AI+OFS vs. Tamoxifen for Premenopausal Patient?

emily_the_cat

AI+OFS vs. Tamoxifen for Premenopausal Patient?

emily_the_cat

I'm 35 years old, and my MO has recommended five years of AI (Aromasin) + OFS (Lupron). There's no data for someone with exactly my pathology and treatment (because I'm in a clinical trial), but she estimates that my chances of 10-year recurrence are 15-20% without hormone therapy, 10-12% with tamoxifen alone, and 7-10% with AI+OFS. I'm extremely upset about the potential impacts on my quality of life, especially SEs that will affect my husband and baby, like depression and fatigue. I'm considering refusing treatment, but a 20% chance of recurrence is scary. Of the two treatments, the SEs of tamoxifen sound to me like they'remore likely to be manageable. Has anyone out there tried both treatments? Which one was better for you? (I'm almost afraid to ask because I think it's going to be an even split - but I can't resist!)

rgiuff

I did tamoxifen alone for 3 years, starting at age 47. But I was also already starting to go through menopause at the time, so it was hard to know what effects were from the tamoxifen and which were from the menopause process. I then was prescribed aromasin, and didn't like the effects, and didn't like the idea of stopping all my estrogen production, so I stopped after 2 months. Unlike you, I had an early stage cancer, so I'm not suggesting that you do what I did.

You could always try the combination your Oncologist is proposing, and then if it's too unpleasant, you could later switch to tamoxifen alone,. Important thing is that you keep your ovaries and suppress them with a medication, not by having them surgically removed! That way you can reverse the menopause effects. Even if you just do tamoxifen alone, the odds are still greatly in you favor of not having a recurrence! You could also exercise regularly, improve your diet, avoid estrogenic chemicals, such as pesticides, household chemicals and some cosmetics, and make sure your Vitamin D level is sufficiently up to par. All these are thought to help prevent recurrence, especially exercise, which many studies have shown to decrease recurrence risk.
Because of these lifestyle changes and my early stage cancer, I felt secure in my decision to do only 3 years of tamoxifen, and then stop hormonal therapy.

Good luck to you!

Oncearunneralwaysarunner

I've tried both tamoxifen and ovary suppression with Zoladex. I was diagnosed at 31 with a triple positive tumour. My daughter was 2 and a half at the time (she's now 4) so I get your quality of life concerns. I'm somewhat in the same boat as you are since there are no stats for me either. The difference is that MO refuses to give me any stats saying "I'm not normal"! He means that in the most caring way Here is my experience with both drugs. Please keep in mind that we all have different side effects and some women don't react to drugs or find the side effects manageable.

I tried tamoxifen first and found the side effects somewhat manageable but I developed anxiety, loss of appetite, mild hot flashes. I had some weight loss and then I started having a really hard time with my runs. I would go for a slow run and cardiovascularly I felt like I was doing an all out sprint. Most of the side effects went away when I stopped.

We decided to try ovary suppression with Zoladex as an alternative to tamoxifen and to see how I would react to being kicked into menopause. Turns out that my body really like its estrogen! While I don't have that weird cardiovascular thing going with Zoladex, I do have some anxiety, mood swings and hot flashes. That being said, I've had some stressful months at the same time so it may not all be due to the drug.

My MO is very much a quality of life kinda guy and would rather make sure that the symptoms I'm reporting are from the drugs I'm on before prescribing something else to deal with those symptoms. As of right now I'm letting the Zoladex wear out and I'll go drug free to see if these symptoms alleviate. He's left the decision up to me on whether or not to continue with hormonal therapy and said that had to do what allowed me to feel comfortable. If I do go back on hormonal therapy it will most likely be tamoxifen. The main reason is that if the side effects come back, it's easier to stop a pill than to wait for the Zoladex to work out of my system.

Best of luck with your decision.