San Antonio Conference--Dr. Winer on Aromatase Inhibitors

Rabbit_fan

Springtime - here's how I interpreted it:

He says that there is a difference in recurrence rates, but not a difference in survival rates at 5 years.  It seems pretty likely to me that for ER positive, even people who have a recurrence within 5 years are not likely to be dead from it within that time span, so survival rates would be close only 5 years out.

I'd like to know what the difference in survival is at 15 years - or longer.  You'd think that a recurrance by year 5 is much more dangerous than no recurrence by year 5, but they don't tell us what happens further down the road.

sam52

Thank you,Rabbit.....that makes more sense to me. I agree that what happens a lot further down the road will be of greater value in assessing the usefulness of endocrine therapy with an AI.

 We have to bear in mind that tamoxifen is seen as a MAJOR step forward in preventing recurrences and prolonging survival - and AI's are considered to be SUPERIOR to tamoxifen.So I canot see AI's suddenly being 'downgraded' in terms of their efficacy.

Sam

mollyann

Rabbit, where are you getting the report that the studies were evaluated at the 5 year mark?

Rabbit_fan

Molly - I watched the video from Yazmin's first link at the start of the post.  He only mentions it once and doesn't make a big deal about it, but that's what he mentions as the time frame of the study.

Member_of_the_Club

I don't understand this idea of holding an AI in reserve in case you get a recurrence.  If its going to be helpful in treating mets it will be much more helpful in preventing them.  The lower the tumor load, the greater the effectiveness.  And since mets generally are treated and not cured, it seems much more prudent to prevent them in the first place.

mollyann

Rabbit, you write: "It seems pretty likely to me that for ER positive, even people who have a recurrence within 5 years are not likely to be dead from it within that time span, so survival rates would be close only 5 years out."

You're assuming nobody died in the Arimidex-takers or the non-takers during the first five years. But apparently they died in equal numbers in both groups. Thus, the specified survival statistics. If survival were not an issue in the five year window, clearly we would hear that all the time.

Anonymous

    I hope I am not butting in here, but am always interested in posts discussing AIs.   I still need to read and try to view the video, but all I know is that when I first was diagnosed with BC,(1990)  they discussed tamoxifen and decided since I had no + nodes out of the 19 they biopsied and my tumor was very small and they were sure they removed it all with the mastectomy, that it was not necessary for me to take it.  I believe they said it would only decrease my chance of recurrence by something like 5 %.  I was also told that by not doing tamox then IF it did recurr, they would then be able to use it as treatment which is what they did.(1998)   My tumors shrunk 50% on the tamoxifen and from there I went to aromasin (after only about 1 month on arimidex sicne my onco said he had read aromasin had more dramatic results) and had great results with both medications and was able to stay off chemo for 10 years because of AIs.  Did faslodex for quite a few years, but the last two it most likely was not effective since I did develop new mets.  I am now once again trying the hormonal route after seeing an onco at MDA for options other than chemo.  When I moved to Stage lV, I was terrified after reading statistics, but found out from experience they are not a predictor as to how you will respond or what the outcome will be.  I hope I am able to view this video.  Would the tamoxifen have prevented a recurrence? It is something I will never know.  Keep in mind, it was 1990 when they decided not to use it as preventative on me and a lot of reasearch and trials have been done since then. 

Thanks for posting the link. 

Member_of_the_Club

Where is any study saying AIs are ineffective?  There are plenty of studies saying they increase odds of survival substantially, I have never seen an actual study to the contrary.

sam52

Surely it stands to reason that if your tumor was estrogen receptor positive, then to remove estrogen production from the body by means of endocrine therapy (AI) will lessen the chance of any possible circulating cells from becoming active. This is exactly how the AI's work and have been shown in numerous studies to decrease recurrence and increase the likelihood of disease-free survival.Both AI's and tamoxifen (a selective estrogen receptor modulator) have been a big step forward in the armory against bc progression.They are both far from ineffective.

Why would anyone want to wait until they have a recurrence (ie progression to mets) and then use an AI ? Cure with stage IV disease is not possible.

Anonymous

  In my case I waited because I was very ignorant at the time and went according to what the onco and surgeon recommended.  They did not actually feel there was going to be any recurrence since my tumor was less that 1 cm, they thought they got everything with the mastectomy, and all the lymph nodes they removed were negative.  I really didn't even worry about recurrence and went back to life as normal until I was diagnosed 8 years later as Stage lV.  If I had known anything at all about cancer in the beginning I would have opted for chemo after the surgery, but as I said I was ignorant at the time. Since then I have learned a lot.  So far as a cure for Stage lV, I do not believe there is a cure for cancer in any stage.....just because you are NED or in remission, does not mean you are cured.  Maybe I am wrong, but I have always heard and read that there is no cure. In my case I have been very fortunate in that they were able to treat me with AIs for a long time and that I have been able to live with my cancer without having it take over my life.  They know a heck of a lot more today than they did 20 years ago and today I would say Put me on the tamoxifen as a preventative. 

RobinWendy

I do not believe that anyone can do anything to actually insure that you never have a recurrence.  I know people from every angle of this spectrum (some did chemo and radiation but no AI or tamoxifen... some did no chemo but went on tamoxifen, etc....)

I think what Dr. Winer is saying is because there is no guarantee that these drugs will prevent a recurrence, and taking these drugs has not statistically affected actual survival rates, there are times where automatic prescription of these drugs following initial diagnosis is not appropriate.  I did not take tamoxifen after I finished AC and radiation due to a blood clot fear.  However, it did give me 9 months as a treatment for mets.  AI's have been working on and off for me for six years of being Stage IV.

Marybe did nothing after her lumpectomy and it took 8 years for it to come back.  I did the chemo and the radiation and I got DCIS a year and a half later and then mets a year after that.  It's all a tremendous crap shoot if you ask me.  But, since you all know that I am Dr. Winer's patient and I have made no secret of admiring his complete dedication, research skills, compassion, and brilliance... I listen to what he says.  He chooses his words VERY carefully.  I would not discount his findings.

Robin 

Yazmin

RobinWendy, you wrote: "...... It's all a tremendous crap shoot if you ask me". I couldn't have said it any better.

Then, when you say: "......there is no guarantee that these drugs will prevent a recurrence, and taking these drugs has not statistically affected actual survival rates," It has been very clear to me all along that this is exactly what Dr. Winer (and other researchers of high integrity) are saying. Of course, some artificial devices (such as "disease-free survival", which has nothing to do with absolute (real) survival, are being used to make all those statistics look a lot better than they actually are).