Aromatase Therapy Timing Key in Breast Cancer Survival

Kathy044

Despite the BCO banner headline the ASCO recommendation for post menopause women using AI's hasn't changed and is still 5 years. Tamoxifen now that is a different  matter. See BCO's article and read it through. (I'm sending this from my iPad or I would provide the link)

Kathy

Anonymous

a few years ago when they came out and said 5 years tamoxifen, then five years AI, my onc adopted it immediately. I was on Tamoxifen at the time, so never had the conversation about just AI

mammalou

my MO today told me there were studies recommending 10 years of an AI.

Capster

Thank you for sharing your story,  I am pretty much an exact case to what you went through for the BC and am now on Tamoxifen! You give me hope!

MomtoIrishQuads

My onc in CA (first diagnosis) told me a week ago that I should get chemo with Stage 1 since it will be much better than 10 years of AI and that many women can't tolerate it - glad that I took his advice after reading about the 10 years and all the SE.   I didn't take Tamoxifen after my first diagnosis and since my second diagnosis was strongly estrogen fueled, I wish I had.  (or at least done more to reduce my estrogen dominance).

Momine

Dear mods, sorry to complain, but that was a super-confusing and disjointed write-up. There is no mention of lobular vs ductal, for example, and no stats except the alarming stat about higher overall mortality with an AI. That is then dismissed as not necessarily being relevant, but no clear explanation of why it wouldn't be relevant. I get the feeling that it was not a doctor or even a science major who wrote that.

It would also be nice to have a direct link to the original study, instead of just a general reference.

Moderators

Momine - we passed along your questions to the editorial team, and this was their response:

Dear Momine:

Thank you for your comments on the Research News article “Is Switching Hormonal Therapies Better Than Taking Only One?”

We’re sorry that you found the article confusing.

As you asked, here is a link to the original study: http://jnci.oxfordjournals.org/content/103/17/1280.full.
The reason that lobular vs. ductal isn’t differentiated in our write-up
is because it’s not differentiated in the study.

Because
aromatase inhibitors are used to treat postmenopausal women, it’s
likely that women who take aromatase inhibitors are older and may have a
higher rate of other health problems, such as heart disease, high blood
pressure and osteoporosis. This, coupled with the aromatase inhibitors
being linked to a higher risk of heart problems than tamoxifen, is why
the researchers thought the results showed worse overall survival with
the aromatase inhibitors. Overall survival is how long a woman lives,
with or without breast cancer coming back. Overall survival also doesn’t
take into account what a woman died from. So these women may have died
from breast cancer or they may have died from something else.

The
reason that this worse survival isn’t considered relevant is because
the difference between survival with 5 years of tamoxifen and 5 years of
an aromatase inhibitor wasn’t statistically significant. This means
that the difference in survival could have just been due to chance and
not because of the difference in treatments. So the researchers don’t
consider it a “real” difference.

Since
this article was published in 2011, much more research has been done on
adjuvant hormonal therapy. We recommend that you read this 2014 article
on the updated American Society of Clinical Oncology Guidelines on
Adjuvant Hormonal Therapy: http://www.breastcancer.org/research-news/10-years-of-hormonal-therapy-recommended. Hormonal therapy is now recommended for 10 years after surgery.

Again, we apologize for any confusion.

The Breastcancer.org team

Lily55

thanks for checking this Momine I had no idea AIs can affect your heart.......! I will read the latest research

Jennie93

This recommendation makes me cry, seriously.  I'm so miserable after just one year of tamoxifen. Thinking 4 more years was remotely possible. But 10 years, no way. I may as well just give up and lay down and die right now.  

Meow13

Jennie,

I with you on that, I'd rather walk over a pit of hot coals than go 5 more years. Almost made 3 years each month a step closer. I'm not in great pain it is constantly a nagging ache, now degenerative arthitis in my neck.

I don't think this is normal aging pain is the medicine.

Kathy044

Mods thanks for the update. I went back to read the revised initial posting on this thread, BTW ASCO is North American, not just for the USA. Karen Gelmon, one of the committee members is Canadian.

For those interested here is a link to the full ASCO  article, note word "Focused" in title.

Adjuvant Endocrine Therapy for Women With Hormone Receptor–Positive Breast Cancer: American
Society of Clinical Oncology Clinical Practice Guideline Focused Update.

http://jco.ascopubs.org/content/early/2014/05/20/JCO.2013.54.2258.full.pdf+html

On page 3: "This Focused Update addresses only duration of tamoxifen
monotherapy. The Update does not address the other clinical ques-
tions posed in the 2010 guideline."

The discussion on options for pre and especially post menopause women starts at the bottom of page 11 and includes,

"There are no new data regarding the optimal initial endocrine
treatment for women who are postmenopausal, whether that should
be tamoxifen or an AI. The 2010 Update Committee recommenda-
tion of initial treatment with an AI or with tamoxifen to be followed by
an AI remains valid."

So Mods in the last sentence the first post on this thread did you really mean to go as far as to say

Hormonal therapy is now recommended for 10 years after surgery..

Kathy

ruthbru

I copied the following quote right from the latest study the mods have noted. It does NOT say to take to an Al for 10 years, it says it can be considered as a option. (I have bolded what I think are the pertinent words to note):

"The American Society of Clinical Oncology (ASCO) has developed new guidelines on adjuvant hormonal therapy that recommend all women diagnosed with hormone-receptor-positive breast cancer be offered the option of taking hormonal therapy for 10 years.

For women diagnosed with hormone-receptor-positive breast cancer, the updated ASCO guidelines recommend:

• newly diagnosed postmenopausal women have several options:
  • take tamoxifen for 10 years
  • take an aromatase inhibitor for 5 years; right now, there isn’t enough evidence to recommend taking an aromatase inhibitor for 10 years. "

 

MargoChanning

hello group, longtime lurker, first time commenter...I've been struggling with AI's since October, 2012 when I started right after completing chemo and rads for Stage 1 (negative nodes, clear margins, sentinel biopsy, Oncotype score of 40).  I developed dizziness and vertigo about 8 months into using Femara, was given a one month holiday by my MO during which all dizziness disappeared.  I take it at night now to reduce dizziness, but I've also developed chronic back and neck pain (made worse by a single dose of Boniva last year - stopped after that one dose because of the pain), also have recurring sleep problems, headaches (never had those in my life), fatigue and mild depression.  The thought of being on this drug another 2.5 years is depressing in itself.  

I have kind of a "well, no duh" reaction to the findings of increased cardiovascular disease, osteoporosis and other serious illnesses related to aging/AI's when those are directly related to lack of estrogen, and the AI's create a state of profound estrogen deprivation.  Also, where are the studies (or are they in progress) on any rebound effect after people are taken off AI's?  Or are estrogen positive people supposed to stay on those the rest of their lives?  Just a rhetorical question, I don't expect an answer, but I do wonder.

ruthbru

I am going to be a bit preachy here; but eventually every woman who lives to a ripe old age (which is what we are shooting for) becomes profoundly estrogen deprived. Some do have significant problems, but others live vibrantly throughout their whole lives. The thing is......it takes lots of work (even extra, I believe, for us who are thrown off the roof into that lack of estrogen instead of slowing going down the hill naturally). If you do want to read a very interesting, funny, medically based, and 'kick it up a notch' book of 'rules' on how to 'Live Strong, Fit, and Sexy-Until You're 80 and Beyond', check out Younger Next Year for Women by Chris Crowley and Henry S Lodge, M.D. 

ruthbru

Margo, I would think at Stage I, five years will be enough, especially since you did chemo. By then you natural estrogen will have had 5 years of dropping too. I don't know about studies, but  can tell you that after I was done with my 5 years, my bone density (which stayed in the normal range but was dropping) went back up, and my blood pressure, cholesterol etc. which had all edged up, went back down....but I worked out really hard, watched the diet, everything, to keep things in check while on Arimidex & have kept it all up afterwards too.

B123

I have been on arimidex for almost 2 years now. I get daily headaches, feet hurt, bones ache and my bone scan went from osteopenia to now osteoporosis! My calcium level is 10. Not sure if I should change to aromasin because I hear it has less SE and people have said they feel so much better, plus less bone loss? I am now beginning to take fosomax pill form but I only hope my bones don't get worse? I'm only 43.. 

oropallo

I have been on Anastrazole for about 5 weeks now. Havent slept since I started. The hip pain unbearable. Got on the floor to groom my dog and barely could get up. Any car ride is aweful once the car stops and I try to walk. Unbelievable. I seem to be suffering more than most. I will call MD tomorrow. I also have high cholesterol and high blood pressure and this drug can make this worse also (heart disease?). I am wondering if its worth it. I already have Osteopenia..........

Am thinking of going with GOD vs. this drug? R

savgigi

Oropallo, are you taking a statin for your high cholesterol? I figured out that my muscle pain was caused by the combination of the statin and Femara. Either drug alone did not cause the pain. But when I took them both together in the evening, pain would wake me at night. Now I take the statin in the morning and the Femara at night and have  some stiffness but no pain that wakes me up.

MiMi11

has anyone on this site been able to take anastrozole without much problems? I took my first pill yesterday & I am paranoid because of all the responses I have read on the site. Thanks!

toomuch

Mimi11 - I've been on Anastrozole for 3 1/2 years. I took the generic TEVA brand for the first 3 years. I admit that I had significant joint pain, mostly in my hips but Ibuprofen always relieved it. The pain was always worse after periods of inactivity. I found that if I exercised regularly the pain lessened but was still present.  About 5 months ago I started to get Arimidex directly from AstraZenaca through their Arimidex direct program. I have had significantly less pain since taking the trade brand. I would say that most of my days are pain free now but I occassionally do have hip or leg pain that is relieved with Ibuprofen. When I have pain, I always remind myself that there was one small study that showed that women who had pain on Arimidex had a slightly lower risk of recurrance. This always helped to make the pain bearable. 

ruthbru

MiMi, I took Arimidex for 5 years and did fine. Most people do. It is just natural that people who have problems are the ones posting about it. The rest are just out living their lives. Be grateful we have this option and EXPECT that you will do well!

oconnor2450

Hi, been on Anastrozole for 5 months...had a Dexa scan last week and have osteoporosis...I am 54, fit and miserable...(

I keep trying to get my head around this feeling of lethargy and general disinterest, doing acupuncture and that is helping.

Does anyone choose between AI's and osteoporosis?? Reminds me of a game my kids used to play called, Would You Rather?

My path was 95% ER+, do I just suck it up and solider on?  Or are there other options? Since Im finished with treatment, last H&P a month ago, my MO has other fires to put out, understandably. 

Anybody?

Thanks!

ruthbru

What about switching to Tamoxifin? A friend of mine had osteoporosis going in & that is what the doctor recommended for her.

keepthefaith

o'connor, I am 59 and also have osteoporosis and osteopenia. I am on Tamoxifen. MO said we'll do another DEXA scan in a year or two and decide if it is worth switching to an Al. I may go to an endrocronologist at that point and see if there are other options to increase my bone density. Right now, I am on Vit D/calcium supplements and trying to increase my walking. Good luck! Feel free to PM me if you like.

golilly2

Hello Ladies,

I have just started taking Aromasin. December 1 st was D-Day for me. After a week I noticed headaches and joint pain but after a couple of days the pain seem to move in and out but my hip pain stays. The hip pain is constant now with a deep burning sensation. Is this normal?.. Has anyone had a burning sensation in their hips due to this medicine?

ktab96

Yep my Onc told me about the new guidelines. I have been on Femara for almost 4 years. After the fifth year she will switch me to Tomoxifin. My Onc also told me Tomoxifin will actually help my bones when the time comes.

SimonaR

thk you for the information - I am rather confused - have been taking Tamoxifen for 3 yrs (I am pot-menopausal) and have been asked to switch to Aromasin (asked to try it to see if my body can tolerate it) - if okay, apparently, only need to take it for 2 more years and then stop all meds. Is there research that says that "switching" after 3 yrs if better than staying on Tamoxifen for 10 yrs OR are these all various options, depending on doctor's advice?

Moderators

Dear SimonaR, Welcome to the BCO community. We hope that you will find some information and support here from our knowledgeable and compassionate members. You also can read some articles on Hormonal Therapy on our website. Keep posting and let us know how you are doing. The Mods

mysunshine48

Is there anyone who does not get bad side effects? And, how do you decide - Arimidex vs Ferara? I am 66 and 98% estrogen posisitive. Does that mean I have way too much estrogen and this is not going to work as well for me as someone who is 59% estrogen? I do not understand.

doxie

Actually it is the reverse. The more estrogen positive your tumor was, the more likely the AI (aromatase inhibitor) will work. Your tumor lives off of estrogen, and the AIs stop the body from producing all but a little. We don't need ovaries for our body to produce estrogen (Men produce estrogen, but have no ovaries.), but clearly we have less produced after going through menopause. The goal is to starve any remaining cancer cells.

It doesn't matter which AI to start with. You might make the decision based on how much your co-pay will cost. Then see how you react and adjust thereafter. I started on arimidex/anastrazole, then switched to aromasin/exemestane due to SEs.