In previous posts we’ve talked about the belief that many ‘female’ cancers are driven by estrogen and its action on estrogen receptors – and we’ve discussed possible treatment options and theories about how different medicines can be used to reduce this effect.
I still believe that the points made in those previous posts are valid and important information.
But, I think the information that will be in this post is at least as important.
You see, there’s an ovarian cancer patient who’s the friend of a friend… and her tumors have come back and are extemely aggressive. My friend asked my opinion relative to options they might try in combination with what her oncologist had tried to slow down the tumors’ growth.
So, we talked about some options – and they eventually implemented some of the ideas I’ve posted on this website – and there was no effect.
None, Zip, Nada… – and this bears very heavily on my mind because that woman is now in chemotherapy again, and I am quite concerned about her well being – and feel a need to understand what’s going on in case my family member’s tumors come back in a similar way.
So, I started digging again to see if I could figure out why her tumors seemed to be driven by something despite the fact that this patient was on an aromatase inhibitor.
And – in the middle of the night – I read this passage in a book written by Dr Aurel Lupulsecu:
‘Ovarian cancer is estrogen dependent in premenopausal women and becomes more androgen dependent in post menopausal women.’ (Hormones and vitamins in Cancer Treatment, 1990, RC271.H55L87, Page 33)
Although I guess I shouldn’t be surprised, this statement caused me to pause and think about its implications for a very long time.
As far as I can tell, the author is as informed as anyone in this area, having dedicated his career to studying these effects.
So I then got busy checking to see if the literature supported Dr Lupulescu’s claim.
The bottom line of that search for confirmation is that it appears Dr Lupulescu is probably correct.
Representative journal articles include ‘Expression of human estrogen receptor-alpha and -beta, progesterone receptor, and androgen receptor mRNA in normal and malignant ovarian epithelial cells’, Kin-Mang Lau, Samuel C. Mok, and Shuk-Mei Ho. Proc. Natl. Acad. Sci. USA, Vol 96, May 1999, pp. 5722-5727. (http://www.pnas.org/content/96/10/5722.full.pdf+html) and ‘Androgen Receptors in Ovarian Tumors: Correlation with Oestrogen and Progesterone Receptors in an Immunohistochemicaland Semiquantitative Image Analysis Study’, M.R. Cardillo, E. Petrangeli, N. Aliotta, L. Salvatori, L. Ravenna, C. Chang, and G. Castagna. J. Exp Clin. Cancer Res. 17, 2, 1998: pp 231-237. (https://www.urmc.rochester.edu/george-whipple-lab/documents/chang-papers/CV113.pdf) There are many more… but some are hard to get copies of, and these two mirror the info presented elsewhere pretty well.
Anyway, based on the articles and works written by Dr Lupulescu and others I’ve read I’ve formulated the following theories that might be helpful in the case of ovarian cancers that don’t appear to respond to the use of aromatase inhibitors –
1. To reduce the levels of androgen hormones that might be driving the tumors’ growth I would try adding finasteride to the woman’s regimen at a dose of 5-10mg per day.
2. If adding finasteride to the regimen doesn’t work I’d add a high dose birth control pill that contains both estrogen and progesterone components.
3. If complete reduction of testosterone levels is desired I’d add ketoconazole to the patient’s regimen.
Your physician will understand what I’m talking about…
The point is that post-menopausal ovarian tumors may need to have their androgen sources opposed, reduced or eliminated if you are going to slow down their growth.
I have no idea whether or not these options might help my friend’s friend. She has already been through an extremely aggressive chemotherapy regimen.. and her tumors came back. – quickly and aggressively. Maybe the chemo created a monster that can’t be killed. I hope not.
Remember, I’m a pharmacist – not a physician – and what I have written above is theoretical, not proven. I’m sure somewhere in the universe a physician or researcher has tried what I’ve proposed. I just haven’t been able to find and read the reports yet.
Anyway, I’m providing information that I think might be useful for you and your physician to consider if the list of options is getting pretty small.
And – as always – don’t change your medication regimens without checking things out with your physician.
But, don’t forget that your physician is only human and it never hurts to try to engage them to think about ideas that the drug companies haven’t dropped on their desks.