Managing Hormonal Therapy and Liver Health in Breast Cancer Patients

Medication Consultation

I apologize for the inconvenience.
I would like to ask the doctor about a patient with stage I breast cancer who is hormone receptor-positive (ER and PR positive) and HER2-negative.
The patient underwent surgery in December last year and has been receiving hormone therapy and radiation therapy.
The patient is now postmenopausal and is taking Novartis medication.
The liver enzyme levels have reached around 150 due to fatty liver, and the doctor has recommended stopping the medication for one month.
If the liver enzymes decrease, a different medication will be prescribed.
I would like to know if stopping the medication poses a risk of recurrence and whether the elevated liver enzymes could be caused by the medication.

Xiao Qing, 50~59 year old female. Ask Date: 2023/01/19

Dr. Yuan Tianmin reply Breast and Thyroid

Your doctor recommends that you stop the medication and monitor your liver function before making any adjustments to the treatment.
You should feel reassured, as you have just undergone surgery for stage I breast cancer, and it is unlikely to recur in such a short period of time.

Reply Date: 2023/01/19

More Info

Managing hormonal therapy in breast cancer patients, particularly those with underlying liver conditions such as fatty liver disease, requires careful consideration of both the efficacy of the treatment and the potential side effects on liver health. In your case, you mentioned that your sister has hormone receptor-positive breast cancer (ER positive, PR positive, HER2 negative) and has undergone surgery followed by hormonal therapy and radiation. She is currently taking anastrozole (Nolvadex) and has developed elevated liver enzymes, prompting her physician to recommend a temporary cessation of the medication.

Impact of Hormonal Therapy on Liver Health
Hormonal therapies, particularly aromatase inhibitors like anastrozole, can have various side effects, including effects on liver function. While these medications are generally well-tolerated, they can occasionally lead to liver enzyme elevations, especially in patients with pre-existing liver conditions such as fatty liver disease. Fatty liver disease can be exacerbated by certain medications, and it is essential to monitor liver function closely in these patients.

Risks of Stopping Hormonal Therapy
The concern about stopping hormonal therapy is valid. Hormonal therapy is a critical component of treatment for hormone receptor-positive breast cancer, and discontinuing it can potentially increase the risk of recurrence. However, the decision to pause treatment should be made based on a risk-benefit analysis. If the liver enzymes are significantly elevated, continuing the medication could lead to further liver damage, which may outweigh the benefits of ongoing hormonal therapy.

Monitoring and Next Steps
1. Liver Function Tests: It is crucial to monitor liver function tests (LFTs) regularly. If the liver enzymes decrease after stopping the medication, it may indicate that the drug was contributing to the liver dysfunction.

2. Alternative Medications: If the liver enzymes improve, your sister's physician may consider switching to a different hormonal therapy that may be better tolerated by her liver. Options include selective estrogen receptor modulators (SERMs) or other aromatase inhibitors with a different metabolic profile.

3. Lifestyle Modifications: In addition to medication management, lifestyle changes can significantly impact liver health. Encouraging a healthy diet, regular exercise, and weight management can help improve liver function and overall health.

4. Regular Follow-ups: Regular follow-up appointments with her oncologist and hepatologist (if necessary) are essential to ensure that both her cancer treatment and liver health are being appropriately managed.

Conclusion
In summary, while there is a risk of increased recurrence if hormonal therapy is stopped, the potential for liver damage must also be considered. It is essential to work closely with her healthcare team to monitor liver function and make informed decisions about her treatment plan. Open communication with her oncologist about the risks and benefits of continuing or pausing hormonal therapy will be crucial in managing her breast cancer effectively while safeguarding her liver health.

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