Who will benefit from hormone therapy?
The effect of hormone therapy in breast cancer patients can be predicted
Hormone therapy for breast cancer is a frequent choice of oncologists. Unfortunately, it does not help everyone, and it was previously impossible to evaluate its effectiveness in a particular person in advance. But recently, a prognostic method based on the assessment of the "operability" of cancer receptors to the hormone estrogen using positron emission tomography was developed for these purposes, which successfully passed the first clinical trial.
Article by Dehdashti et al. The Association of PET-Based Estradiol-challenge Test for Breast Cancer Progesterone Receptors with Response to Endocrine Therapy is published in the journal Nature Communications.
Breast cancer is the most common among oncological diseases in women: according to WHO, it occurs in about one woman out of a thousand. It is believed that about 70% of cases of this disease are caused by so-called hormone-dependent tumors. These are tumors whose cells carry on their surface receptors for the female sex hormones progesterone and estrogen, which stimulate cell division and, accordingly, the growth of malignant neoplasm.
Patients with hormone-dependent breast cancer are often prescribed hormone therapy aimed at blocking the action of estrogens. This method of treatment is quite effective and has few negative side effects compared to others, but it works in about half of patients. The question is how to find out who is included in this half? The answer, in fact, comes down to understanding how effectively estrogen receptors work in cancer cells in a particular patient. After all, the receptors may be present, but not function, and in this case the hormonal "weapon" against the tumor will be useless.
Recently, scientists from Washington University in St. Louis (USA) have developed a method for assessing the "operability" of cellular estrogen receptors, taking advantage of the fact that their stimulation leads to an increase in the number of progesterone hormone receptors. The substance 21-[18F]-fluorofuranylnorprogesterone (FFNP) binds to these receptors, which can be detected by positron emission tomography (PET). And the more progesterone receptors there are on the cells, the higher the PET signal will be.
The method was tested in a clinical study involving 43 women suffering from hormone-dependent breast cancer in severe form. Before that, most of them had already received treatment, mainly with various hormonal drugs. The researchers injected FFNP intravenously into the patients, and then stimulated the estrogen receptors with a certain amount of this hormone during the day. According to PET data, the number of progesterone receptors increased in 28 (65%) of them, which serves as an indirect assessment of the high sensitivity of estrogen receptors.
Bright spots on the image indicate that cancer cells in a woman with breast cancer reacted to a one-day load of estrogen. A picture from the press release of Imaging identifies breast cancer patients unlikely to benefit from hormone therapy - VM.
For at least six months after the experiment, the patients underwent hormone therapy in accordance with medical prescriptions. Menopausal women, such as the participants in this study, are often prescribed aromatase enzyme inhibitors that prevent the production of estrogens, or estrogen receptor blockers on cancer cells, while treatment regimens and specific drugs may vary.
In 15 women whose tumors did not respond to estrogen, the condition worsened during this time. But in those whose estrogen receptors worked well, the condition either remained stable or improved.
This suggests that the new method can work as a prognostic for any therapy, the success of which depends on the operability of the estrogen receptor, and primarily for the treatment of hormone-dependent breast cancer. More large-scale clinical trials will soon take place to verify the results obtained.
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