What are the steps for switching from Tamoxifen to an AI?

farmerlucy

Ladies - I need some guidance. I had a ooph yesterday, so I am finally post-menopausal (happy dance). My onc wants to talk to me after we get the final path report in. I stopped Tamoxifen yesterday and am loathe to restart it since it plays havoc on my uterus. For those of you who have switched from T to any AI - how long did you stop T before you started the AI? Also did your onc order any tests beforehand like a bone density scan? Is that protocol? Thanks so much everyone!

SpecialK

I have not switched from Tamoxifen to an AI, but have switched between different AI drugs. I took 2-3 weeks off between drugs (Femara, then Arimidex, then Femara again but a different manufacturer) so that I could more easily assign SEs to each since I was switching due to problems.  I would definitely get a baseline bone density done, and it should be standard for anyone who has an ooph.  Also, since AI drugs are notoriously hard on bones, having a baseline will help you see if this is an issue for you, but could be clouded by having the ooph and starting an AI so close together.  In any event you need to know what your bone health status is now. I had a TAH/BSO nine years prior to breast cancer, and I became osteopenic, but was stable and un-medicated. Chemo and six months of Femara were enough to push me to the brink of osteoporosis.  I started bi-annual Prolia injections and have regained normal density after two years.

Mommato3

I will be off tamoxifen about three weeks before I start Anastrozole. My MO didn't give a time frame because I wasn't having any side effects from it. If There wasn't a problem with the prescription getting to Express Scripts, I would have already started. I am switching because I became premenopausal again and the results of the SOFT trial recommended it. I did have to have a dexa scan done to get my baseline. Right now 'm doing OS until I have my ooph in Sept/Oct.

daisylover

I switched from one day to the next, with no break in between. I started the Aromasin a month after my oophorectomy. My oncologist did not have me stop Tamoxifen for surgery. I confirmed by email that there should be no break for surgery or between drugs. I think every oncologist is different on this??

I did not have bone density scan either... My oncologist at Dana Farber seems loathe to do any scans.

SpecialK

daisy - with the blood clot risk I am surprised you were not instructed to stop Tamoxifen - that is usually the surgeon's call, water under the bridge but glad there were no issues.  You need a baseline DEXA, bone loss from AI drugs and estrogen loss from the ooph can happen quickly - if your MO won't order it, ask your GYN or family practice doc to do it - it is not so much an oncology type of scan.

Nancy2581

hi Jill - no words of wisdom, but wanted to say I'm glad everything went well. Take care

Nancy

farmerlucy

Thanks everyone! I do think my onc orders the bone density scan. I did breakdown and take my Tamoxifen today. Don't want to be caught uncovered! Silly I know.

inks

My onc wanted me to have a wash out period between tamoxifen and exemestane. So I stopped it one week before the surgery and started exemestane one week after the surgery. No bone scan for me either, maybe it's a newer policy or because I am 38. The gynecologic oncologist who did my surgery (because of BRCA) and my MO both agreed that I'll need a bone scan in 2 years.