Dr. Eric Winer on Aromatase Inhibitors (SABCS 2009)

wallycat

So I saw my new oncologist yesterday.  I LOVE HER!!  She actually reads all the studies we here read!!

I asked her about the 4 years and not 5 plan and she said she thinks 5 years is smarter, even if we have low risk of recurrence.  She does not think staying on drugs longer is necessarily better.  

I also asked her if Evista was an option.  She said (which we already know) that it is not used for preventing recurrence, but...since it is very similar to tamoxifen, minus the uterine cancer risks, if I opted out of the arimidex/anastrazole, she could see my wanting the evista (and I have osteopenia).  I felt very relieved that she had an open mind but knew the studies.

I guess for those of us freaking out on AI and tamoxifen, even though not standard of care, evista type meds are an option for those of us wanting a safety net.

There was a new blurb out today about bone density meds and women living 5 to 10 years longer (healthy women) and seems something about the bone density.

orange1

Hi MOTC,

Thanks for all your informative posts.

 I have a clarification regarding the effectiveness of tamoxifen after 5 years - the effectiveness does not decrease, the risk of recurrence decreases.  Thus the relative benefit decreases (because overall risk is lower).  

orange1

In case anyone is interested in staying on tamox longer than 5 years... FYI - the study that caused the FDA to recommend a 5 year limit on tamox was an early readout of a study that had only 200 women in it.  The much larger ATLAS trial is going on now.  In this trial women are being given tamoxifen well beyond 5 years (I believe it will be 10 years, but I am not positive).  At the 6 year read out, deaths were lower in the tamox arm than in the placebo arm.    

 

One huge complaint I have is that theories are often presented as fact or near-fact, and are given much more credibility than they deserve.  A lot of this occurs on the Alt forums.  But the sad thing is, a lot of presenting-theory-as-fact occurs the on other forums, by our doctors and regulators (FDA) as well. 

 

Don't even get me started on the misrepresentations/interpretations of statistics - especially by the medical community.   

mathteacher

Orange1,

I'm trying to find some of the ATLAS info you mention going out further (5-10 years). 

 SABCS in 2007 - ATLAS (Adjuvant Tamoxifen, Longer Against Shorter): International randomized trial of 10 versus 5 years of adjuvant tamoxifen among 11 500 women - preliminary results.

Clearly Tamoxifen benefits recurrence when recurrence is the endpoint. But can you tell me if they looked at overall survival or just death from breast cancer? The SABCS in 2007 report says the difference in overall survival was statistically insignificant. Am I reading this wrong?  Thanks.

PS Do you have any idea why they include noncompliant women in the final numbers? Doesn't that misrepresent the results?

pip57

On my last visit to my onc she asked if I really take my arimidex every day.  I was rather stunned at the question and asked why she would ask that.  She had just returned from a seminar where the stats about 'non compliance' were discussed.  Apparently oncs are very surprised by this.  I told her she would have known already if she went on line!

So, yes, I bet that 'non compliance' does alter the stats.  A woman, who was in the same study as my mom was, admitted that she did not like the se's and so she did not take her pill every day.  However, it turns out that she was on a placebo. ?

molly52

PIP - LOL!!!!

Fearless_One

One should either take it or not take it.   To take it inconsistently (i.e. non-compliance) makes no sense, IMO.  

pip57

I would also let my doctor know if I wasn't taking it.  It is my decision after all. 

mathteacher

PIP, my doctor told me some patients agree to be in clinical trials just so they can get free health care and medicine during the trial.

So if a woman stopped the drug and confessed she might be kicked out and not have medical care.

pip57

mathteacher...good point.

Member_of_the_Club

Wait a minute, most clinical trials only pay for the medication itself, not the checkups and other medical care.   I was in a trial for a chemo drug and that was the case, and I was told it was typical.  So I don't think free medical care would be the goal of most women entering the trial, though certainly free meds might be.  But then again, if that was their goal, why would they not take the meds.

I would be interested in a comparison, if there was one, of noncomplicance with AIs compared to other drugs that are essentially prophylactic, not treating immediate symptoms.  Thats essentially what AIs are, unless you have mets.  You take them to prevent a recurrence so you don't get any immediate feedback. 

pip57

I think that regular follow ups and tests are very important to the outcome of the study.  Then the study group would look after any testing that they had determined to be necessary.  

I think comparing non compliance with other drugs would be a study in itself.  In my mom's case, she was followed for 10 years.  Tamoxifen for the first 5 and femera for the next 5.  It was the study that stopped the placebo arm as the results with AI's was overwhelmingly more successful.  However, my biggest issue with that study was that my mom had DCIS. Hard to compare survival stats with IDC.

scareds

A comment about Dr. Eric Winer. I was his patient at Dana Farber for over one year. While I was his patient, I had a double mastectomy and reconstruction. I found him to be the rudest, most arrogant doctor I've ever met in my life. (My father was a Surgeon, so I grew up knowing a lot of professionals in the medical field.) Every time I met with Dr. Winer, he would rush in stating that he only had a couple of minutes because he "just got back from Switzerland." Or, he needed to rush out because he was speaking at "B.U."  He is more interested in his own personal publicity than he is the care and well-being of his patients. His Fellow, Julie Gold, called me to apologize for his rude behavior. He hated the fact that I chose to get a mastectomy. He pushes women to have radiation, and if you don't abide by his recommendation, he ridicules and humiliates you. He put me on Femara after my operation, and did not offer any explanation regarding side effects or efficacy of the drug. He is not well-liked nor respected by the nursing staff at DFCI. I have watched him talk about "Proper Patient Care" in videos. He provides anything but that. Just because he might have a "big name" in the breast cancer field does NOT make him a good doctor.  

annettek

amen, scareds.....we all have to be cautious and have our eyes wide opn when it comes to any guru-be they in traditional or alternative medicine...