Lupron/Femara vs. Tamoxifen

tlundy

After completing chemo, my onc recommended Lupron shots with Femara as opposed to Tamoxifen for estrogen suppression.  I was surprised, as Tamox seems to be much more widely used in premenapausal women.   Just wondering if anyone has any feedback/info on this.

voraciousreader

I'm premenopausal and doing Lupron/Tamoxifen.  Plan, as of now, is hopefully to go into natural menopause in a year or two...then either continue Tamoxifen for the full 5 and then consider 5 years of an AI.....Or, switch from Tamoxifen to an AI after 2 or 3 years for a total of 5.  For me, it's about when menopause will finally hit me...and what the future studies, that STILL aren't concluded, say.  So far...I've just passed a little more than a year into my treatment plan...so I have some time to decide what to do next.  I don't think there's any definitive answer to your question.  I know women who couldn't take tamoxifen, so they did ovarian suppression and were placed on an AI.

Omaz

thundy - I was 51 when I started chemo and still having regular periods.  I haven't had a period since round two last sept.  My onc said that I have to go a year from the end of chemo without a period and then will be considered menopausal.  I am on tamoxifen until the end of that year then they want to switch me to femara.  They offered the lupron/femara option if I couldn't tolerate tamoxifen.  I think some trial(s) have shown a slight advantage for AIs vs Tam but I don't know that literature very well.

Latte

i'm menopausal but young (had an ooph), and am on tamoxifen - my onc said the difference in effectiveness between tamox and femara is negligible, and the side effects are easier on tamox. so she wanted me to do tamox for 5 yrs and then switch to an AI. I know there have been studies that show that it is best to do tamox and an AI, but there is no conclusive evidence which is better to start with.

Omaz

Latte - I like hearing that there is minimal difference in effectiveness between the two.  I also read that about it being good to go from one to the other since they have different mechanisms.

jennyboog

I'm on Lupron and Aromasin, I was on Arimidex until couple weeks ago.  You're probably in my age group, we fall right in the middle...I was 34 at dx.  Chemo sent me into menopause, when I questioned my dr as to why she chose a postmenopausal she said, b/c my periods never have returned.  But in my opinion they were never given a chance to return, right after chemo I started lupron & AI.  I think every dr has their own opinion as to which is better.

tlundy

Jennyboog: 

I am 43, so I assume my period would have returned, but I started the Lupron/Femara a couple of weeks after my last chemo so who knows.  The head of my onc group had previously told me I would go on Tamox, but the onc I normally see said that he preferred the L/F combo in my case. So just goes to show opinions differ greatly on this, sometimes even within the same onc group

americanpinay

I was 41 at diagnosis. My onc told me I'll be on Tamox until I am permanently on menopause. My period never returned after the second Adriamycin. I recently did a blood test to figure out if I am on menopause or still on chemopause but it came back borderline. So for now, I am on Tamox. I thought I read somewhere that five years of Tamox followed by five years of AI is good to prevent recurrence??? So I may stay on Tamox for full five years then do AI but will certainly discuss with my onc on the next visit.

jennyboog

I'm sure my period would have returned too, I was told I'd be on AI's for 10 yrs if I could tolerate them.  I didn't realize there is a blood test that showed menopause...my dr never mentioned it to me.  I have an appt with a new onc next week and I'm interested to see her opinion on things.  She is a civilian dr and I've been seen by military so far & do know they make cut backs when they can. It's crazy but I'm sooo excited to meet her but trying not to get my hopes up b/c she might change things completely, I'll be talking to her about this for sure.  Thanks ladies.

Mocity

i was 37 at dx and now I am 40.  I have been on lupron for 2 1/2 years now.  My Onc said there are studies about tamox v lupron.  We choose the lupron because I was still hoping to have kids and he said you can stop the lupron and periods come back fairly quick.  Now I dont think kids are in this story so I stress about taking the lupron and not tamox.  I have been trying to find others in the same situation.  My Onc said lupron is usually given for a 3 year period so I am also stressed about when I stop and feeling like I am not doing anything to prevent it coming back.  Dont get me wrong... I would LOVE to stop the lupron because the side effects are not fun!

I thought Femara was only given to post menopausal women??

em1

That is correct, Femara is only given to post menopausal women.  My onc feels that Femara is superior to Tamoxifen, so he has me on Lupron to shut down the ovaries so I can take Femara.  I am 47, have been taking it almost a yr now.  Have not had a problem with too many side effects..mainly hot flashes.   If you look google "Femara vs Tamoxifen" they will give you statistics on the two.  Femara seems to be the better choice...less side effects and better protection against recurrance.  I do not want to have children, but I don't want to have my ovaries removed.  If you do research on that, there have been studies that show that early removal of ovaries may reduce bc, but can lead to other things...heart disease, dementia, lung cancer and overall mortality.  I am confused also about whether to stay on Lupron/Femara regimen...shots cost $3700 where I have been going, or take Tamoxifen for 2 yrs then switch to Femara, or get my ovaries removed.  Tough decisions!!   

mmm5

Cristi

am in exact boat as you, and there are studies out there that show for premenopausal women that Zoladex/Lupron are equally effective and maybe even more so effective than Tamox, (ZEBRA STUDY) in addition my ONC and others on here as well have mentioned the concern and studies of mixing Tamox with Her2 cancers.

I have been on Zoladex 3 years now and took a 2 month break my one Onc says you dont need to do anymore, and my other says 5 years. I am confused not sure what to do. I am wondering which side effects you are dealing with on the Lupron I just wanted to compare.

The theory is that if Her2 is treated with Herceptin in early stage cancers and it does not come back in the first 3 years (grade 3) that the chance of recurrance is below 5 percent maybe lower. So they are not sure if you need to worry about the hormone blockers any longer. My one Onc says he is very confident in this theory and he has been researching for years and works in conjunction with MD Anderson.

Thoughts? 

Omaz

mmm5 - Do you have any references for those studies, I would like to show them to my onc?

faithfulheart

Thundy,

How are you sweeti, I think about you and keep meaning to pm you!!   This is what my onc. told me.

First of all,  he treated me very aggresevly, through the book at me!!  We went back and forth about what we would do after treatment was over. My onc .Really is brilliant,  I trust him so much!  He highly recommended that I get an ooph, this was a no brainer for me as you can see from my signiture.

I was 41 and I have 2 small kids to raise!  After I had my ooph, I went on tamox, His thinking behind this is,  even though I am post meno, you can only take arimidex and femara for 5 years and then they stop working as well. You can not go from femara or arimidex to tamox. He felt that by putting me on tamox for 5 years, he can then switch me to femara or arimidex, giving me 10 years of hormonal theropy!!!  It made since to me. I have no ovarie's, but our adrenal glands will still make est. so the hope is the tamox will block the minimal est. that I have. I am really happy with my decesion. I have lost weight since having ovarie's out and starting tamox, I feel great. The risk of cancer coming back verses the risk from lack of est in my body was not a hard choice for me at all. Everyone is different, I just feel we need to do all we can to fight this beast!!  I have no regrets!!!  You will make the decision that is right for you, and really feel confident in your onc. that is so important! your doing great.

Let us know what you decide to do! Remmeber at 10 years, I bet there will be something even better that we can countinue to take, or maybe even a cure!!!!

God Bless,

steph

joannacco

hi Em1-

Can I ask the Stage that was your breast cancer and whether it was also her2+? My oncologist wants me to do Lupron and Femara at 43.Can one do that for 5 years? And follow it with Tamoxifen later? Have you had joint pain, vaginal dryness during intercourse or any other really difficult side effects? I was stage 2B very her2+ and only 10 percent ER+.

dtad

joannacco...hi just want you to know that Em1's post is very old. Maybe you can start a new thread. Good luck to all.