SOFT/TEXT study results=tamox only or ovarian suppression + AI?

tshire

Hi ladies. Sorry in advance for this book of a post. I was diagnosed (right about this time!) three years ago at age 31 (almost 32). I was diagnosed with Stage 1A, ER(98%+)/PR(86%+), HER2-, grade 1 tumor. No lymph nodes involved. Clean genetics. Oncotype score 20. I did a lumpectomy, 4 rounds of TC chemo, and now I've been on tamoxifen for about 2.5 years. Overall I've had an easy time with it, except for some night sweats and uncomfortable ovarian cysts around ovulation time- periods came back immediately after chemo, and have been relatively regular since. I'm definitely still premenopausal. So, the SOFT/TEXT study results recently came out from ASCO and have me worried. https://www.nejm.org/doi/full/10.1056/NEJMoa180316...

"Women who receive the diagnosis of hormone-receptor–positive breast cancer before the age of 35 years are at particular risk for recurrence.4,5,14,15 On the basis of the primary findings in SOFT,6 guidelines were revised to include recommendations for the use of ovarian suppression in this age group.16-18 The 8-year results in this age group in SOFT showed that the rate of freedom from distant recurrence was 82.4% with exemestane plus ovarian suppression, 77.5% with tamoxifen plus ovarian suppression, and 73.8% with tamoxifen alone (differences of 8.6 percentage points and 3.7 percentage points, respectively)"

I was never recommended ovarian suppression- in fact, the oncologist I saw at MD Anderson told me NOT to do it, because the risks outweigh the benefits. My local MO told me "it's up to you." It's so hard for me to decide because the study wasn't stratified by grade, stage, etc- just age and chemo status. I did the chemo more as a safeguard than a necessity (indeed, the TAILORX study showed that I only received about a 2% benefit from chemo, and my chance of recurrence at 9 years is about 4%).

Another issue is that I'd like to try getting pregnant next year. I'm worried what would happen to my body if I was slammed into menopause, then directly into pregnancy, then right back into menopause again. It sounds incredibly hard.

Do any of you have any thoughts or experience with this?

Cpeachymom

Hi tshire- First, did the onc tell you what the risks were for ovarian suppression? I’m curious because I’ve been getting monthly Lupron shots for OS, and the only downside I know of is it’s hard on your bones. So I got my MO to order a bone density scan and it came back good, so we’re going to stay the course.

If I were you, and wanted to try for a baby next year, I would wait on starting OS. You’ve already had chemo, which could complicate things enough without trying to turn your ovaries off and on. All these things take time to leave your body too.

If you decide to wait the 5 Years...then it makes more sense to try OS for those extra percentage points.

exercise_guru

I think you need more information because from what I read the texta/soft study were not meant for women who had the intention of getting pregnant within a year. In fact it seems almost like they never have any attention of women getting pregnant again. Younger women are at the highest risk of recurrence. This is the group The study seem to do the very best for. But I have seen absolutely zero data on women having children after doing this regiment. You have some time to think about this don't let them make the decision for you you need more information.

Meow13

Hi tshire, good to hear from you. I sure hope you can safely have a baby, what does your mo say?

Good luck, keep in touch.