Targeted Therapy & Hormone Therapy

Precision Medicine

The current approach in diagnosing, treating and prevention of breast cancer is called Precision Medicine or Personalized Medicine. The idea is to analyze an individual’s genetic makeup, along with the molecular (cell) characteristics, such as genes and other markers, of the disease to help in decision making. Non-genetic factors, or lifestyle choices are also considered, such as alcohol consumption or weight. Targeted therapy is an example of this approach. (See more on Precision Medicine in the links below.)

Targeted Therapy

Chemotherapy will kill cancer cells as well as healthy cells. Targeted therapies include drugs that target specific cancer cells without harming the healthy ones.

A good example of a drug used in targeted therapy is Herceptin (trastuzumab). Herceptin is used in HER2-positive breast cancer patients. HER2+ breast cancer is aggressive. It grows and spreads rapidly. Herceptin specifically targets the growth-promoting protein (HER2) found on the surface of the cancer cells. It cuts off communication and inhibits the growth of the cancer cells.

You can read more about Targeted therapies in the Helpful Links section, below. But always speak to your doctor for your specific needs.

As I write this, I am currently on Herceptin for 52 weeks. I have approximately 9 months left of treatment.

Hormone Replacement Therapy

According to the American Cancer Society: “Some types of breast cancer are affected by hormones in the blood. ER-positive and PR-positive breast cancer cells have receptors (proteins) that attach to estrogen, which helps them grow. There are different ways to stop estrogen from attaching to these receptors.

Hormone therapy is a form of systemic therapy, meaning it reaches cancer cells almost anywhere in the body and not just in the breast. It’s recommended for women with hormone receptor-positive (ER-positive and/or PR-positive) breast cancers, and it does not help women whose tumors are hormone receptor-negative (both ER- and PR-negative).”(1)

Hormone therapy is typically used after surgery to help prevent the cancer from returning, although it can be used to help shrink a tumor before surgery.

As of this writing approximately 2 out of 3 breast cancers are hormone receptor-positive and may need hormone therapy.

The different types of hormone therapy are:

• Medications that block hormones from attaching to cancer cells
• Medications that stop the body from making estrogen after menopause
• Treatments to stop ovarian function in premenopausal women (ovarian suppression)
• Combining targeted therapy with hormone therapies

I met with my chemo oncologist in May 2019 after my radiation treatment ended. I was prescribed an aromatase inhibitor (hormonal treatment), Arimidex (generic name anastrozole).

I will be on the anastrozole for a minimum of 5 years (until 2024). My oncologist will determine, given the most recent research at that time, if I should stay on it for more years.

I started taking the pills on May 11th (2019-2024). So far my side effects have been bouts of blurry vision, which goes away, dizziness and some nausea. I am hoping that the symptoms will dissipate over the next weeks or months. And I need to continue strength building and exercise in general to keep my bones strong during treatment.

As of June 15th or so, most of my symptoms are gone. In general, the numbing of my hands from Chemo is letting up, my nose bleeding is almost completely gone now, and the effects of the AI, anastrozole, is getting better each day. My hair has grown a good 1/2″ to 1″ and my finger and toenails are growing out to looking healthy again. The only issue from the AI that is lingering is insomnia and fatigue. And from the chemo, radiation and months of being sick, my muscles are still weak. I’m currently training them with dumbbells and getting back to normal activities (walking and cleaning house, etc.), which helps a lot. My latest blood work showed me only 0.1 away from White Blood Cell normal readings. All the rest of the stats were normal. Thinks are looking up.

Due to the risk of bone weakening and degradation, I was also prescribed Vitamin D. 10,000UI tablets to be taken once a week. I already voluntarily take Calcium/Magnesium/Zinc supplements. I am also continuing my B complex supplements.

As of June 15th or so, most of my symptoms are gone. In general, the numbing of my hands from Chemo is letting up, my nose bleeding is almost completely gone now, and the effects of the AI, anastrozole, is getting better each day. My hair has grown a good 1/2″ to 1″ and my finger and toenails are growing out to looking healthy again. The only issue from the AI that is lingering is insomnia and fatigue. And from the chemo, radiation and months of being sick, my muscles are still weak. I’m currently training them with dumbbells and getting back to normal activities (walking and cleaning house, etc.), which helps a lot. My latest blood work showed me only 0.1 away from White Blood Cell normal readings. All the rest of the stats were normal. Things are looking up.

As of September 13th, 2019 I have almost completed my Herceptin infusions (17 cycles of 3 weeks per cycle although at the beginning I was having Herceptin infusions weekly during chemo treatment, then every 3 weeks once chemo ended). My side effects are increasing and the first week after the infusion (which I get every 3 weeks) my side effects are pretty pronounced. I have been experiencing flu and/or cold-like symptoms. Nausea/indigestion, chills, runny nose, sneezing, weakness and fatigue. My oncologist stated that these are normal reactions and it is normal that they are worse in the first days or weeks of the infusion. Also, he mentioned that I’m feeling more fatigue because the chemo is still in my body (for 18 months, he says) and now that I am starting to get back to my normal life and routines, I am noticing how weak I had become and am becoming fatigued due to my physical activity.

My knuckles and hands are swelling quite a bit from the hormone inhibitor, Anastrozole. He mentioned that since I am on the cusp of menopause that my symptoms are a bit worse and that my hands are like “70 year old” hands right now. Argh!

On some positive notes, my MUGA heart test that needs to be done regularly due to Herceptin infusions came back with no problems.

My newest bloodwork was all very good too.

I‘m experiencing insomnia from the Herceptin and Anastrozole, so I began taking Melatonin. My oncologist said this was okay but warned me it would take about 2 weeks to notice the effects.

On a very high note, I was able to lose all of the weight I had gained due to the steroids. Yay!

August 2020 Update

I am about 1 1/2 years into using Anastrozole. The most important advice that my oncologist gave me was to keep moving! This helps arthritic side effects more than anything else for me. I do not want to take over the counter pain medication on a continual basis, so I was looking for ways to relieve the soreness without them. I, personally, was having reactions to Naproxen and Diclofenac. I was having debilitating cramps, so I was relying on Ibuprofen and Acetaminophen. But I still did not want to take any pain relief in excessive amounts. The key turned out to be exercise. I was getting bad ankle and knee pain, and wrist pain at night that inhibited my sleep. Now I cycle on a recumbent before bed for 15-20 minutes or so and I have no joint pain in my legs. I am amazed this worked. 

For my wrist pain, I purchased an overnight wrist brace. They are made to keep your wrist straight but not have the painful bar on top. It is a bar underneath and shaped like a spoon in the palm. This worked very well for me. I still have some pain, but not the excruciating pain I was experiencing each morning. 

So overall, I have relieved the arthritic symptoms quite a bit. My fingers are still a bit puffy, especially in the morning, but much better. 

I have had a history of migraines all of my life, but they had basically gone away for the most part after menopause, but now I get them again, more frequently and they last longer, about 2 days each time. That is all I have to deal with.

Some women may experience vaginal dryness and issues associated with that.

I am trying two different over the counter meds for that:

Replens products.

RepaGyn suppositories.

Both are non-hormonal, which is what I need being HER2+/post menopausal. (Anastrozole decreases the amount of estrogen the body makes.)  TALK TO YOUR ONCOLOGIST FOR ANY MEDICAL TREATMENT AND ADVICE. YOUR SITUATION WILL BE DIFFERENT THAN MINE.

Eat healthy, exercise and keep your weight down. 

NOTE: due to COVID-19, my blood work and regular visits have been delayed. I should be back on track soon. Fingers crossed.

December 2020

Good news! I had my one year mammogram and all was clear. My bloodwork remains good. And after two years, I have finally had my port-a-cath removal surgery. It wasn’t an easy surgery like it is for the  majority of patients. One of the two stitches inside that were holding the port down from flipping over was difficult to remove so the surgery took a bit longer. Also the surgeon pricked herself in the process so there were protocols that needed to be followed for more blood to be drawn from me and the surgeon to check for any issues that could be transferred back and forth. Ugh. Bad luck on port-a-cath surgeons both in and out. But it is over. I am just getting back to normal. The area is still somewhat sore but healing. All dressing removed. 

As far as arthritis from the AI Anastrozole, my wrists are suffering the worst. My hands and fingers are still swollen and dropping items due to problems with grip are ongoing. I also have to be careful touching hot items as my fingers due to the numbness in my fingers. 

It is a struggle in managing my weight under this drug but it can be done. I have to weigh myself every day and adjust if I see it go up a pound or more.  

I am taking small doses of melatonin to sleep better each night. I had to get the okay from my oncologist for the melatonin, so be sure to check with your doctors before taking anything. Melatonin is a hormone and it has side effects. Not everyone can take it.

Anastrozole also increases my sense of smell and has changed my taste somewhat.  I cannot wait until I am finally off of this, but three more years to go at a minimum. It is worth it if the cancer stays away.

I am now a breast cancer survivor and it feels really good. My hope is that all of you reading this get to the same place. After at least two  years I can finally relax for a change. The focus is on my health going forward now. Stay positive.