Estrogen cream safe for older breast cancer patients

Hello Health Rounds readers! Today we highlight another two potentially important studies from the American Society of Clinical Oncology (ASCO) annual scientific meeting in Chicago, which concluded on Tuesday. Both contain some positive news for patients. 

We have lots more news from ASCO: Blood test-guided treatment with AstraZeneca pill cuts breast cancer progression; Gilead's CAR-T cell therapy shows promise in deadly brain cancer; Pfizer-Arvinas breast cancer drug tops AstraZeneca's in delaying progression; and wildfire smoke exposure may shorten lung cancer survival. 

And more from ASCO: Gilead's Trodelvy, with Keytruda, cuts breast cancer risk by 35% in trial; Amgen drug cuts small cell lung cancer death risk by 40%; and Novartis' Pluvicto shown to slow prostate cancer in earlier setting.

Finally, some general breaking news: Trump administration scraps Biden-era policy on emergency abortions; Measles cases in Texas rise to 742; US FDA launches AI tool to speed up scientific reviews; Harvard seeks end to US funding cuts; EU backs curbs on Chinese medical device firms' bidding in public tenders; and Trump administration 'MAHA' health report cited nonexistent studies.

American teens are increasingly turning to the weight-loss drug Wegovy as more families and their doctors gain confidence in its use for young people with obesity, new data shared with Reuters shows.

In older women diagnosed with breast cancer, use of estrogen creams to treat menopause symptoms was not only safe but was also linked with longer survival in a large U.S. study.

Use of the hormone creams by postmenopausal breast cancer survivors was associated with a lower risk of disease progression, recurrence or death, rather than an increased risk as had been feared, researchers reported at the ASCO meeting.

Vaginal estrogen creams help with menopause symptoms such as vaginal dryness, discomfort, and pain during intercourse, but breast cancer survivors often avoid these products over concern they might stimulate breast cancer cells that use hormones to grow.

Researchers reviewed national database records on 18,620 female breast cancer patients aged 65 and older who were diagnosed between 2010-2017, including 800 who used vaginal estrogen creams.

After accounting for patients' race, cancer stage, treatments and other factors, the researchers saw a statistically significant increase in overall survival among patients who used vaginal estrogen. The cream users also had a significant increase in breast cancer-specific survival – the interval from diagnosis to death from breast cancer.

On average, estrogen cream users had a 47% lower risk of dying from breast cancer and a 44% lower risk of death from any cause during the study period, compared to non-users.

Even in patients whose tumors were known to use hormones for growth, estrogen cream use was associated with a 38% lower risk of death from any cause. Estrogen cream users with hormone-positive breast cancer also had a lower risk of death from breast cancer, but that difference was not statistically significant.

Use of the creams for more than seven years appeared to confer an additional survival benefit.

"These findings add to a rising contemporary paradigm shift that local hormone therapy is not associated with increased risk to overall or breast cancer specific survival, which has important clinical implications," the researchers said.

Cannabis use does not worsen outcomes of patients receiving immunotherapy cancer drugs such as Merck's Keytruda or Opdivo from Bristol Myers Squibb, according to data presented at the ASCO meeting.

In what researchers say is the largest study so far looking at the effect of cannabis on patients starting cancer treatment with the drugs also known as immune checkpoint inhibitors, there was no difference between users and non-users either in length of survival or length of survival without complications.

"Cannabis is known to be anti-inflammatory and immunosuppressive in laboratory studies, which is why it is a concern... as it may cancel out the immune stimulating effects of immunotherapy," said study leader Dr. Song Yao of Roswell Park Comprehensive Cancer Center in Buffalo, New York.

Yao and colleagues recruited 1,666 patients, most with advanced cancer, who were starting treatment with one of these immunotherapies.

About 17% said they regularly used cannabis. During follow-up lasting up to 31 months, with a median, 10.4 months, their cannabis use remained fairly steady.

The researchers are not advising patients who aren't using cannabis to consider starting.

"But for patients who are using cannabis to manage cancer symptoms or treatment side effects, our study shows that use of cannabis or cannabinoid products will not lessen the effectiveness of immune checkpoint inhibitor therapy," Yao said.

The study looked only at immune checkpoint inhibitors, and the results would not necessarily be the same for other cancer treatments, he noted.

"It's really important for immunocompromised patients - a group that includes many people in active treatment for cancer - to discuss any use of cannabis or CBD products with their physicians and to use these products only with caution, as cannabis products may increase the risk of infection or interfere with the metabolism of immunosuppressants," Yao said.

This newsletter was edited by Bill Berkrot; additional reporting by Shawana Alleyne-Morris.

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