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New Treatments and Developments in Breast Cancer
To the Editor:Tamoxifen (TAM) has been used for many years for reduction of recurrence of breast cancer. It was the original estrogen blocking agent that has demonstrated that if taken over a five year period, it significantly reduced breast cancer recurrence (1). Unfortunately, its use markedly increases the incidence of debilitating hot flushes in the patients taking it. Data show that more than 50% of such patients might be non-compliant after 180 days from initiation of TAM treatment (1). The oncostatic mechanism of TAM is currently believed to be by the reduction of estrogen. This does not seem to be the case, since TMF has been shown to increase estrogen levels significantly. More specifically, after two years of TAM use, Serum dehydroepiandrosterone (DHEA) levels increased by 133% and mean estradiol (E2) levels increased by 239% (2). Taking this information into account, the mechanisms of TAM action needs to be redefined. Based on above, incongruence exists since increased levels of estrogen have been linked with breast cancer incidence increase, and estrogen supplementation has been known to be the most effective treatment for hot flashes. We believe we may have an answer that will help define the new mechanism of action. The mechanism was suggested during our most resent publication further explaining the neurobiological and neurophysiologic mechanisms of action of the stellate ganglion block (SGB). Keep in mind that we have reported successful unilateral SGB on breast cancer survivors (total of 13 with 7 on TAM) where reduction of hot flashes was noted up to 90 percent (3). We believe that SGB works by reduction of nerve growth factor (NGF) thus deactivating a brain norepinephrine pathway that maintains the hot flashes response (4). This report is relevant here since an 18-fold increase in NGF following dosing with tamoxifen was described (5). We believe this gives further explanation and a rationale for using the SGB in this sub group of patients as well as possibly resolving the incongruence. Our expertise’s are not in oncologic treatments. Thus, we only have a limited possible explanation for TAM oncostatic actions , however one possible choice is its effect on maspin . Maspin (mammary serine protease inhibitor) which is a tumor suppressor gene that plays an important role in inhibiting tumor growth, invasion and metastasis, may be the possible explanation. Maspin expression is down regulated at primary and metastatic breast tumor cells. TAM can exert its anti-tumor function by up regulating maspin gene expression (6). The purpose of the above is to offer a plausible explanation for tamoxifen increasing estrogen levels, leading to incongruence with the conventional explanation of its oncostatic action and severe increase in hot flushes, which may lead to new lines of research for this important drug in the use for breast cancer treatment. Lipov EG, Joshi JR, Sanders S. References 1. Tuma RS. Non-compliance with tamoxifen increases risk of death. A new mechanism of action for tamoxifen. |
From "A Cool New You"ForewordMany years ago, I met Dr. Eugene Lipov when he was working as an anesthesiologist and pain specialist at Rush North Shore Hospital in suburban Chicago while I was chairing the OB/GYN department there. I quickly recognized him as a brilliant and creative “think outside the box” individual—someone we need in medicine! Recently, I was delighted to find he is applying his expertise to alternative treatments for menopausal symptoms. If the 20th century was an era of major medical breakthroughs—vaccines, antibiotics, and transplant surgery — the 21st century may be a time of regrouping and exploring alternatives and recognizing the importance of choice. Dr. Lipov’s willingness to pursue a promising line of research very “outside the box” of traditional menopause medicine is a breath of fresh air. ********************************************* Dr. Lipov is currently the Director of Research, Northwest Community Hospital and Medical Director, Advanced Pain Centers. He has had numerous appearances on network television for his innovative treatment of Hot Flashes and stimulators. He was an instructor for ISIS (International Spine Injection Society) and is a member of ISIS and NASS (North American Spine Society). Dr. Lipov formed and was the first president of the Illinois chapter of AISPP (American Society of Interventional Pain Physicians). Dr. Lipov lectures internationally and has authored Articles on his research for hot flashes, hybrid stimulators, and other pain topics. He and his team have developed methodologies to relieve various discomforts in new ways. His office has been recognized by the 2007 Chicago Innovation awards. Dr. Lipov is the founder of Advanced Pain Centers, and has been practicing in the field of pain medicine for 18 years. *************************************************** For more information please call (877) 964-7246 |
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Eugene G. Lipov, MD is board certified in Anesthesiology as well as Pain Management. He completed Northwestern Medical School in 1984. He then attended Rush St. Luke’s Medical Center to pursue advanced training in Anesthesiology and Pain Management. He was on academic faculty at Rush St. Luke’s for more than five years.
