Estrogen deprivation therapy

Estrogen Deprivation Therapy (EDT) is a medical treatment primarily used in the management of hormone receptor-positive breast cancer in postmenopausal women and prostate cancer in men. This therapy aims to reduce levels of estrogen in the body because estrogen can promote the growth of certain types of cancer cells. Estrogen deprivation therapy can be achieved through various methods, including the use of medications that block estrogen production or action, and surgical procedures that remove organs producing estrogen, such as the ovaries in women.

Overview

Estrogen plays a crucial role in the growth and development of normal breast and prostate tissues. However, in certain cancers, estrogen can stimulate the growth of cancer cells. Estrogen deprivation therapy seeks to block this effect by lowering estrogen levels in the body or by preventing estrogen from interacting with its receptors on cancer cells.

Types of Estrogen Deprivation Therapy

There are several approaches to estrogen deprivation therapy, each with its mechanisms of action:

Aromatase Inhibitors

Aromatase inhibitors (AIs) are drugs that inhibit the enzyme aromatase, which is responsible for the conversion of androgens into estrogens in the body. By blocking this enzyme, AIs reduce estrogen levels, slowing the growth of hormone receptor-positive breast cancer. Examples of AIs include anastrozole, letrozole, and exemestane.

Selective Estrogen Receptor Modulators

Selective estrogen receptor modulators (SERMs) bind to estrogen receptors on cells, preventing estrogen from binding to these receptors. However, SERMs can act as estrogen agonists or antagonists depending on the target tissue. Tamoxifen is a widely used SERM for treating and preventing breast cancer.

Ovarian Suppression

In premenopausal women, ovarian suppression techniques may be used to reduce estrogen production by the ovaries. This can be achieved through the use of gonadotropin-releasing hormone (GnRH) agonists, which inhibit the secretion of hormones that stimulate the ovaries. Surgical removal of the ovaries (oophorectomy) is another method of ovarian suppression.

Fulvestrant

Fulvestrant is a selective estrogen receptor degrader (SERD) that binds to estrogen receptors, leading to their degradation. This drug is used in the treatment of hormone receptor-positive metastatic breast cancer.

Side Effects

The side effects of estrogen deprivation therapy vary depending on the specific treatment but may include hot flashes, mood swings, vaginal dryness, decreased libido, and bone density loss. It is important for patients to discuss potential side effects with their healthcare provider and to receive regular monitoring during treatment.

Conclusion

Estrogen deprivation therapy is a critical component in the treatment of hormone receptor-positive breast and prostate cancers. By understanding the various types of therapies and their potential side effects, healthcare providers can tailor treatments to individual patient needs, improving outcomes and quality of life for those affected by these cancers.