Breast Cancer Therapy

Pausing Long-Term Breast Cancer Therapy to Become Pregnant Appears to Be Safe

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Many young women who are diagnosed with early-stage breast cancer ask their doctors about the possibility of becoming pregnant in the future. New results from an international clinical trial may help inform these discussions.

Shayla Johnson was diagnosed with early-stage breast cancer just as she was planning to start her family. She became pregnant with her son, Ronin, during a pause in her hormone therapy.

The trial focused on the use of endocrine therapy (hormone therapy), such as tamoxifen. Hormone therapy is typically given for 5 to 10 years to women who have been treated for early-stage breast cancer to help prevent the cancer from coming back.

The study found that women could temporarily stop their hormone therapy for up to 2 years as they tried to conceive without raising the risk of a recurrence in the short term.

Most of the 518 women in the trial became pregnant and delivered a healthy baby during the treatment pause. A total of 365 babies were born during the study, according to results presented at the San Antonio Breast Cancer Symposium (SABCS) on December 8.

“This [study] is great news,” said Carlos Arteaga, M.D., who directs the University of Texas Southwestern Simmons Comprehensive Cancer Center and moderated the SABCS press conference at which the trial results were presented. 

The POSITIVE clinical trial included women under age 43 who desired to become pregnant. These women had undergone surgery for early-stage hormone receptor (HR)-positive breast cancer and had received at least 18 months of hormone therapy.

The trial participants will be followed for at least 10 years after study enrollment. This additional follow-up will be needed to assess the recurrence risk over a longer time among women who paused hormone therapy, Dr. Arteaga noted.

For many young women with breast cancer, questions about fertility are of “paramount importance,” according to Ann Partridge, M.D., M.P.H., of the Dana-Farber Cancer Institute, who co-led the trial and presented the results at SABCS.

Women with early-stage HR-positive breast cancer may initially be treated with surgery, radiation, and/or chemotherapy, followed by 5 to 10 years of additional, or adjuvant, hormone therapy.

Hormone therapy slows or stops the growth of HR-positive breast cancers. These treatments block the body’s ability to produce hormones or interfere with the effects of hormones on breast cancer cells.

But many young women are reluctant to receive hormone therapy because the treatments may make it harder for them to conceive, noted Dr. Partridge.

Many successful pregnancies, no increase in cancer returning

The POSITIVE trial, which was conducted on four continents, was the first prospective study to follow women who paused hormone therapy as they attempted to conceive.

“Most of the women had at least one pregnancy” during their treatment pause, Dr. Partridge said, noting that most became pregnant within two years.

She and her colleagues tracked the pregnancy status of 497 women from 20 countries in the trial, which was funded in part by NCI. Of this group, 368 (74.0%) had at least one pregnancy and 317 (63.8%) had at least one live birth.

These rates of conception and childbirth were similar to or higher than rates in the general population, according to Olivia Pagani, M.D., of the International Breast Cancer Study Group, who co-led the trial. 

By 3 years after their initial treatment, the cancer had come back in about 9% of participants. That recurrence rate was nearly identical to what was seen among a similar group of premenopausal women participating in a similar study but that did not include a treatment pause.

The trial results will likely help patients, their families, and their doctors feel more comfortable about pursuing a pregnancy, according to Dr. Partridge. She stressed that the approach involves interrupting rather than stopping hormone therapy.

In the trial, at a median follow-up of 3.4 months, about 76% of the women had resumed hormone therapy and 15% had not resumed hormone therapy. About 8% of the women had a recurrence, a new cancer, or had died before they had resumed their hormone therapy.

After completing the study, participants will continue to receive hormone therapy for up to 5 to 10 years. Each woman’s treatment will be determined in consultation with her physician based on her risk of a recurrence.

Celebrating an important birthday

In San Antonio, Dr. Partridge thanked the women who participated in the trial, noting that they did not have to join a research study to pause hormone therapy. “Their participation in the trial was very altruistic,” she said.

Shayla Johnson, who is 40 years old, joined the study with the hope that the results could help other women “feel a little more secure about starting a family.” She was diagnosed with early-stage breast cancer 6 years ago, just as she was planning to start her family.

Shayla, and the many friends and family members who supported her, celebrated Ronin’s first birthday in January 2023.Credit: Used with permission from Shayla Johnson

Her diagnosis led to a double mastectomy and eight rounds of chemotherapy. Johnson eventually became pregnant through in vitro fertilization during a pause in her hormone therapy. Today, she cannot imagine life without her son, Ronin, and wants to share her story.  

“You shouldn’t have to choose between a treatment to help save your life and starting a family,” Johnson said, adding that “cancer can be very complicated, especially for young women.”

When Ronin turned a year old this month, the many friends and family who have supported Johnson for the last 6 years attended the party. These people are also Ronin’s biggest fans.

“After all I’ve been through, they think my son is a miracle,” Johnson said. “And everyone wants to be around a miracle.”

Medical Marijuana: The Future of Breast Cancer Therapy?

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Breast cancer is a disastrous disease that affects the lives of patients and families in all parts of the world.

 marijuana-cannabis-breast-cancer

Breast cancer remains the most common malignancy among Western women and accounts for 22.9% of all cancers in women across the globe. In 2008, breast cancer was reported as the cause of over 450,000 deaths worldwide.

CANNABINOIDS AND CANCER

Although the medical properties of marijuana were first documented by human civilization over a thousand years ago, the therapeutic potential of cannabinoids – the medical compounds found in marijuana – in the treatment of cancer has only been discovered recently. Since the late 1990s, numerous preclinical studies have demonstrated the antitumor effects of cannabinoids in a variety of cancers.

Studies show that cannabinoid receptors are over-expressed in the tumor cells of certain cancers, such as cancers of the liver, lung, prostate and breast. Thus, researchers have been led to believe that the endocannabinoid system may be up-regulated in cancer in an innate biological effort to fight off this disease.

Studies also show that when cannabinoids are administered and bind to these receptors, they are able to inhibit cancer cell growth by preventing the proliferation of cancer cells and by inducing cancer cell death (apoptosis). Furthermore, cannabinoids have been found to impair both tumor angiogenesis – the increase in localized blood flow induced by tumor cells – and metastasis – the spreading of cancer to other organs.

CANNABINOIDS AND BREAST CANCER

While medical advancements in breast cancer have progressed in recent decades, certain breast tumors continue to be resistant to conventional treatments. Breast cancer is comprised of tumors that are distinct in their molecular profiles, leading medical professionals to categorize the disease into 3 main subtypes.

Research suggests that synthetic cannabinoids and phytocannabinoids (mainly THC and CBD) may be useful in treating all 3 subtypes of breast cancer, with the strongest evidence of therapeutic potential pointing to treatment of HER2-positive and triple-negative breast tumors. The therapeutic potential of cannabinoids is particularly important for patients with triple-negative breast cancer, as there is no standard therapy that currently exists and prognosis for this group of patients is poor.

In addition to their anti-cancer effects, research also shows that cannabinoids are considerably safer and less toxic than conventional treatments. Cannabinoids are non-toxic to non-tumor cells and are well tolerated by patients – only eliciting relatively mild side-effects such as dizziness and fatigue.
“This compound offers the hope of a non-toxic therapy that could achieve the same results without any of the painful side effects.” – Dr. Sean McAllister

In 2007, Dr. Sean McAllister and his team of researchers were one of the first to discover that CBD’s cancer-fighting properties could be successfully applied to breast cancer.

As it turns out, cannabinoids can provide a variety of other benefits in the treatment of cancer, including the prevention of nausea and vomiting associated with standard chemotherapeutic treatments and reduction of cancer-associated pain. Research also shows that, when combined with conventional cancer treatments, cannabinoids are able to induce a synergistic action against cancer and tumor cells, suggesting that the combination of conventional and cannabinoid-based treatments may more powerful than the administration of either treatment alone.

CLINICAL APPLICATIONS: THE CURRENT STATE

Unfortunately, scientific research on the effects of cannabinoids on breast cancer has been limited to preclinical trials involving cell cultures and animal models. Researchers believe that further preclinical trials are necessary to identify which patient population is the most appropriate for cannabinoid treatment and which cannabinoids specifically present the best therapeutic option for patients before trials can advance to the clinical stage.

Until these factors are established, it is unlikely that oncologists will be willing to prescribe cannabinoid-based medicine for the treatment of breast cancer, despite the fact that research authors continue to assert the need for health professionals to be aware of cannabinoid research.

In a recent update (2013) published in the Oncology Nursing Forum, associate editor Susan Weiss Behrend concluded:
“…cannabinoids have demonstrated antitumor activity in preclinical breast cancer models. Practicing oncology professionals need to be aware of the clinical potential of these agents…” – Susan Weiss Behrend, RN

While medical marijuana remains inaccessible for most, cannabinoid-based pharmaceuticals such as Marinol and Cesamet (oral capsules of synthetic THC) are widely available to cancer patients for the treatment of chemotherapy-induced nausea. As well, Sativex (a natural-cannabinoid derived mouth spray) has been approved in Canada for the treatment of cancer-associated pain.

As modern cannabinoid research flourishes and continues to provide strong evidence of the cancer-fighting effects of these compounds, patients should remain optimistic about the future of cancer research and the emerging role of marijuana-based treatments that may one day take center stage in the battle against this devastating disease.