Trying to decide on Lupron

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lynninpa
lynninpa Member Posts: 28
edited June 2014 in IDC (Invasive Ductal Carcinoma)

My oncologist recommended that I go on Lupron for 2 years along with Tamoxifen for 5.  I am wondering if that is the best route for me or if there are other options.  For example maybe I should consider an oophrectomy and then aromatase inhibitors instead, as I saw some studies that showed that AIs were more effective than tamoxifen after menopause.

I am 50 and in excellent health, am going through menopause right now (some hot flashes, erratic periods, etc.) and am currently in radiation therapy, have not yet started hormone therapy.  My tumor was 1.7 cm, Grade 2, Stage 1c, IDC, ER+ 100%, PR+ 6%, HER2- via FISH test.  Oncotype was 18 so am not going through chemo.  

 I would love to hear the treatment regimens of other women with similar diagnoses and who are perimenopausal.  My oncologist said that she could understand if I did not want to do Lupron but she said, "We have to respect the size of the tumor" and she is a very strong advocate for Tamoxifen.  A friend with a very similar diagnosis and age says that she is on Lupron but that her oncologist started her out with monthly injections of Lupron instead of one-three month injection (my onc wants to start with one-three month injection) to see how the side effects were.  Just hearing from my friend about her doctor's approach made me wonder what else I need to think of as I face hormone therapy. 

I plan to get a second opinion too but wondered if anyone else here is wrestling with the same treatment decisions?  Thank you so much.

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  • juniper
    juniper Member Posts: 110
    edited June 2009

    I am 38 and was nowhere near menopause.  I had lupron shots every month and took arimidex.  I had no problems with either one - other than irritating hot flashes.

     I had a complete hysterectomy/salpingo in December so I am off the lupron now.

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  • Mocity
    Mocity Member Posts: 451
    edited June 2009

    I am also 38 and taking Lupron shots every month.  I finished chemo Jan09 and am taking Herceptin till Oct09.  Only side effects wtih Lupron I have noticed is the hot flashes and loss of libido.  :-(

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  • TenderIsOurMight
    TenderIsOurMight Member Posts: 4,493
    edited June 2009

    I hope you don't mind my sharing some thoughts, here, yet I just read an update on premenopausal breast cancer and ovarian suppression. I was well into perimenopause when I was diagnosed with breast cancer and chemotherapy ended my cycles, so did not face this question.

    Ovarian suppression plus Tamoxifen is a well-known adjuvant treatment in estrogen sensitive premenopausal breast cancer. Tamoxifen blocks circulating free estrogen from stimulating breast cancer cells, so any left over ovarian estrogen should be blocked too.  Aromatase inhibitors (AI's) and ovarian suppressors in premenopausal women such as Lupron or Goserelin (the clinical studies actually used Goserelin, not Lupron, but many oncologists use Lupron off label) raises the risk of inadequate ovary suppression, and there then is no estrogen blocker on board to cover adherence to any breast cancer cells, raising the risk of recurrence. Bilateral oophorectomy and AI use is a widely used alternative, should an AI be desired.

    Once every month is the standard dosage for Goserelin (3.6 mg sub cu q 28 days) with Tamoxifen (20 mgs orally daily). Some oncologists choose once every three months yet much depends on one's premenopausal or perimenopausal status (are you near menopause or just beginning perimenopause, ["peri" meaning "around the time of" ]). If you feel comfortable with every 3 months, you might request at least measuring your serum estradiol (estrogen) level and morning FSH after one or two cycles to ensure they both are in menopausal levels rather than waiting to the end of the third month. 
     
    One new treatment considered for ER premenopausal women is Zoledronic acid, an IV bisphosphonate. Recent clinical trials suggest that in premenopausal women (and while yet to be confirmed, possibly and hopefully a similar action in postmenopausal ER+ women) that the addition of zoledronic acid to endocrine therapy, as compared with endocrine therapy without zoledronic acid, resulted in "an absolute reduction of 3.2 percentage points and a relative reduction of 36% in the risk of disease progression" (please see below reference). You may wish to ask your oncologist about this too.
     
     
    Good luck to you,
    Tender
     

    Endocrine Therapy plus Zoledronic Acid in Premenopausal Breast Cancer

     

    http://content.nejm.org/cgi/content/short/360/7/679

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  • lynninpa
    lynninpa Member Posts: 28
    edited June 2009

    CristlC, thanks for the post.  I am not looking forward to loss of libido.  Oh well I guess it beats loss of life! Laughing

    Tender, that is AWESOME information, thank you!  I will definitely get a second opinion, especially about the timing of Lupron and Zoledronic Acid.  I am also still trying to weigh which of the two routes would be better for me: Lupron/Tamoxifen or oophrectomy/AI.  Really appreciate the detailed response and all the information.

    Hugs to us all!

    ~Lynne

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