Tamoxifen. The gold standard of hormone therapy in breast cancer is tamoxifen, marketed as Nolvadex, a drug in pill form that interferes with the activity of estrogen. Known as the "antiestrogen," tamoxifen is a pill that has been used for more than 30 years to treat patients with advanced (metastatic or stage IV) breast cancer.
Tamoxifen is also used as additional therapy following surgery for early (stages I and II) and locally advanced (stage III) breast cancer and as a means of reducing the risk of ever developing breast cancer among women at particularly high risk (those with a genetic predisposition to and a family history of the disease). Tamoxifen is useful in both premenopausal and postmenopausal women.
Tamoxifen is also used to treat men with breast cancer.
Arimidex and Femara. The most well known of these drugs, Arimidex and Femara, belong to a class of medications known as aromatase inhibitors. After menopause, a woman's main source of estrogen comes through a process called aromatization, in which male hormones called androgens (produced by the adrenal glands located at the top of the kidneys) are converted into estrogen. This process takes place throughout the body, in the fatty tissue. These drugs fight tumor growth by stopping the conversion of androgens into estrogen.
Arimidex (anastrozole is the generic name) was initially approved for the treatment of advanced (stage IV) breast cancer in women who've gone through menopause and whose cancer has grown despite taking tamoxifen. It has replaced tamoxifen as the first-line therapy for postmenopausal women with hormone-positive or hormone-unknown locally advanced (stage III) or stage IV breast cancer. It is also approved as an add-on treatment of early hormone-positive breast cancer (stages I and II) in women who are postmenopausal. It is also taken in pill form.
Femara (also called letrozole) is approved for initial or follow-up treatment of hormone-sensitive locally advanced or metastatic breast cancer in women who have gone through menopause. It is taken in pill form, once each day.
Tamoxifen and raloxifene (marketed as Evista) are the only drugs currently approved for breast cancer prevention in high-risk women. However, studies are under way to test whether the aromatase inhibitors can also be safely used for this purpose.
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