Complementary Therapy Hormonal Treatment and Plant

Complementary Therapy Hormonal Treatment and Plant

Diagnosis and Treatment of Patients
with Primary and Metastatic Breast Cancer
© AGO
e.V.
in der DGGG e.V.
sowie
in der DKG e.V.
Guidelines Breast
Version 2010.1.1
Complementary Therapy
Hormonal Treatment and
Plant Alternatives
in Breast Cancer Survivors
Survivorship
– Complementary Therapy –
Hormonal Treatment and (Plant) Alternatives
in Breast Cancer Survivors - Survivorship
© AGO
e.V.
in der DGGG e.V.
sowie
in der DKG e.V.
Guidelines Breast
Version 2010.1.1

Version 2002:
Hanf / Göhring

Version 2003–2009:
Bauerfeind / Gerber / Hanf / Janni / von
Minckwitz / Oberhoff / Scharl / Thomssen

Version 2010:
Oberhoff / Janni
Advice on nutritional facts by Prof. Dr. Gabriele Stangl, Martin-LutherUniversity Halle-Wittenberg, Germany
„Alternative“ Therapies
© AGO
e.V.
in der DGGG e.V.
sowie
in der DKG e.V.
Guidelines Breast
Version 2010.1.1
CAM
UCT
Complementary + alternative medicine
Unconventional Thx
Complementary
Alternative
Unconventional
In addition to
scientifically
based medicine
Instead of
scientifically
based medicine
Unproven outsider
methods
Modifiable Lifestyle Factors
Nutrition after Breast Cancer Diagnosis
© AGO
e.V.
Oxford / AGO
in der DGGG e.V.
sowie
in der DKG e.V.
Guidelines Breast
Version 2010.1.1
LoE / GR
Adherence to normal BMI
(improves prognosis – DFS/OS)
2b
Low fat diet
(improves prognosis – DFS - espc. postmenopausal, ER neg.; <20% fat calories,
only with dietary counseling!)
1b(-) B +
Adherence to general nutrition
guidelines
Dietary extremes
(are associated with less favourable
outcomes)
B ++
2a
B +
1b
B --
Modifiable Lifestyle Factors
© AGO
e.V.
in der DGGG e.V.
sowie
in der DKG e.V.
Oxford / AGO
Guidelines Breast
Version 2010.1.1
LoE / GR
 Physical Exercise
2b
B ++
(Equivalents to 3–5 hrs moderate pace
walking per week improves DFS and OS,
quality of life, cardiorespiratory fitness,
physical functioning and fatigue )
 Smoking
2b B
-
 Reg. alcohol consumption (>6 g/die)
2b B
-
Complementary Treatment
Prevention of Recurrence
© AGO
e.V.
in der DGGG e.V.
sowie
in der DKG e.V.
While on anti-cancer treatment:
beware of drug interactions
Oxford
AGO
LoE / GR
Guidelines Breast
Version 2010.1.1
 Orthomolecular substances
(Selenium, Zinc...)
5
D
-
2b
B
-
 High-dose vitamines
3b
 Proteolytic enzymes
5
(Papain, Trypsin, Chymotrypsin)
 Soy (Phytoestrogenes)
5
 Black Cohosh (Cimicifuga racemosa)
2b
 Mistletoe (Viscum album)
1a
 Thymus, splenic peptide
5
 Oxygen- and ozone therapy
5
 Antioxidant supplements
2b
 Cancer bush (Sutherlandia frutescens), Devil's claw
(Harpagophytum procumbens), Rooibos tea (Aspalathus
linearis), Bambara groundnut (Vignea subterranean)
5
C
D
-
D
C
B
D
D
B
+/+/-
D
-
 Selenium for alleviating side effects of therapy
Hormone (Replacement) Therapy (HT) of
Estrogen Deficiency after Diagnosis of
Breast Cancer
© AGO
Oxford / AGO
e.V.
in der DGGG e.V.
sowie
in der DKG e.V.
LoE / GR
Guidelines Breast
Version 2010.1.1
 Endocrine responsive disease
(HT may increase risk)
 Endocrine non-responsive disease
(apparently no risk increase)
 Endocrine responsive disease: combined
treatment TAM plus low-dose-HT
 Tibolone
 Topical vaginal application of
 Estriol
 Estradiol during AI therapy
1b
B-
2a
B +/-
2b
B +/-*
1b
A--
5
4
D +/C-
*Study participation recommended
Contraceptive Options for Women
after Diagnosis of Breast Cancer
© AGO
Oxford / AGO
LoE / GR
e.V.
in der DGGG e.V.
sowie
in der DKG e.V.
Guidelines Breast
Version 2010.1.1




Barrier methods
Sterilization (tubal ligation/vasectomy)
Non-hormonal intrauterine devices (IUDs)
Levonorgestrel-releasing IUDs
 Removal in newly diagnosed patients




Timing methods
Injectable progestin-only contraceptives
Progestin-only oral contraceptives
Combined oral contraceptives
5
5
5
5
D
D
D
D
+
+
+
-
4
D
+/-
5
5
5
5
D
D
D
D
-
No trial included women after diagnosis of breast cancer,
non-estrogen containing devices do not increase the risk to
develop primary breast cancer
Alternatives to Reduce
Menopausal Symptoms after BC (1)
© AGO
e.V.
Oxford / AGO
LoE / GR
in der DGGG e.V.
sowie
in der DKG e.V.
Guidelines Breast
Version 2010.1.1
General approaches:
 Physical exercise
2b D +
 Comprehensive intervention (yoga,
hypnosis, education, counseling,
non-hormonal drugs)
1b A ++
 Vaginal lubricants and moisturizers
4
 Acupuncture
1a A +/-
C +
Alternatives to Reduce
Menopausal Symptoms after BC (2)
© AGO
Oxford / AGO
LoE / GR
e.V.
in der DGGG e.V.
sowie
in der DKG e.V.
Guidelines Breast
Version 2010.1.1
Medical approaches:
 Selective serotonin reuptake inhibitors and
serotonin-(noradrenalin) reuptake inhibitors
(SSRI-SNRI): reduce hot flashes in BC patients
 1st choice: venlafaxine, paroxetine




1a
 2nd choice: desvenlafaxine, sertraline, fluoxetine 1b
 3rd choice: duloxetine, escitalopram
1b
Gabapentin (BC and TAM-use)
1a
Clonidin (BC and TAM-use)
1a
MPA (i.m. 500 mg single shot)
(most potent, but endocrine agent!)
1b
Vitamine E
1b
A
A
A
A
A
+
+/+/+
+
A
A
+/+/-
Botanical Approaches to
Reduce Menopausal Symptoms
© AGO
e.V.
in der DGGG e.V.
sowie
in der DKG e.V.
Guidelines Breast
Version 2010.1.1
While anti-cancer treatment:
Beware of drug interactions!
Oxford AGO
LoE / GR
 Soy-derived phytoestrogens – isoflavonoids
(might stimulate BC especially in endocrine
responsive disease)
1b
A
-
 Flaxseed-supplementation (40 g/d)
3
D
+/-
 Black Cohosh for hot flushes
(Effectiveness could not be clearly shown)
1b
A
+/-
 St. Johns Wort in combination-therapy
(pharmacokinetic interference with
cyctotoxic drugs and tyrosinkinase inhibitors)
1b
A
--
 Kava-Kava (Piper methysticum)
5
D
--
 Red Clover leaf (Trifolium pratense)
5
D
--
 Dong Quai root (Angelica sinensis)
5
D
--
 Ginseng root (Panax ginseng or P. quinquefolius)
5
D
-