Another Poll - Bisphosphonates
I'm curious - how many Her2+ are getting Zometa or are enrolled in the bisphosphonate trial for reducing the chance of recurrence?
I am curious to know what ladies here have decided and why. Thanks.
Comments
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What? - Zometa 4mg infusion every 6 months for 3 years
Why?- To prevent metastasis and help preserve bone strength (chemical induced menopause)
Edited : I said NO to the trial..
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I'm enrolled in the trial and randomized to Clodronate
Why? I'm not worried about bone density. I was through menopause before chemo (at 55 or 56 depending on whether the period I had 12 months after my penultimate one counts, my bones are in good shape and I don't have much in the way of risk factors for bone density problems. I enrolled because
- I benefited from the women who were brave enough to enroll in the Herceptin studies and had decided that if I was offered atrial with appropriate risk-benefit for me I would join.
- 30% reduction in recurrence sounded like a good idea if the risk of the treatment was very low.
However, I'm considering dropping out of the trial. My creatinine has been elevated all the time I've been on Clodronate. The study allowed me to take a break and it went down almost to normal in the 3 weeks I was off Clodronate. I've been back on it for about 5 weeks now and my last Creatinine was elevated higher than before the break. I'll take another Creatinine test tomorrow and talk to my oncologist about what risk to my kidneys this represents. I may also ask for a referal to a nephrologist to get a kidney specialist's take on it.
Since I'm only stage I and had TCH chemo, my risk of recurrence is low anyway so 30% probably buys me at most 2% reduction in recurrence. Staying on the study only makes sense for me if it is very low risk.
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I finished Herceptin in April and just talked to my onc's nurse practitioner a few days ago. She had me on Fosomax for osteopenia, but I stopped taking it because I was hoarse all the time - could have been chemo or Herceptin, of course. Anyway - I asked about Zometa after reading about the studies showing that it offers protection from bone mets. She called me later to tell me that my insurance would cover Reclast. I begin in November.
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Great news suemed...
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I am on the Clodranate arm of the study, I actually meet with one of the Onc's involved in study., The phase 3 trials are to determine if all3 drugs work as well as Zometa. My Onc believes that the data will show that are as effective. I don't think much about this drug I don't have a lot of SE's that I am aware of I mostly blame them on the AI's.
I took it because I was concerned about recurrance and also becasuse I am consisdered young at dx (42) and wanted to preserve bone health.
My Dentist was not very concerned about Osteocrenosis of the Jaw and my blood work has been good.
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Same as Lexislove and the same reasons except that I am on an AI
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I am considering enrolling in the phase 3 trial. It will be closing soon for a period of time to revamp some of the rules?-at least that's what the nurse in charge of the trial at the local hospital here in Ohio told me. They will reopen it once they are done revamping. She said I had up to 7 months post chemo to enroll which I will start August 24. My dentist informed me that the patients they are concerned about getting that jaw necrosis are patients who don't have regular teeth maintenance (i.e. cleanings, fillings, etc...) He said that people that have holes/abscesses in their teeth at the start are at high risk for jaw necrosis. He said that because I faithfully come in for cleanings and x rays every 6 months I would be at a low risk of developing this. So, I think it would be wise to make sure your teeth are in good shape before you start.
However, I have a 15 year breast cancer surviror who is an RN and now in research advise me that there are many dangerous side effects to drugs like boniva. I am waiting for her to get me info on these biophosphanates and after reviewing all the facts I will make a decision. My oncologist had no opinion about weather or not to enter the trial (cold like a fish!!) I need a new compassionate onc.. which I am working on.
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If the trial is SWOG 0307, which is the bisphosphonate trial that I know of, the rules say that you have to enroll within 8 weeks after chemo. Maybe that is a rule that will be revamped and your trial nurse has some advance knowledge about that?
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Sorry, I meant to say 7 weeks after chemo to get enrolled not 7 months.
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carcharm
Please share anything you find out on this trial so we know any potential danger zones
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My onc switched me from actonel for my osteopenia to zometa 4 mg every 6 months for 3 years to cover the osteopenia and cut chance of contralateral bc. My original onc says he doesn't support that idea because the Spain study that supported this is not mainstream philosophy yet. Have had 2 doses of zometa. Had a bone density done and my osteopenia is worse but onc says he won't switch me back and that in 2 more years I will have to switch back anyway. My insurance will only pay for the new onc and not the original onc so I'm stuck with what he has to say. I'm hoping my osteopenia doesn't continue to worsen.
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Thanks everyone for your responses. I'm happy to see that quite a few of us are getting a bisphosphonate. Within reason, anything that reduces are chance for a recurrence is a good thing.
Bre - The zometa should improve your osteopenia.
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I am in the trial and was randomly selected to receive Boniva.
I do it, like one of our sisters said...I do it to make a difference and prevent a reoccurance. I need to know I did everything available to me to stay healthy.
I have had absolutely no side effects at all. When I asked the nurse what the most common side effects are and she told me..."If I tell you, then you will start to look for them when don't even exist, most pts do this" and you know..she is right..Its the old placebo effect. If I told you Boniva makes your face tingle...half of us would start to feel tingles. So, I just go along my merry way knowing that I feel fine, like majority of pts on these drugs. Preliminary data from Europe says the pills are comparable to Zometa....time will tell thanks to ladies like us!!
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I am on the clodronate arm of the study and I do have some joint pain BUT they are not sure if it is the clodronate, lack of estrogen (still do not have my period back) or herceptin that is causing it. I had the nurses slow down the herceptin last time and I am not as sore as what I was. I don't have any other side effects from it but before my little break because of surgery I felt like an 80 yr old woman and i am 32.
I do it for the possible reduction of mets.
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The info on the most common and less common side effects of the 3 drugs was in the informed consent package that they gave me to read and sign before I joined. I have pdf of it that I found by googling SWOG 0307 but it is scanned so I can't do find on it.
I've got an appointment with a nephrologist tomorrow for her to help me try to understand the implications of the raised creatinine level that Clodronate seems to give me.
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Blue~ I hope you get some answers.
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I have a question: If you have Zometa infusions for 3 years, at the end of 3 years do you take an oral biosphosphate or are you finished forever with that therapy?
I'm a stage 3 survivor (4 and a half years) and also have osteoporosis. I take Boniva and just asked my onc about Zometa. She didn't want to switch me -- said the trials were too small and the Boniva would do the trick.
It's great to share info on this.
Annaanne
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I am Her2+ with Stage IV BC. I have been on Herceptin for a year and will be on it until it stops working. I started boniface 8 months ago and will be on it until it stops working. I am also on tomoxophen and started it with the boniface. I am happy to see there are so many folks surviving longer than me. Its very encouraging.
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Annaanne - Good question. I feel uncomfortable getting off zomate entirely after the 3 years is up. My plan is to continue it once per year to "prevent osteoporosis' (It is approved for this use under the brand name Reclast - identical drug). Of course the real reason is to prevent recurrence. I haven't talked to my onc about this yet.
One interesting thing in the Austrian study that demonstrated zometa's effectiveness - the effect of zometa treatment persisted even after three years - there was data out to about 5 years and there was no sign of an increase in rate of recurrence.
Ihavehope - I know of multiple women who have done extremely well with Herception - some out over 10 years since mets diagnosis. I hope you have similarly good results.
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Orange1-- thanks for the reply. I wonder if it's different if you are using Zometa solely to prevent bc recurrance or if you also have osteoporosis/osteopenia. If you had bone loss before bc, I wonder if you'll take some kind of biophosphate forever, no matter what.
I'll keep asking my onc -- luckily I don't have to see her for another 6 mos.
Ihavehope -- there are stage 4 women on the Her2 Support site that have been NED on herceptin for ten years, so long that their docs finally stopped the herceptin.
A
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Thank you Orange1 and Annaanne. It is good to know that I am walking a trail blazed by stong pioneers ahead of me.
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Well, I got my answers - as much as one can get answers on a trial drug.
I've decided to leave the trial. I was on clodronate and I've been agonizing about staying on it because of elevated creatinine levels that appear to be caused by the drug - it went down when I took a 3-week break from the drug and back up when I went back on.
My oncologist and PCP weren't able to tell me what level of risk to my kidneys this posed so I got a referral to a nephrologist and met with her Friday. If I had to stay on it, then she recommended cutting down to a half dose because of elevated creatinine. The risk of kidney failure is dose and duration dependent. Since my kidneys have trouble dealing with the drug, 3 years on this dose is too much risk for me.
I'm just stage Ib so the benefit isn't that large and risk vs benefit of the trial doesn't make sense for me.
BTW, for those on Zometa, she also mentioned that the kidney result was also dependent on infusion time when the drug is IV so longer infusion time carries less risk.
I hope the rest of you do well on the trial.
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Bluedasher - your decision certainly makes sense - with such a small tumor, grade 2, your risk of recurrence doesn't seem great enough to possibly risk your kidneys.
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