Tamoxifen alternatives: What can I take instead of tamoxifen?

Compare tamoxifen alternatives | Other SERMs | Faslodex  | Aromatase inhibitors  | Natural alternatives | How to switch meds

Most breast cancers (almost 70%) are hormone receptor-positive; in other words, the tumors contain estrogen or progesterone receptors. Estrogen or progesterone hormones can promote the growth and spread of breast cancer cells if left unchecked. Blocking hormone receptors or decreasing the amount of estrogen produced in the body is the standard way to treat hormone receptor-positive breast cancer. 

Tamoxifen, known by the brand names Nolvadex and Soltamox, is a commonly prescribed prescription drug used to treat hormone receptor-positive breast cancer. It is classified as a selective estrogen receptor modulator (SERM) that can treat all stages of breast cancer in men and premenopausal or postmenopausal women. Tamoxifen has been shown to reduce the risk of dying from breast cancer by 27%. However, serious side effects of tamoxifen include uterine cancer and blood clots.

Other hormone or endocrine therapies, such as aromatase inhibitors, are available to help treat or prevent breast cancer. Continue reading to learn more about tamoxifen alternatives and how they work. 

What can I take in place of tamoxifen?

Other options to treat hormone receptor-positive breast cancer are available. The most popular alternative to tamoxifen is an aromatase inhibitor, such as Arimidex (anastrozole) and Aromasin (exemestane). Other SERMs, such as Evista (raloxifene), and estrogen-receptor antagonists, such as Faslodex (fulvestrant), may also be prescribed instead of tamoxifen. These treatment options may be preferred because they are effective and tend to carry a lower risk of severe side effects associated with tamoxifen. Most breast cancer drugs are used as adjuvant therapy or treatments that are given after surgery. 

Top 3 tamoxifen alternatives

1. Other SERMs, such as Evista (raloxifene) and Fareston (toremifene)

Raloxifene and toremifene are other SERMs that act similarly to tamoxifen. They stop cancer growth by binding to estrogen receptors and blocking the ability of estrogen to bind to these receptors. However, SERMs can also mimic the effects of estrogen in other parts of the body, such as the uterus, which can increase the risk of certain cancers. These drugs are not usually recommended if previous treatment with tamoxifen has not been successful. Toremifene is only approved for the treatment of metastatic breast cancer in postmenopausal women, so its uses are more limited than those of tamoxifen. 

Some healthcare providers may prescribe raloxifene over tamoxifen due to its lower risk of serious side effects, such as uterine cancer. Raloxifene may be prescribed to postmenopausal women with osteoporosis who are at a high risk of invasive breast cancer. However, raloxifene may be less effective at preventing breast cancer than tamoxifen and has only been tested in postmenopausal women. On the other hand, tamoxifen is an option to prevent breast cancer in premenopausal women. 

SERMs are generally taken by mouth. Side effects may include hot flashes, muscle or joint pain, and leg cramps. Serious side effects may include an increased risk of uterine or endometrial cancer and blood clots in the legs or lungs. 

2. Antiestrogens or estrogen receptor antagonists, such as Faslodex (fulvestrant)

Antiestrogens, such as fulvestrant, bind to estrogen receptors and cause the receptors to break down. These drugs are effective when used alone or in combination with other hormone therapy drugs to treat advanced breast cancer. A healthcare provider may prescribe fulvestrant if SERMs, such as tamoxifen, or aromatase inhibitors, such as letrozole, have stopped working.

Unlike tamoxifen, fulvestrant is administered as an intramuscular injection. Fulvestrant needs to be given along with a luteinizing hormone-releasing hormone (LHRH), such as Lupron (leuprolide) or Zoladex (goserelin), in premenopausal women. Common side effects of fulvestrant include pain at the site of injection, nausea, headache, and fatigue. 

3. Aromatase inhibitors, such as Arimidex (anastrozole), Femara (letrozole), and Aromasin (exemestane)

Aromatase inhibitors work by blocking the production of estrogen in the body. They are generally reserved for postmenopausal women with breast cancer whose estrogen is primarily produced by the aromatase enzyme. Aromatase inhibitors may be used in premenopausal women if ovarian suppression treatments are also used. 

Unlike tamoxifen, aromatase inhibitors have a low risk of causing uterine cancer or blood clots. However, aromatase inhibitors can cause muscle and joint pain, which can lead to some women discontinuing treatment. Because they block the production of estrogen, aromatase inhibitors can cause bone loss in women after menopause. 

Common side effects of aromatase inhibitors include vaginal dryness, muscle pain, joint aches, and hot flashes or night sweats. 

Natural alternatives to tamoxifen

Healthcare providers do not recommend replacing tamoxifen and conventional treatments with natural therapies. No natural alternatives to tamoxifen have been proven to help treat breast cancer, and they may even cause harm in some breast cancer patients. Certain supplements or herbal treatments may lead to an increased risk of drug interactions or adverse effects if used without the guidance of a healthcare provider.

Some natural therapies may be helpful to support the body and mind while battling breast cancer. Healthcare providers may recommend natural therapies in addition to standard breast cancer treatments. These therapies may include:

Acupuncture

Acupuncture involves placing thin, tiny needles into certain points of the skin. This type of treatment is believed to stimulate the central nervous system and support the body’s natural healing abilities. The foundation of acupuncture lies in the belief in chi or qi, the body’s source of energy, according to traditional Chinese medicine. 

Massage

Massage may be beneficial for relieving stress and fatigue in breast cancer patients. An experienced massage therapist can apply the appropriate amount of pressure to release muscle tension. 

Meditation

Meditation is the practice of deep focus, mindfulness, and relaxation, and it may help lower anxiety and stress in people with cancer. Some people find that meditation also helps improve sleep and pain. Setting aside one or two parts of the day to meditate, either alone or with guidance from a group or sole practitioner, may help improve the quality of life in people with cancer. 

Aromatherapy

Aromatherapy involves the use of fragrant oils that release scents into the air. Inhaling the aroma of these oils is considered safe and may help relieve stress, pain, and nausea. It’s important to always test the oils before using them to avoid any allergic or hypersensitivity reactions. Applying lavender or tea tree oil on the skin should be avoided in women with breast cancer since these oils may affect breast tissue growth. 

Diet

A healthy diet is always recommended to support general overall health. Eating a balanced diet can help support the body’s natural functions while being treated for breast cancer. It’s best to stick with nutrient-rich foods, such as fruits and vegetables, as well as lean meats and whole grains. Avoid foods high in fat, sugars, and processed ingredients. 

How to switch to a tamoxifen alternative

Hormone therapy for breast cancer is typically started after surgery. Switching to a tamoxifen alternative may depend on the response to treatment. The timeline for hormone therapy may look like one of the following:

• Start an aromatase inhibitor two to three years after treatment with tamoxifen. Continue taking the aromatase inhibitor for two to three years for a total of five years of treatment with tamoxifen and the aromatase inhibitor. This treatment timeline is appropriate for postmenopausal women. 
• Start an aromatase inhibitor two to three years after treatment with tamoxifen. Continue taking the aromatase inhibitor for five years for a total of seven to eight years of treatment with tamoxifen and the aromatase inhibitor. This treatment timeline is appropriate for postmenopausal women. 
• Start an aromatase inhibitor five years after treatment with tamoxifen and ovarian suppression therapy. Continue taking the aromatase inhibitor for five years for a total of 10 years of treatment with tamoxifen and the aromatase inhibitor. This treatment timeline is appropriate for women who are premenopausal at the time of diagnosis. 

 An oncologist will recommend follow-up care every few months to assess the effects after treatment with hormone therapy. They will also assess the risk of recurrence of cancer and determine the next steps for treatment as needed.