Division of Medical Oncology in Genoa, Italy. “Tamoxifen, 5 mg a day (splitting the tablet) or 10 mg every other day, is applicable in clinical practice tomorrow.” Breast cancer experts at the meeting said this is news they can use. “Looking at these data, I would definitely give lower doses of tamoxifen, especially in patients with atypical ductal hyperplasia and lobular carcinoma in situ,” said Virginia G. Kaklamani, MD, Professor of Medicine at The University of Texas at San Antonio and leader of the Breast Cancer Program at The University of Texas MD Anderson Cancer Center, Houston. “This information tells me I can perhaps cut back on the dose for patients who are not tolerating tamoxifen. This would help me keep them on the dose, rather than have them abandon therapy,” said John Cole, MD, of the Ochsner Health System in New Orleans. 6, 2018 (Health Day News) -- Tamoxifen is considered a vital weapon in the fight against breast cancer, but many women who have to take the drug struggle with its significant side effects. The side effect rate for the low-dose therapy was significantly less than what previous research has shown with the standard 20 milligram (mg) dose of tamoxifen, he noted. Now, new research shows that a lower dose of the hormone therapy helped prevent breast cancer from returning and guarded against new cancers in women who had high-risk breast tissue. In addition, the risk of serious side effects, such as blood clots and endometrial cancer, were similar to that of the placebo, and less than what typically occurs with the 20 mg dose, De Censi said. On top of that, the lower dose -- just 5 milligrams daily -- came with fewer troubling side effects."Low-dose tamoxifen is as effective as the standard dose," said study author Dr. He is director of the medical oncology unit at the National Hospital E. Hormone therapy for breast cancer interferes with the growth of cancer cells in a few ways. De Censi said the rate of side effects -- such as hot flashes, vaginal dryness, pain during intercourse and muscle pain -- was similar to the rate that occurred with a placebo pill. One is by blocking the body from producing certain hormones. Another is by disrupting the effects of certain hormones on cancer cells, according to the American Cancer Society. In the case of tamoxifen, it works by binding to estrogen-receptors.

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    Risk factors for breast cancer are female sex and advancing age, inherited risk, breast density, obesity, alcohol consumption, and exposure to ionizing. The low-dose tamoxifen arm had invasive breast cancer and 11 had breast intraepithelial neoplasia. In the placebo arm, 10 had invasive breast cancer and 18 had breast intraepithelial neoplasia. There were 12 serious adverse events among the patients in the low-dose tamoxifen arm and 16 among those in the placebo arm. Women with DCIS and women at high risk for breast cancer. Serious and life-threatening events associated with tamoxifen in the risk reduction setting women at high risk for cancer and women with DCIS include uterine malignancies, stroke and pulmonary embolism

    However, the toxicities of tamoxifen such as thromboembolic events and endometrial cancers still pose a clinically significant problem. To reduce the risk of these adverse events, effective, yet safe drugs are being sought that could replace tamoxifen. Indeed, new endocrine agents such as selective ER modulators (SERMs) and aromatase inhibitors are being evaluated as alternatives to tamoxifen for the treatment propose a different strategy to reduce the side effects of tamoxifen. They suggest that, by using a lower dose of tamoxifen, it may be possible to reduce tamoxifen’s side effects while retaining its therapeutic and preventive efficacy. To investigate the biologic effect of low doses of tamoxifen, Decensi et al. measured biomarkers associated with breast cancer, cardiovascular disease, and bone fracture risk. They conducted a randomized, double-blind, three-arm study to investigate the ability of different doses of tamoxifen (1 mg/day, 5 mg/day, or 20 mg/day) to modulate these biomarkers in women with ER-positive breast cancer. For many people living with life-limiting and life-threatening diseases like cancer, medical cannabis has long been hailed as a gift, both for symptom control and for its potential to limit the disease process itself. N., a Hospice and Oncology Nurse who is a fierce patient advocate with a passion for investigating and educating about the evidence surrounding cannabis and cancer, recently broke down some of the most recent evidence and issues in a recent interview. But especially in the case of breast cancer—or, more accurately, breast cancers—the therapeutic potential of cannabis also comes laden with the potential for harm, and, like all medications, patients need to understand that powerful drugs can create unanticipated interactions with other powerful drugs. “New and emerging research from the past several years reveals that tamoxifen, and other Selective Estrogen Receptor Modulators, or SERMS, bind not only to estrogen receptors. They also bind with high affinity to one or both cannabinoid receptors, for CB1 and CB2,” said Wohlschlagel. “Tamoxifen apparently binds to both receptors, as what is called an ‘inverse agonist.’ The possible effects caused by that binding are just beginning to be explored.’” Unlike most forms of cancer, “breast cancer” is actually a blanket term rather than a single diagnosis. It covers several distinct types of cancer that are further distinguished by diagnostic laboratory tests. The specific diagnosis drives individual considerations among patients and their medical teams regarding which treatments are most likely to produce the optimal outcomes for each patient. Tamoxifen is the oldest and most widely used of a class of drugs called Selective Estrogen Receptor Modulators (SERMS).

    Tamoxifen dose for breast cancer

    Is Low-Dose Tamoxifen Useful for the Treatment and Prevention of Breast., Low-Dose Tamoxifen Was Safe and Effective at Reducing Recurrence and.

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  3. Tamoxifen, sold under the brand name Nolvadex among others, is a medication that is used to prevent breast cancer in women and treat breast cancer in women and men.

    • Tamoxifen - Wikipedia.
    • Soltamox tamoxifen dosing, indications, interactions, adverse effects..
    • Basic Information On Tamoxifen Breast Cancer.

    Tamoxifen Nolvadex, a hormone therapy drug, is used to treat breast cancers and to lower risk in women at high risk of breast cancer. Read about Tamoxifen side. The dose for metastatic breast cancer treatment, DCIS, and prevention of breast cancer is 10 mg twice daily or 20 mg once daily for 5 years. The dose for stimulation of ovulation is 5-40 mg twice daily for 4 days. Tamoxifen can be taken with food. Breast Cancer, Cannabis, and Tamoxifen Understanding the Dangers of Drug-Drug Interactions August 31, 2017 Breast Cancer, Cancer, Headlines, Pharma and MMJ, Popular, United Patients Group For many people living with life-limiting and life-threatening diseases like cancer, medical cannabis has long been hailed as a gift, both for symptom.

     
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    Day 1: 10 mg PO before breakfast, 5 mg after lunch and after dinner, and 10 mg at bedtime Day 2: 5 mg PO before breakfast, after lunch, and after dinner and 10 mg at bedtime Day 3: 5 mg PO before breakfast, after lunch, after dinner, and at bedtime Day 4: 5 mg PO before breakfast, after lunch, and at bedtime Day 5: 5 mg PO before breakfast and at bedtime Day 6: 5 mg PO before breakfast Immediate-release: ≤10 mg/day PO added to disease-modifying antirheumatic drugs (DMARDs) Delayed-release: 5 mg/day PO initially; maintenance: lowest dosage that maintains clinical response; may be taken at bedtime to decrease morning stiffness with rheumatoid arthritis Take with meal or snack High-dose glucocorticoids may cause insomnia; immediate-release formulation is typically administered in morning to coincide with circadian rhythm Delayed-release formulation takes about 4 hours to release active substances; thus, with this formulation, timing of dose should take into account delayed-release pharmacokinetics and disease or condition being treated (eg, may be taken at bedtime to decrease morning stiffness with rheumatoid arthritis) Allergic: Anaphylaxis, angioedema Cardiovascular: Bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement, circulatory collapse, congestive heart failure, fat embolism, hypertension, hypertrophic cardiomyopathy in premature infants, myocardial rupture after recent myocardial infarction, pulmonary edema, syncope, tachycardia, thromboembolism, thrombophlebitis, vasculitis Dermatologic: Acne, allergic dermatitis, cutaneous and subcutaneous atrophy, dry scalp, edema, facial erythema, hyper- or hypopigmentation, impaired wound healing, increased sweating, petechiae and ecchymoses, rash, sterile abscess, striae, suppressed reactions to skin tests, thin fragile skin, thinning scalp hair, urticaria Endocrine: Abnormal fat deposits, decreased carbohydrate tolerance, development of cushingoid state, hirsutism, manifestations of latent diabetes mellitus and increased requirements for insulin or oral hypoglycemic agents in diabetics, menstrual irregularities, moon facies, secondary adrenocortical and pituitary unresponsiveness (particularly in times of stress, as in trauma, surgery, or illness), suppression of growth in children Fluid and electrolyte disturbances: Fluid retention, potassium loss, hypertension, hypokalemic alkalosis, sodium retention Gastrointestinal: Abdominal distention, elevation of serum liver enzymes levels (usually reversible upon discontinuance), hepatomegaly, hiccups, malaise, nausea, pancreatitis, peptic ulcer with possible perforation and hemorrhage, ulcerative esophagitis General: Increased appetite and weight gain Metabolic: Negative nitrogen balance due to protein catabolism Musculoskeletal: Osteonecrosis of femoral and humeral heads, Charcot-like arthropathy, loss of muscle mass, muscle weakness, osteoporosis, pathologic fracture of long bones, steroid myopathy, tendon rupture, vertebral compression fractures Neurologic: Arachnoiditis, convulsions, depression, emotional instability, euphoria, headache, increased intracranial pressure with papilledema (pseudotumor cerebri; usually following discontinuance of treatment), insomnia, meningitis, mood swings, neuritis, neuropathy, paraparesis/paraplegia, paresthesia, personality changes, sensory disturbances, vertigo Ophthalmic: Exophthalmos, glaucoma, increased intraocular pressure, posterior subcapsular cataracts, central serous chorioretinopathy Reproductive: Alteration in motility and number of spermatozoa Untreated serious infections Documented hypersensitivity Varicella Administration of live or attenuated live vaccine (Advisory Committee on Immunization Practices (ACIP) and American Academy of Family Physicians (AAFP) state that administration of live virus vaccines usually is not contraindicated in patients receiving corticosteroid therapy as short-term ( Monitor for hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing syndrome, and hyperglycemia Prolonged use associated with increased risk of infection; monitor Use with caution in cirrhosis, ocular herpes simplex, hypertension, diverticulitis, hypothyroidism, myasthenia gravis, peptic ulcer disease, osteoporosis, ulcerative colitis, psychotic tendencies, renal insufficiency, pregnancy, diabetes mellitus, congestive heart failure, thromboembolic disorders, GI disorders Long-term treatment associated with increased risk of osteoporosis, myopathy, delayed wound healing Patients receiving corticosteroids should avoid chickenpox or measles-infected persons if unvaccinated Latent tuberculosis may be reactivated (patients with positive tuberculin test should be monitored) Some suggestion (not fully substantiated) of slightly increased cleft palate risk if corticosteroids are used in pregnancy Methylprednisolone is preferred in hepatic impairment because prednisone must be converted to prednisolone in liver Prolonged corticosteroid use may result in elevated intraocular pressure, glaucoma, or cataracts May cause impairment of mineralocorticoid secretion; administer mineralocorticoid concomitantly May cause psychiatric disturbances; monitor for behavioral and mood changes; may exacerbate pre-existing psychiatric conditions Monitor for Kaposi sarcoma Pregnancy category: C (immediate release); D (delayed release) Drug may cause fetal harm and decreased birth weight; maternal corticosteroid use during first trimester increases incidence of cleft lip with or without cleft palate Lactation: Of maternal serum metabolites, 5-25% are found in breast milk; not recommended, or, if benefit outweighs risk, use lowest dose Glucocorticosteroid; elicits mild mineralocorticoid activity and moderate anti-inflammatory effects; controls or prevents inflammation by controlling rate of protein synthesis, suppressing migration of polymorphonuclear leukocytes (PMNs) and fibroblasts, reversing capillary permeability, and stabilizing lysosomes at cellular level; in physiologic doses, corticosteroids are administered to replace deficient endogenous hormones; in larger (pharmacologic) doses, they decrease inflammation The above information is provided for general informational and educational purposes only. 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