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Tamoxifen

Feb 10, 2013|

The Roswell Team discusses Tamoxifen Therapy for breast cancer.

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Automatically Generated Transcript (may not be 100% accurate)

This is -- wellness -- by Roswell Park Cancer Institute. European opinion or your total options. Your -- him -- welcome back to Roswell new -- comprehensive look at all aspects of cancer care treatment and diagnosis and research. From a comprehensive source that would be runs -- -- cancer institute right here in Buffalo, New York. I'm Jim -- thanks for joining us and today on the program something you may have heard about that. Probably don't understand that much about Tamoxifen therapy. For breast cancer and also some. Research going on regarding that doctor Stephen edges with us today he's the -- -- foundation endowed chair in breast oncology here at Roswell park. Also the medical director of the breast center in chief of breast surgery as well -- thanks for being here appreciate it thank you for having me -- and with you today we have doctor Google thus. He is an associate member in the department of pharmacology and therapeutics also an associate professor of oncology co director. Of the breast disease site research group. Here at Roswell park. Doctor das thanks for being here appreciate it. Thank you and you've been responsible your lab for some pretty exciting things with regard. Two breast cancer and -- will be getting into those in just a moment. Thank -- so. Thanks for being here both of you Tamoxifen. We hear about the drug doctor and to think in the news we hear about it from friends and relatives who me. I have gone through or are going through breast cancer what is tomorrow. Clarksville Missouri. Drug group directly interacts with breast cancer cells. But I have a specific protein known him and called the estrogen receptor. Estrogen has many effects of many cells. Types of organs and cells around the body. And specifically in the -- may stimulate growth of cells. Many breast cancers. Respond and grew faster in response to estrogen. Tamoxifen. Blocks of the interaction. Of Tamoxifen and breast cancer cells and stops them from growing and ultimately kills them. Women who have breast cancer. Whose cancers have this estrogen receptor. Are less likely to die from breast cancer if they take Tamoxifen for five years and possibly even longer. So. This use of Tamoxifen in breast cancer has been no. Since the discovery of months and is now living standard treatment for more than thirty years in many circumstances. But to Knoxville is a discovery that was made in breast cancer as a result many other forms of research showing that. By taking estrogen or wave. -- breast cancer cells. That you could improve the survival rates were women with breast cancer and before the advent of these drug Tamoxifen back and so back in the 1950s. And sixties. People have many different types of surgical interventions to remove the organs that would produce estrogen the ovaries. Or and women who core two men oppose the so called dream of last little Glenn's review of the kidneys that produced many hormones like Aetna Truman. When we get our adrenaline rush they completed a rush comes from me adrenal glands. Well as well as portico steroids -- on steroids in your bloodstream the normal stories about the kind of -- Thursday. Because jurors in your bloodstream come from the adrenal gland and another hormone is produced by that is responsive estrogens so. Via -- of the drug Tamoxifen in the 1970s. Stopped people having routine surgery. Two. Influenced the impact of estrogen on breast cancers and must prove in the 1980s to improve the survival from her breast cancers has been in use. But since that -- so remarkably safe drug has few side effects. Most notably prolonged use him older women and rarely causes cancer of the uterus and blood clots but. That benefit for women breast cancer far outweighs that risk. So much objection to replace. For overruling breast cancer -- another class of similar drugs Tamoxifen is. Probably one of the most important -- -- or yours ever I can't prove this statement that. I think you probably could say that Tamoxifen has saved. More lives from cancer then all other cancer drugs come -- things. Well at what point is Tamoxifen. An option we hear -- when when someone is diagnosed with breast cancer of the options. You know surgery. Chemotherapy. -- what point -- Tamoxifen -- option. With a woman dealing with with breast cancer. Well in very very briefly you for treating breast cancer there's two issues one is the treatment for breast itself which is don't recall that local therapy. Which is done by treating the -- was surgery in sometimes with radiation therapy. Separately we know that women with breast cancer have the potential to have. The cancer has spread to other organs and their bodies to deliver -- -- -- no bones -- people die from breast cancer that's the reason. We have to consider whether to give them drugs to kill cancer cells -- spread elsewhere. The choice of drugs are the anti estrogen pills Tamoxifen or some new drugs that are available for certain classes of cancers. And chemotherapy and based on the characteristics of the cancer. The most notable one is does the cancer have this estrogen receptor protein. Based on me. Characteristics of a protein and whether the lymph nodes are involved as some other factors of the decisions remain as to whether you used to have tea estrogen drugs. Tamoxifen. Chemotherapy. Or vote. In a few cases Tamoxifen may actually be used to prevent breast cancer in the first place people at increased risk for breast cancer. But its primary use this for -- who have had breast cancer to present breast cancer from ultimately resulting in -- him into. But unfortunately. Foxman is not effective and a 100% of women for some reason some of the women with breast with breast cancers cancers. Are resistant to Tamoxifen. It doesn't really work. And doctor dar us. There's people around the world -- trying to understand. Tamoxifen resistance. And there's a number of different theories about it and doctor -- is one of the nation's -- world's leading authorities. On Tamoxifen resistance and has developed some very. Interest in theories based on his laboratory work. About Tamoxifen resistance. So. One of the important things are also part is we don't just treat breast cancer we have people here are trying to understand how we can treat it. Better and doctor -- some very important series that we're now testing. To see if we can improve the way that we use too much and another drug for breast cancer. The doctor -- bring you into the conversation now is is doctor edge has just mentioned it was your lab. That is establish this connection I think it -- doctorate disease these leading to. That would indicate whether some women might respond to Tamoxifen or not in my correct that's very. Yes who -- them long enough you know the so it's going out there from different parts of the loaded it. Why a decent assistance focus because TNT giving us and -- pointed out at the beginning. Then. Breast cancer says as these protein all of these callers -- receptive the other go to a seal a decent press good. The educated those patients should be benefited by this back some cases he did. Even though they have a protein on -- has emphasized that says the -- does not look. So that's. How -- in my lab at Clemson. And below are looking forward but he sandman to have what can be found out surprising indeed. The case that deeds. Precedent salt air I don't know protein. He sees a lot of the major tumor suppressor protein beaches in -- many cancers married including breast cancer. And his routine night and he he's guarded. Because that's what's made based and then -- name game risk based on its particular size in -- -- experimentation. Long ago. So if days of protein. He's. What happens is that estrogen -- The stand -- and he sees it too -- -- process do its job needs to suppress. That tumor formation. -- you know party. So -- in the -- delicate Nazis. -- its function and who idolized -- stranded appease his -- separates them. And that way you acting instinct that. What I'm most offended that's like we found out. Is dad to regulated and he sat down I could prevent. The use that town -- In Ireland basically prevent faster than a cent. From. Stopping. You must have -- tax. You know some based on active like the found out in the -- in the -- he might have a net -- east active. Those -- to process. Need to pass. Both pastors and sat down and these do not supposed to be fifty city. East d'antoni didn't need to Tamoxifen and -- bit I mean it. Dictate do they would not what -- they thought it couldn't daily. That stop you right. They got a list of those days and if you take it in their patients. Situation. Our expectation is that in this in advance it happened in and have in my city tidbit. You know -- NASA says. -- it would have the advantage off. Preventing. That tumor formation and do my -- that in those stations. Oh who passed bulletin as to intercept it and it be 53 these -- now. He has shown that it not Ali and tenacity. Looking gentleman he then -- you protect patients who had been given Tamoxifen therapy flawed. And it happened -- -- -- and -- before or thought fifteen years hard longest alive and it turned out there. That can be analyzed today that Dole's -- patients who had it. These still -- episode protein. Has far back does provide -- -- dental school. So that is what is strategize and it is gone never prospect duke Piet. Eight -- supple what's -- consistently -- laboratory study expecting that's not directly April. I'll watch the also demand that indeed happens in the patients that slightly started -- new. Back I am indeed exclusivity fought hopes that they don't finding out these lies and that's -- guard prospect of trying to look right here and there it in now -- So really that that that connection between the ER NP 53 that was really determinative factor in. Some of this research that is underway right now that's actually to can't audit the assignment basic us and it's on the bands like the days it. And we -- -- dotted name. Two but at the at NBC Nash and Adam I was sad to say or do much says and now. The testing that indeed -- he's been on an up close. And the patient and I -- highly successfully to vehicles. At Denver being the radical national -- On mediation out faster than a step dad Andy's -- must have president BT DT. Do those still nicely responder group Tamoxifen therapy that's those stations. -- -- estrogen receptive but he -- don't have these broad and had a proteins that must have present on -- that too. You must not present protein east defects -- regarding anti tax data and aspects of new and -- deeply -- ticketing. Then -- not responded to the happy but right now in their clinic has snagged out today and -- No most. That. Both these data to -- -- station Saturday not to is going to be to the global assets doesn't have stepped up. And that's do you need protein needs to be to Tamoxifen is opposed to luck so. But did it right now in -- clinic any -- and tailored. These particular protein -- not -- a protein B fifty threes -- a -- into consideration and then deciding that happy. And act. Do you not think -- exceeds that is supposed to teach that was -- doesn't India back and and shifted in breast cancer therapy if they see if it. He expects that story we wanna talk more about this clinical study that that you that you guys are working on here at Roswell park it really is important and other future where we go from here and we will continue to do do that this is -- Roswell this. That is the voice of doctor Google -- associate member in the department of pharmacology. And therapeutics here Roswell park doctor Stephen edges with a self hero foundation endowed chair. In breast oncology. Another large chunk of research that was. -- Delineated success. With the current doses are current and duration of time of a patient receives Tamoxifen. You don't five your treatment vs ten years can either you come -- and then that the success rates. Well. What -- referring to was that a large international trial. Too much from -- clinical study. It was just recently reported it was in the news quite a bit about off. Two weeks ago. And the standard for treating with Tamoxifen is that we give women Tamoxifen for over five years after they start. And the best information we've had a real the last twenty years is that taking it for five years gives you the maximum benefit. And that taking longer provides no additional benefit and there was strong. Research data from the 1980s and early 1990s. Showing that taking longer than that. Provided no additional benefit. Actually some women -- very nervous talking too much for consumers and during while Obama on this drug want to continue to do well the reason is is that. But the the serious side effects though rare -- to continue to slowly occur so. That's what we've done is to stop the -- and for many years. Sometime in the mid 1990s and international group based in England. Started a study called the atlas trial. And once the atmosphere is for adjuvant. Tamoxifen them longer. And shorter. And it took. Gosh well over 101000 -- thirteen thousand women around the united around around the world -- the United States actually and half of them continued to marksman -- turn it up to ten years and half of them. Stop the Tamoxifen at five years. And it it's taken many many years to get the results of this study that study was started like 1985 so here -- fifteen years later we finally have the full results from -- study shows that. Actually -- ten years of Tamoxifen. It is. Better than five years of Tamoxifen so. The results are very clear what the results were just published so we will know treat people with remarks from for. Ten years and five -- so again we have replaced so much room for many older women with a new class of drugs called aroma taste inhibitors. And there there are also some evidence that taking what that does not have those two serious side effects and mentioned them. That there's already information -- Longer term use of those -- beneficial but we will know his Tamoxifen. For that period but we've still we'll have the problem. But some women still have breast cancer recurrence despite being -- -- and so they must be resistant and it may well be. That those women who have mutated. 53. Other women who will not benefit from Clarksville. This issue of being able to find. Specific genetic changes. That allow us to identify. Which cancers are susceptible to want one type of drug or another type drug is an area of exploding interest around the world. Both because we know that there must be some reason with some people don't respond to a drug that everybody else seems to respond to. And because we now have new tools to studies such drug routes such drug resistant so. -- actually Russell park has just implemented what's called the center for personalized medicine. Specifically aiming to do just that to look for things that allow most personalized -- and -- by defining. Which drugs will be effective. Doctor -- has important theory that is now being tested as to why some people. Don't -- from Tamoxifen so. We're actually looking for people who are having their breast cancer surgery who might wanna participate you know. Clinical trials or something that. So you saw I don't wanna be a Guinea pig -- -- -- research you know and yet. Those same people are benefiting. Direct beneficiaries of 200000 women over the last 35 years who participated in clinical research trials around the world. Lumpectomy vs mastectomy was the region tomorrow all the studies on chemotherapy and appreciation in the hormone therapy were talking about clinical trials. Many people find a lot of value to themselves. Of knowing that not only are day getting the best possible treatment. Because they do they get the best possible treatment under the political tomorrow. -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- Here and they can they sleep better tonight knowing that not only thing having the best possible treatment that their treatment is gonna help. Their daughter. Or their sister. -- their friend. -- the world and remember rural somewhat early separated from everybody else in the world by six degrees of freedom is that what I read about. You know so we're all we are all one family. And many people I've I've been so heartened to see people -- clinical trials tell me the stories about why the participated in clinical trials. And they do do it because they are worse to be acutely. They do it because they want people to do have a better chance than they even have themselves today. Doctor does this clinical study is open here do you still recruiting you're looking for people who what what type of -- patient are you looking for. How many people can't be up looking full. About sixty patients. Let's zoom -- past bullets. As hasn't sucked up and these two must oppose them wrote in an anonymous humorous episode -- Those out of patience V wandered to as to the effect of Tamoxifen. And as a fact mentioned earlier he had done that in isolated camps that breast cancer says the bullying scheme patient says it's doing -- that map. Definitely and -- -- out and it didn't hand you know ordered they better prospect you to -- I guess the abilities in that patient -- it differently. And he did not deny all that watney also noted it. Peace. -- can be taken to -- efficiency now analysts that have liked what happened and events can be taken to the bat saves and isolate these very important. Involved and so many -- rather -- ankle couldn't be overemphasized. And -- -- -- -- justice. -- -- -- -- -- -- -- Here taking it to have both finding. To -- -- -- so even if that particular patient who participate duties. May not be anything different this night. Doctors on you know -- doctors on -- their patience and Lehman. Would be the many features he -- out so that's important thing and and also one -- and bought an outcome if these. That is the consensus for a stagnant he would not all Condo who'll hopefully be many feet and who do not -- -- -- -- Tamoxifen even though. Day conventionally data and it is thought that the because to have this isn't receptive but it is not even if he did it. So why don't give the united aren't necessarily -- pat Bradley says. The center and it has an effect as delta and find out if staff and I'm going to be benefited by -- -- so it so intact and aerosols. These set priorities that he bought indeed state of the consensus will be the V. Illegals. You know classify artist community patients who will be. Have been defeated by Vista happy and who may not be benefited by therapy that's a basic concept out. The Indonesian nice stat on a personalized. Medicine it is he's he's you know. Going faster because of the -- -- Q&A because of the major advancement it happening in -- Atlanta and Kansas. -- exceeds. And I should also mention that more babies and did experiment an act that's coming out of my -- as saying just that a Marxist and may be. Maybe I would -- this is effective in other types of breast cancer -- land that suggest not and -- -- -- I professors and disciplined and other types of the centers on this and maybe on some institutes of Hamas offense. Is that is that they bought in Baghdad and dead tomorrow be no hobby -- sense and do equally be -- and movies are being benefited. That that generally mean had cancer patient I patients. If you throughout the term and I've heard it many times bench to bedside in -- obviously that is from the research side to the clinical side. And clearly that is that's that's what's going on here and it's really important to point out I think. That that is what one of the benefits of a place like Roswell park and there are many of them. Around the country. It that's one of the great benefits you can get treated for cancer in many places but the latest and the greatest is that a place that does have. The research and the clinical I obviously side of cancer treatment. This this study he's really. A complete. A mirror image of the other phrase that we always use in this studio which is multi disciplinary. Comment for me perhaps full view on. The importance of that why that's so important yet do you study will -- -- have been times tactics. Just a light wind -- -- -- one sentence for -- It is my typical -- not in its advertisement and expertise necessary for this that's missiles. Brian. Steady I -- For example there. As we have that active in -- Amanda calls for a people a lot of experts in pharmacology inactives. Those are the people who will hold analysts. -- after an antique mediation -- as effective today the match of icing on the endless amounts of Tamoxifen Angel. And do. Hey agents and also we have -- people who who'll -- experts and but he declined to -- mark caller dynamics and -- -- cocaine addicts. Did all high and how -- -- -- -- -- but people that had such as Tamoxifen -- cities. And earnings of audio deal under the patient YST just hope that the that dead and how we can become effective. So those people not important and of course that you know breast cancer says inside an important part as my apologies to learn and I -- Duma. Now are extremely important qualities and it you know -- -- -- beat by electing in my and I have a lot of experts in molecular biology and sent back out as you are socially he's. ED MIT discipline not mean. I TVT. Says sanctions on this that's the south these tires -- when examined up. Did -- say totally pleased that -- and -- -- and dynamics and that -- that facilities in barred. I advised I police there on academic excellence and answered Lauderdale. And don't she typical -- and I have citizen had meted out -- it out agencies involved so that out of my mind about the upon -- assemblies -- apologies -- so on this that talent and indeed he does not necessarily. Do fought for the success of these type of western doctorate he says something and I thought was really impressive and important a few minutes ago in that is. Everybody wants the best care right we all want the best -- and you certainly want tune in provide. The best care who would we all like better care and that's what this is all about right. Well I think that's an important point here not only arousal part who provide the best care available and we're not the only ones are compared could care. Not only will provide the -- here the best care available and doctors commitment has always to provide each individual -- some of us here but we also. Give people the opportunity. To participate in programs. To help us to better for people tomorrow. And that cultural -- it sounds purely altruistic. But I have heard so many stories. From women who participated -- trust I will never Africa. The woman who persist -- visible impacting me. Purses. Mastectomy trial from the early nineteen mid 1970s I didn't treat her. But I -- the 25 year results of that study. At a public session and this woman in the audience started smiling from ear to hear it was so obvious he was on the study I asked him the presented in the audience on that studied she raised her hand. And everybody would assume hearing that that she must have been on the group of women who go lumpectomy but in fact. At the time remember mastectomy was the standard treatment and everybody had a mastectomy she had randomly assigned to go on mastectomy. She was just as proud because that study to -- everybody else in the room from having a mastectomy she was justice pros -- -- she's had a lumpectomy. She had so much personal gratification from having participated in clinical trial she got the best care available. And she helped everybody else in that room so. We're looking for women who have small breast cancers. Who. That are estrogen receptor positive who want to do something for their daughters and their sisters and other women. With breast cancer to Cumberland and franciose. They have to see just before their surgery because for this trial. They have to take Tamoxifen for 28 days of those delay the surgery by about a week or ten days there's no medical danger especially there on the -- and anyway. -- which helps effect the cancer. But. We're looking for women who want to have their breast cancer surgery in a situation whether or not only getting the best available surgery. But they're also helping women in the future so if you're interested. And you know somebody in your family who have breast cancer please give us a call. -- part of the number out here momentarily. Doctorate is always thank you so much for the time appreciate it. That's doctor Stephen -- Shapiro foundation endowed chair in breast oncology here at Roswell park. Also the medical director of the press editor in chief of breast surgery. And doctor go -- thank you for your time today appreciate it thank you that is doctor Doss he's an associate member. In the department of pharmacology and therapeutics and associate professor of oncology and co director. Of the breast disease site research group at Roswell park cancer institute and as you just heard doctor I'd say. If you're interested in this study you can call Roswell park. At 877 ask our PCI that is 8772757724. And of course. Lots of information at Roswell park. -- Listen to roster bonus Sunday mornings at 630 young WB yeah. -- by Roswell Park Cancer Institute your -- opinion for your total options on line at Roswell this god of war. Hanging. And hanging do you. Then.

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