Hormone Therapy as FIRST Course of Treatment?

AndysMom

This is my first post. I will post my backstory below, but here are the questions if you don't want to read it all:

• Has anyone used hormone therapy as a first course of treatment to shrink tumors before surgery? How long did you stay on the medicine for? What kind of results did you have?
• Did you stay with the same type of anti-hormone medicine throughout the course of your treatment?
• How does your MO measure the size of your tumors when going through treatment? Is it common to use hands and a tape measure rather than using a mammogram every 6 weeks?

Here is where my questions are coming from: My mom was dx'd Stage 3 with tumors in both breasts and lymph nodes in January. The larger tumor was 6 cm, the smaller was about 4 cm. Both Estrogen +, one Progesterone +, one HER2 equivocal.

In late February, she declined chemo (she takes immunosuppressant drugs and feared chemo's interaction) but opted for hormone therapy to shrink her tumors before surgery. She takes Anastrozole/Arimidex daily now. By February, the larger tumor had grown to nearly 10 cm, but when we went back to the MO in April, it had shrunk to about 8 cm; the other tumor has remained consistent around 4 cm.

Yesterday we visited the MO again and she said that the larger tumor seemed to have grown to 8.5 cm and the smaller tumor to about 4.5. She is going to stay on the pill for another 7 weeks and then will go back for another exam and possibly a mammogram to more accurately determine the size of the tumors (she has been just using her hands and a tape measure). The doctor said she expected to see a larger decrease in size of the tumors and if there was no change next time, she would recommend surgery.

My mom feels very defeated with yesterday's results - to the point that she's even talking about declining surgery. She is 64 and in good health but has had many health problems over the years and is tired of doctors and nurses. I am hopeful that she will come around to the idea of surgery - whether that's later this summer or in the fall - but I will support her whatever she decides.

I haven't been able to find many stories here about people using hormone therapy as a neoadjuvant therapy, but wanted to ask to see if this pulls any out of the woodwork. If you have any resources or articles to share about it, I am open to that too.

Thank you!

ElaineTherese

Hi AndysMom!

You're right that most neoadjuvant therapy involves chemo; that's what I got. My MO measured the lump during chemo with a ruler, but I ended up getting an MRI and PET scan before my surgery. However, there are some ladies who are diagnosed with Stage IV breast cancer who are initially treated with hormone therapy. (Some oncologists don't recommend surgery for Stage IV BC -- it's already spread, so surgery seems less imperative.)  Maybe one of those ladies will post about the impact of hormone therapy on their situation.

inks

Endocrine therapy is used as neoajuvant, and that's not just for late stage cancer. Here is an older study that it's safe and effective Letrozole in the neoadjuvant setting: the P024 trial .

And there is a current trial running too about neoadjuvant hormone therapy. Anti-Hormone Therapy (With Anastrazole and Fulvestrant) Before Surgery to Treat Postmenopausal Women With Breast Cancer.

Sounds like a good option for someone unable/refusing chemo, you get to see right away if there is improvement.

And a note about the size of the tumor you are feeling - you may be feeling dead or dying tissue. This often happens with neoadjuvat chemo too, during treatment the mass may seem not to shrink, but when the surgery happens it turns out to be dead.

AndysMom

Hi ElaineThere and inks! Appreciate your insight and resources. Good to know that measuring without the help of a mammogram at every visit isn't abnormal.

We will have to wait and see what the outcome is in early July. I am hoping that inks may be on to something with it being dead or dying tumor. I feel like moral victories are almost important as medical ones for her right now. I need to keep her thinking positively!

Thanks again.