[Hormone dependence of cancers of the breast and endometrium. Reflections. Attempt at synthesis. Proposing a therapeutic plan].
It has long been known, because of the epidemiological criteria and because of the results of treating with hormones, that certain cancers of the breast and of the endometrium are hormone-dependent. This has been confirmed by the discovery of hormone receptors in these tumours. These are oestradiol receptors and progesterone receptors. The concentrations of these are variable so that some of these tumours can be classified as hormone-dependent and others as not hormone-dependent. Using these characteristics, we have attempted to select which cases will benefit from hormone therapy. All the same, the treatments that are suggested are mainly empirical, consisting in suppressing oestrogens by removal of the ovaries and the use of anti-oestrogens (progestogens) and also using drugs that compete for oestrogens such as Tamoxifen. The results, although they have not been negligible, have not fulfilled all hopes and a finer and more detailed analysis of the mechanism by which hormone therapy works should perhaps be considered, since there are so many failed treatments. We have tried to show that: suppressing oestrogens is not logical and may be damaging; for preference, progestogens should be prescribed in a sequential manner; doses of progestogens do not have to be very high, so that they are better tolerated; the classification of receptor values is perhaps less necessary, because that at first does not seem to be able to help to decide whether to give hormones or not. it may be it that is possible to avoid transforming a hormone-dependent tumour into a non-hormone dependent tumour by boosting the synthesis of receptors. These thoughts on the physiopathology lead to a suggestion that therapy should take much more account of the age of the woman, her hormone status and whether she has or does not have her ovaries. At the same time different types of hormone therapy can be combined with other therapies that have been proved useful, and in particular chemotherapy with which hormone therapy may be in competition. Properly worked out, these treatments need not oppose one another but could complement and potentiate one another.
D000328:Adult; D001943:Breast Neoplasms / Q000628:therapy*; D003131:Combined Modality Therapy; D004958:Estradiol; D004965:Estrogen Antagonists / Q000627:therapeutic use; D005260:Female; D006801:Humans; D009376:Neoplasms, Hormone-Dependent / Q000628:therapy*; D011374:Progesterone / Q000037:antagonists & inhibitors; D011980:Receptors, Progesterone; D011987:Receptors, Steroid; D014594:Uterine Neoplasms / Q000628:therapy*
D004965:Estrogen Antagonists; D011980:Receptors, Progesterone; D011987:Receptors, Steroid; D011374:Progesterone; D004958:Estradiol
Hormono-dépendance des cancers du sein et de l'endomètre. Réflexions. Essai de synthèse. Proposition d'un schéma thérapeutique.