Estrogen Levels for Neoadjuvant Treatment

benpsu99

My wife has been diagnosed with ER and PR positive breast cancer. It is also HER2 negative. She was given Zoladex & Aromatase to lower her estrogen to levels below a woman in menopause. My wife is premenopausal. Her estradiol levels were not checked before she started the treatment but was checked after being on the medication for two months. She did experience some visible signs of her cancerous breast shrinking to be much more symmetric with her unaffected breast. She did have some light periods during this time as well as hot flashes. When he estradiol levels were checked at the end of two months (and she was very regular with all med and injections) she has 75 pg/mL. According to the chart I read, post menopausal women should be less than 10 pg/mL and pre can be 15 - 350 pg/mL. Unfortunately the MRI show some mixed results as she a very nebulous / field effect type breast cancer so some slices looked better but overall size was the same. Then her Ki67 number remained around the same at about 25%. So the doc said it not working, but we feel like it was doing something. We think maybe it did not work enough because her estrogen levels were that of a normal premenopausal woman (but I am sure they were lower that what normally she would have if not on the hormone treatment). Are there any options to enhance the estrogen suppression? The doctor can't explain why her estrogen levels are not in the post menopausal range.

Lula73

without a baseline number you won’t ever know if the labs show a decrease, increase or stable estrogen level. Perhaps her OB/GYN did some hormone labs in the last year or so you could use for comparison?

On the meds/treatment options: it sounds like she may have had some response but not a complete response. In the case of anti-hormonal treatment you’re looking for complete response otherwise the estrogen that’s still there will continue to feed any cancer cells that may still be present. Did they try tamoxifen or evista first? That is usually first line for pre-menopausal. That may be an option. Oophorectomy and continued therapy with an AI is another. The tamoxifen and Zoladex options obviously allow keeping if the ovaries if you’re planning (more) children in the coming years. If you’re not planning on (more) children then oophorectomy may be an excellent option. Good luck!

Goodie16

I had an incomplete response to Lupron and as a result my onc recommended an Oophorectomy. The Ooph turned into a complete hyster due to undiagnosed endometriosis. However, 1 month after the ooph, my levels were where my onc wanted and I was able to being Arimidex. Hope that helps!

Moderators

Hi Ben, and welcome to Breastcancer.org,

We're so sorry for the circumstances that bring you here, but we're really glad you found us. As you can already see, our Community is an awesome source of information, support, and advice for you and your wife.

Thank you for posting and we look forward to hearing more from you soon, and helping as much as we can! Please keep us posted!

--The Mods

benpsu99

Thank you for taking the time to respond. I am calling all her old docs. Maybe someone checked it.

LeesaD

My MO told me before I started the Zoladex shots that there are a percentage of women who just cannot be suppressed with shots. He said many doctors found this out as some women were actually getting pregnant while having ovaries suppressed with shots. My levels three weeks post my first shot were less than 5 pg/ml which is lowest detectable level. After four months of shots I went ahead with having my ovaries and tubes removed so I didn't have to get the shots anymore. That could be an option for your wife. Best of Luck