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>>> Dr. Margileth: In premenopausal women with hormone receptor-positive breast cancer
who are candidates for anti-estrogen therapy, the most common treatment is the pill called
Tamoxifen.
There have been a number of trials looking at the metabolism of Tamoxifen and asking
the question: “are there different patients that metabolize Tamoxifen in different ways
such that the Tamoxifen may be more or less effective?” These studies have revolved
around studying a gene called the CYP2D6 gene that is one of the main genes that metabolizes
Tamoxifen to the active drug Endoxifen.
Research has shown that some women are what is called normal metabolizers and some women
are what is called low metabolizers. There was a period of time in which it was felt
the testing for this gene was important to determine whether the Tamoxifen was going
to be effective in that particular patient.
Recent data, however, has negated that and there is now little to no evidence that CYP2D6
testing is helpful in determining whether Tamoxifen is effective or not. This probably
resolves around the fact that there are multiple other enzymes that can convert Tamoxifen to
Endoxifen, so that in general we now do not recommend testing for this gene and the Tamoxifen
would in fact in general be the anti-estrogen treatment of choice for premenopausal women.
Tamoxifen replaced removing the ovaries and in fact when Tamoxifen first came out, it
was called a medical oophorectomy, such that we did not need to take out the ovaries like
we did in the past.
Another option for therapy in premenopausal women, used more in Europe than in this country,
would be one of the LHRH agonist such as a drug called Zoladex that put the ovaries at
rest. These drugs, however, put the patient in a severe menopause and are somewhat more
difficult to take than Tamoxifen.
So in general there is no specific test to tell whether Tamoxifen is working in a particular
person, but we would use Tamoxifen as our primary agent in premenopausal women.
*****
Hi, I am Dr. Jay Harness and I want to share with you an important information that I believe
that every newly diagnosed patient with breast cancer needs to know.
Susan Denver: “I am a breast cancer survivor.”
Katherine Stockton: “I am a breast cancer survivor.”
Coree: “I am a breast cancer survivor…”
Susan Denver: “…and I want every woman to know…”
Katherine Stockton: “…about personalized breast cancer treatment…”
Susan Denver: “…and the Genomic Test.”
Coree: “A test that helps guide a woman and her doctor…”
Katherine Stockton: “…to the best treatment options for her.”
Susan Denver: “Pass it on!”