Arimidex - Coping with the SE's

 For those wondering about the effect of being overweight or 'obese' on recurrence for those taking Arimidex or Tamoxifen, here's a study that actually suggests women who weigh more might need to take more of the Arimidex. 

As my BMI puts me in the lower end of the obese category, I have been worried about this and brought it up to my onco, who dismmissed it and told me I wasn't obese!  (I am glad he thinks so).  I have had very few side effects on Arimidex (more with the generic anastrazole but I have switched back to the name brand), so I am concerned.  I am trying to lose, but it's been hard.

Effect of Body Mass Index on Recurrences in Tamoxifen and Anastrozole Treated Women: An Exploratory Analysis From the ATAC Trial

Ivana Sestak, Wolfgang Distler, John F. Forbes, Mitch Dowsett, Anthony Howell, Jack Cuzick

From Cancer Research UK; Queen Mary University of London, London; Royal Marsden Hospital; Christie Hospital National Health Service Trust; Cancer Research UK, Manchester, United Kingdom; Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Dresden, Germany; and University of Newcastle, Newcastle, Australia.

Corresponding author: Ivana Sestak, PhD, Cancer Research UK Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, United Kingdom; e-mail: i.sestak@qmul.ac.uk .

ABSTRACT

Purpose Third-generation aromatase inhibitors have been widely usedin postmenopausal women for the adjuvant treatment of hormonereceptor-positive breast cancer. As aromatase inhibitorswork by inhibiting the conversion of androgens to estrogensin adipose tissue, we hypothesized that anastrozole may be moreeffective in women with a high body mass index (BMI).

Patients and Methods The Arimidex, Tamoxifen Alone or in Combination (ATAC) studywas a double-blind randomized clinical trial in which postmenopausalwomen with early-stage breast cancer were randomly assignedto receive oral daily anastrozole (1 mg) alone, tamoxifen (20mg) alone, or the combination in a double-blind fashion. Analyseswere based on the 100-month median follow-up for women withhormone receptor-positive breast cancers (estrogen [ER]and/or progesterone [PgR] positive). Here, we investigate theimpact of BMI on recurrence and the relative benefit of anastrozoleversus tamoxifen according to baseline BMI.

Results Overall, women with a high BMI (BMI > 35 kg/m²) at baselinehad more recurrences than those women with a low BMI (BMI <23 kg/m²; adjusted hazard ratio [HR], 1.39; 95% CI, 1.06 to1.82; P_{heterogeneity} = .03) and significantly more distant recurrences(adjusted HR, 1.46; 95% CI, 1.07 to 1.61; P_{heterogeneity} = .01).Overall, the relative benefit of anastrozole versus tamoxifenwas nonsignificantly better in thin women compared to overweightwomen.

Conclusion These results confirm the poorer prognosis of obese women withearly-stage breast cancer. Recurrence rates were lower for anastrozolethan tamoxifen for all BMI quintiles. Our results suggest thatthe relative efficacy of anastrozole compared to tamoxifen isgreater in thin postmenopausal women and higher doses or morecomplete inhibitors might be more effective in overweight women,but this requires independent confirmation.

NOTES

See accompanying article doi: 10.1200/JCO.2010.29.5113

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NativeMainer -"Given that aromatase works in fat cells to convert cholesterol to estrogen" - wow, I didn't know that's how the aromotase worked - is THAT why we get higher cholesterol without having any estrogen????  Cuz my cholesteral really went up when I joied the A Team.  Have gotten it down (thank you, Ruthbru) with Niacin, Fish Oil, no meat, but it's still just above 200 (203) - and was 180 b4 taking arimidex.....

Anybody else have good ideas on lowering cholesteral ( I know, get rid of some of this excess weight) well, in addition to that

Happy, HEALTHY, peaceful, hope filled New Year to all....

I wonder if that is why we are at higher risk for heart issues when on the Al's. I do know cholesteral causes heart attacks so to me it would make sense. I'm already on meds to lower my cholesteral as a preventative because of family history.  The whole thing makes my head spin.

Lane, Do you think it would be safe to use it while on the cholesteral meds? I'm not sure I want to just stop the meds, and am pritty sure my Onc. isn't into alternative drugs.

Linda:  Thank you for that information, I'm printing it out for my oncologist.  I was on tamoxifen for 3 1/2 years, then switched to Aromasin in Sept. 2010, all that time was totally post-menopausal (chemo-induced Oct. 2006), NO periods at all til Xmas Day.  I am overweight, never was until chemo/tamoxifen/menopause.  THAT is interesting...could be WHY my period started again?  I was on TOO LOW of a dose of Aromasin?  OR need to be back on Tamoxifen??  Questions to be asked...and see if onco knows anything...I also see a Gyn specialist, see if she knows anything as well...probably not (not much faith here, as there is no faith in the vitamin d stuff either).  This is great news, and probably true on the dosages (I simply cannot lose the weight, I've tried).  Thank you. 

To lower cholesterol, one can try Niacin (it does cause flushing) and/or Omega 3-6...but ALOT of it, like 9 grams a day (which I take, it lowers the cholesterol, but mostly the triglycerides).  I am VERY whacked out right now due to all of this going on...AND my hot flashes/night sweats that I've also had since Oct. 2006 have stopped...and I don't flush ( I flush REAL easily, no niacin for me, even the non-flushing kind ).   THX!  ~juli

I take "Slo Niacin" (found at Walmart & I'm sure other places). It's controlled released so I don't have the flushing. Do NOT take the 'no flush' niacin as it is not as effective.

I've been taking the Slo Niacin ( wal-mart) that "Dr. Ruthbru" suggested - and, thank you!  No flushing. Was thinking of taking Red Yeast Rice, but googled "red yeast rice side effects" - after quite a bit of reading, decided not to risk it.  My liver held up well during chemotherapy, and don't want to add anything that might effect it now.  Also, the warnings about joint & muscle pain, similar to the SE's of statins.  So have changed diet: no red meat, no butter ( ok, sometimes when I make popcorn, but not much!), Nordic Naturals Fish Oil, COQ10, & can't remember why I'm taking tumeric, but I am and Vitamind D, multi vitamins.

<sigh>  Tell me about it...

I tried so hard to avoid the special fudge my dh's aunt sent us, and the cookies my mom bought, and the huge meals (including serious desserts) they served at my MIL's retirement center... only to succumb to a jar of honey-roasted peanuts, a bag of pistachios, and an endless supply of re-heated coffee with cocoa mix and French Vanilla creamer.  (Try it -- it tastes really rich and expensive.)

It's just the 2nd day of January, and already I've broken the only resolution I made this year.  May I have a do-over?

otter

Ohhhh, Trish, thank you so much!  January is probation.  I've slipped up a little, but there is still time to make it right. 

otter

Trish - I like your way of thinking!

Of course! I actually ate three of the pieces and licked the frosting off the other before destroying the evidence!!!

for me its, I'll start tomorrow

AZ is AstraZenica, the company that developed Arimidex.  They can be reached at http://www.astrazeneca.com/Patients

(sorry I can't make it link).  The site has contact info for assistance with medicine access. 

Otter,

EVERY day is a do over