DCIS 1/xrt/tamoxifen

[Clay Coker]

This might not be the right board, but I’d like to get your opinion. My46 year oldSister recently diagnosed with D CIS 0-1,Just starting radiation, recommendation for tamoxifen.Estrogen receptor positive. BRCA negative.

I am only involved peripherally, but she is looking for advice in regard to tamoxifen. At this point I feel the benefit is minuscule, bordering on nonexistent.

In regard to radiation therapy, I recommend keto nesters, not really sure about the dose, but have suggested five ML’s at bedtime, five ML’s In a.m., and five ML’s, one hour prior to her radiation therapy.

in a.m., and five ML‘s, one hour prior to her radiation therapy.

Does anyone suggestFasting mimicking diet in addition to that?

[Kristelle Reyes]

Hello @byurthgmail-com and @drkriswyahoo-com, would love to have your insights here. Thank you!

[Madison Lepore]

I am assuming she had lumpectomy?

I would agree that hormonal therapy or radiation without surgery has minimal benefit. Assuming that she had lumpectomy, it should be understood that adding radiation and hormonal therapy does not change the 10-year survivorship which is 98 percent.

As you will see below these additional further treatments of radiation and hormonal therapy lead to a decreased recurrence at 10 years.  So, it comes down to a discussion of decreasing recurrence versus the side effects of Radiation and hormonal therapy. Hormonal therapy statistics are based on 5 years of treatment which can be difficult with compliance because of the side effects

This becomes a decision between the doctor and the educated patient. Optimal treatment seems to vary among doctors.

Because of the variable rate of DCIS transformation into invasive cancer recent clinical trials will help give a better understanding of patients whose DCIS is monitored instead of surgery, as those new clinical trials shed new light on this potential. Presently, most of the focus is on reducing the risk of invasive cancer and treating DCIS like early-stage breast cancer with the treatment of lumpectomy, radiation and hormonal therapy.

 Ductal Carcinoma In Situ (DCIS)

• Non-invasive breast cancer
• Starts inside the milk duct and does not spread beyond the milk duct into surrounding breast tissue
• Can increase risk of developing invasive breast cancer later on in life
• Chances of recurrence are under 30%. They usually occur within 5-10 years after initial diagnosis
• Lumpectomy surgery without radiation=25%-30% chance of having a recurrence. Lumpectomy surgery with radiation=15% chance of having a recurrence
• Chemotherapy is usually not needed for treatment of DCIS
• Hormonal Therapy beneficial to prevent recurrence post-surgical – important to recognize the adverse events and different side effects associated between anastrozole and tamoxifen. Both have similar rates of recurrence with treatment. Reference below is a good read.

Tamoxifen

• Used for breast cancer treatment that has spread to other parts of the body in both men and women
• Used with Ductal Carcinoma in Situ to reduce risk of developing a more serious type of breast cancer
• Dual mechanism of action:
  • Compete with 17B-estradiol (E2) at receptor site and block promotional role of E2 in breast cancer
  • Bind to DNA after metabolic activation and to initiate carcinogenesis

KE4

• D-3HB may starve cancer cells
• In glioma and glioma-like stem cells KD altered energy metabolism resulting in increased reactive oxygen species (ROS) production and increase in apoptosis of tumor cells
• Adding D-3HB can potentially enhance anti-cancer effects of chemotherapy
• When using D-3HB patients do not need to follow the KD diet in order to achieve ketosis

To get the best benefit for the Ketone Esters our practice recommends using 5mL’s 4 times per day (Female). She can space it out every 3-4 hours but make sure her last dose is not after 7:00 PM so her sleep is not disturbed. If using at bedtime 2.5 mls for sleep nothing more.  And before radiation recommend 30 min before 15 mls. This will give a higher nutritional ketosis around 2-3 millimole during the radiation treatment.  If she is doing the Ketone Esters, she does not need to follow a strict ketogenic diet because the esters will help put her body in a ketogenic state. Ketogenic diet may be difficult during treatment with radiation. Intermittent fasting or the calorie restrictive Fasting Mimicking diet could add synergy to the program.  Many nutritional options- but major goal would be more focused on glucose starvation of tumor.

We wish her the best with her treatment!

Here is a great article reviewing Ketone Esters that we recommend reviewing. Yao, Aliya, Zihua Li, Jinyan Lyu, Liusong Yu, Situ Wei, Lingyun Xue, Hui Wang, and Guo-Qiang Chen. “On the Nutritional and Therapeutic Effects of Ketone Body D-β-Hydroxybutyrate.” Applied Microbiology and Biotechnology 105, no. 16 (August 1, 2021): 6229–43. https://doi.org/10.1007/s00253-021-11482-w.

Anastrozole vs Tamoxifen to Prevent DCIS Recurrence: Key Difference May Be Side-Effect Profile

https://ascopost.com/issues/january-25-2021/anastrozole-vs-tamoxifen-to-prevent-dcis-recurrence-key-difference-may-be-side-effect-profile/

https://www.cuimc.columbia.edu/news/stage-zero-breast-cancer-whats-optimal-treatment-dcis

 

@clay_cokeryahoo-com

 

[Clay Coker]

Madison – thanks for the info.

Update, she did have a lumpectomy Her doctor is encouraging her to take tamoxifen. She and her husband are slow to endorse it at this point. I will forward this information to her. In the meantime, she started XRT before getting ketone Esters. She had some discomfort with the first week, quick resolution, feltMuch better with Keytone supplements, taken five ML’s, three times a day, morning, prior to XRT, and at bedtime.

[Kristelle Reyes]

Claim your CME here: https://earnc.me/LRnmYm

[Author]

Posts