Stage III women: instead of AI chosen "natural" treatment?

I am just in that decision making phase right now.  I was diagnosed wit stage 3 ER and PR positive with lymph involvement.  Oncotype was a 3.   I have been told by a biochemist friend that Myomin by Chi Enterprises was studied and shown to be  more effective than Femara and Tamoxifen.

So far it has been recommended to me that I have zolodex next week to chemically induce menopause (did you have to do that?)  followed by femara.  I think of going ahead with part 1 put then using Myomin after instead.  I have also heard that Indolcarbinol 3 works just as well but there are not as many studies.  I know it is a gamble but something in me is having a hard time going the drug route.

Thanks for the info.  What is Arimidex?

Arimidex has no track record for overall survival. It has only been studied compared with Tamoxifen for improvement for recurrence.

Please see the thousands of posts on the BCO boards of people trying to get through days "coping with Arimidex." And hundreds more posts of women dropped Armidex because the pain, mood problems, etc.

I believe the study Janeluvsdogs is referring to is the ATAC study.  This study compared Arimidex with Tamoxifen as adjunctive therapy for women who had Early Breast Cancer - NOT as treatment for Stage III Breast cancer.  To me there is a BIG difference between adjunctive therapy for early breast cancer and treatment for Stage III Breast cancer. 

Although this particular study (ATAC) showed no overall survival improvement for women with Early Breast Cancer taking Arimidex versus Tamoxifen, the 10 year follow-up analysis of the participants had the following findings:  In the full study population, there were significant improvements in the anastrozole (Arimidex) group compared with the tamoxifen group for disease-free survival  time to recurrence, and time to distant recurrence. For hormone-receptor-positive patients, the results were also significantly in favour of the anastrozole (Arimidex) group for disease-free survival, time to recurrence; and time to distant recurrence. In hormone-receptor-positive patients, absolute differences in time to recurrence between anastrozole (Arimidex) and tamoxifen increased over time (2·7% at 5 years and 4·3% at 10 years) and recurrence rates remained significantly lower on anastrozole (Arimidex) than tamoxifen after treatment completion, although the carryover benefit was smaller after 8 years. There was weak evidence of fewer deaths after recurrence with anastrozole (Arimidex) compared with tamoxifen treatment in the hormone-receptor-positive subgroup, but there was little difference in overall mortality. No differences in non-breast cancer causes of death were apparent and the incidence of other cancers was similar between groups and continue to be higher with anastrozole (Arimidex) for colorectal (66 vs 44) and lung cancer (51 vs 34), and lower for endometrial cancer (six vs 24), melanoma (eight vs 19), and ovarian cancer (17 vs 28). No new safety concerns were reported. 

There were 3 studies presented at the 2005 San Antonio Breast Cancer Symposium did show improvement in overall survival for women taking Arimidex versus Tamoxifen - Again these studies were conducted with woman having an Early Breast Cancer diagnosis: Three key international trials [ABCSG - Austrian Breast & Colorectal Cancer Study Group 8 (n = 2262), ARNO - 'Arimidex'-'Nolvadex' 95 (n = 962), and ITA - Italian Tamoxifen Anastrozole (n = 448)] were similarly designed to assess, in women already being treated with tamoxifen, whether or not replacing tamoxifen therapy with 'Arimidex' after 2-3 years was more effective than remaining on tamoxifen for the full five year treatment period. Professor Jonat presented a meta-analysis of these three trials at SABCS today. The data showed at a median follow-up of 30 months, patients who started taking 'Arimidex', rather than remaining on tamoxifen, experienced a:
* 29 per cent improvement in overall survival 
* 45 per cent improvement in event-free survival 
* 39 per cent improvement in distant recurrence-free survival 

(Event-free survival: any disease recurrence - local, contralateral or distant; Distant recurrence free survival: distant recurrence only)

And I agree with Mountains1day: All the woman who are taking AI's without problems are not the ones posting about complaints and problems on these boards.

So Arimidex is better than Tamoxifen. But it still doesn't help you survive longer than somebody not taking it?

Thanks for sending this!

"other cancers continue to be higher with anastrozole (Arimidex) for colorectal (66 vs 44) and lung cancer (51 vs 34),

Lung and colon cancer are so much more deadly than breast cancer.

Unlike Tamoxifen, Arimidex doesn't yet have the longevity to prove a 10 or 20 year OS curve (previous studies have shown improvement with many more studies to come) so would it be premature to assume taking Arimidex will or will not help you survive longer than someone not taking it?   

lucy 88, you left the other part out of that study......"and lower incidence of endometrial cancer (6 vs 24) melanoma (8 vs 19) and ovarian cancer (17 vs 82),  btw, all cancers are equally deadly in later stages.

Like Emma, I'm Stage III and I'd like to find a natural way to cope with ER+ and would like to believe that diet control is the best way to deal with this. (Having removed so many sus foods from my diet, I am already feeling mild SEs that others complain about on AIs and don't want to take an AI unless my life depends upon it - which is a moot point).

I am very concerned about so many of us needing oophs and other surgeries to fix up the SEs of taking AIs. Like Mountains1day wrote, I wonder whether taking AIs help you survive longer than someone not taking them - does it, or is it too early to tell?

How do oncs determine which AI to prescribe for us? If the AIs are in experimental mode, then we are all guinea pigs, and I wonder whether one type of AI is allocated to oncs in one area, another AI to oncs in another area, or what.

And what is their record, so far, in preventing recurrences? Has anyone had a recurrence while taking an AI?

Before anyone gets bent out of shape about a 51 vs 34 incidence of lung cancer out of more than 6200 woman over 10 years - let's not forget that statistically one in 16 women will develop lung cancer in her lifetime with or without Arimidex and/or Tamoxifen.  The rate of lung cancer incidence for the Arimidex group (over 10 years) was 1.6% and the tamoxifen group 1.1% 

Rationalize - defend, explain, clear away, or make excuses for by reasoning

Stating Facts and Study Findings is NOT rationalization: Fact: one in 16 women will develop lung cancer in her lifetime; 10 year ATCA Study Findings: Arimidex cohort: 51 out of 3125 = 1.6%  Tamoxifen cohort: 34 out of 3116 = 1.1% (lung cancer incidence rate over 10 years).

Without a control group of 3100 woman with ER+ Early Stage Breast Cancer who are 10 year Tamoxifen/Arimidex Naïve to compare these incidence rates to there is no way to conclude whether or not Arimidex and/or Tamoxifen increases or decreases the incidence of lung cancer or if the incidence is basically the same. 

Now, I will concede what I am writing in this next paragragh could be rationalization: Since cigarette smoking is a known risk factor for both breast and lung cancer,  women with Early ER+ Breast cancer who do not take Arimidex and/or Tamoxifen could  have a  the same (or even higher) incidence of lung cancer than those who do take these medications.  But, fortunately we may never know as it is unethical to so a study which withholds at least standard treatment (Tamoxifen).  

Lucy88: I do not know what I wrote to fuel such hostility from you.  I am truly sorry that you seem to think I have no feeling or empathy towards woman with breast cancer who have died from lung cancer (or who are experiencing as I write).  If you had even the slightest inkling of who I am and what I have experienced, you would never ever even hinted at this.  Your reaction is why I rarely post anything on this message board and when I do, I try very hard to keep it very factual and conciliatory.

Personally, I have not researched whether or not a 1.1-1.5% ten year incidence rate of lung cancer in woman with Early Stage ER+ Breast Cancer is something more alarming  than a 1 in 16 lifetime risk. If it is more alarming, I sincerely apologize for making the statement "before anyone gets bent out of shape".

 I did read lucy88's original post, which included this information about Arimidex: a lower incidence for the following cancers: endometrial cancer (6 vs 24), melanoma (8 vs 19), and ovarian cancer (17 vs 28).  I am extremely glad for all those woman and their families who do not have cope with these cancers along with breast cancer.  I will not speculate why lucy88 decided to eliminate this information from her original post.  

This thread is about treatment for Stage III ER Positive Breast Cancer!  Emma 56 needs to decide whether or not to take an AI as part of her recommended treatment for Stage III Breast Cancer (which according to her post seems to be actually  Femara NOT Arimdex - which makes this discussion irrelevant - Femara is not Arimidex)  She specifically asked for Stage III women to respond - so far only weesa is Stage III. 

For anyone to use findings from Early Stage Breast Cancer Adjunctive therapy studies to dissuade a physician prescribed therapy for a more advanced stage of breast cancer to me inappropriate

Rationalize - defend, explain, clear away, or make excuses for by reasoning

Stating Facts and Study Findings is NOT rationalization: Fact: one in 16 women will develop lung cancer in her lifetime; 10 year ATCA Study Findings: Arimidex cohort: 51 out of 3125 = 1.6%  Tamoxifen cohort: 34 out of 3116 = 1.1% (lung cancer incidence rate over 10 years).

Without a control group of 3100 woman with ER+ Early Stage Breast Cancer who are 10 year Tamoxifen/Arimidex Naïve in order compare these incidence rates to there is no way to conclude whether or not Arimidex and/or Tamoxifen increases or decreases the incidence of lung cancer or if the incidence is basically the same. 

Personally, I have not researched whether or not a 1.1-1.5% ten year incidence rate of lung cancer in woman with Early Stage ER+ Breast Cancer is something more alarming  than a 1 in 16 lifetime risk. If it is more alarming, I sincerely apologize for making the statement "before anyone gets bent out of shape".

Now, I will concede what I am writing next could be rationalization: Since cigarette smoking is a known risk factor for both breast and lung cancer,  women with Early ER+ Breast cancer who do not take Arimidex and/or Tamoxifen could  have a  the same (or even higher) incidence of lung cancer than those who do take these medications. 

Lucy88: I do not know what I wrote to fuel such hostility from you.  I am truly sorry that you seem to think I have no feeling or empathy toward woman with breast cancer who have died from lung cancer (or who are dealing with it as I write).  If you had even the slightest inkling of who I am and what I have experienced, you would never ever even hinted at this.  Your reaction is why I rarely post anything on these message boards and when I do, I try very hard to keep it completely factual and conciliatory.  I did read your original post, in which YOU DID included this information from my post about Arimidex: a lower incidence for the following cancers: endometrial cancer (6 vs 24), melanoma (8 vs 19), and ovarian cancer (17 vs 28).  I am extremely glad for all those woman and their families who do not have cope with these cancers along with breast cancer and I will not speculate why you decided to eliminate this information from your original post.  

This thread is about treatment for Stage III ER Positive Breast Cancer!  Emma 56 needs to decide whether or not to take an AI as part of her recommended treatment for Stage III Breast Cancer (which according to her post seems to be actually  Femara NOT Arimidex - which makes this discussion irrelevant - Femara is not Arimidex)  She specifically asked for Stage III women to respond - so far only the only woman with Stage III Breast Cancer who have responded are robinf, weesa and allalone. 

For anyone with a lesser stage to use findings from Early Stage Breast Cancer Adjunctive therapy studies to dissuade a physician prescribed therapy for a more advanced stage of breast cancer to me inappropriate

It gets very frustrating when folks start from the point that AIs haven't been around long enough for long term studies to they don't help (Huh?  If studies show that tamoxifen improve outcomes and AIs improve them over tamoxifen, then . . .) and then take the extra step that AIs will kill you.  This is hyperbolic and not helpful. 

What we have here are a variety of tools available to us to fight a deadly disease.  And stage III is a lot deadlier than what many of you had.  This is a good thing.  In the bad old days women with er/pr+ bc died at higher rates than they do now.  And some women can't take tamoxifen or, like me, have completed their five years of tamoxifen and are grateful to have another option.  We don't need to be told in exaggerated language that a drug that may save our lives will kill us.  Don't take it if you don't want to, I don't care, but calm down.  Lower your voices.   

And frankly if you are anti-drug treatment but looking at alternative drugs that haven't been studied or scrutinized nearly as much as the mainstream meds, there is a contradiction. These are drugs.  They have side effects.

Avastin was never in the official guidelines, I believe, it was in clinical trials.  And the fact that it has been "thrown out" is terribly controversial.  It works for few women, hence being thrown out.  But for those few it has prolonged their lives dramatically.  For some women, Avastin is a life-saver and has now been taken from them.   I don't know what the solution here is but I wouldn't use it as an example of anything.

As for only hearing from women with side effects, i can only share my story.   After reading all the posts about women with side effects on these boards, I was terrified of switching from tamoxifen to arimidex.  I was sure my life would essentially be over and I would get each and every side effect mentioned.  But I had a stage IIb cancer and two children I want to raise all the way through and I felt I had a responsibility to them to do everything I could to prevent a recurrence.  What a pleasant surprise when I found I feel substantially better on Arimidex.  It works by preventing the conversion of testosterone into estrogen and my theory (which my onc supports) is that I am getting a bit more testosterone as a result.  The effect has been that I am sleeping better, have more energy, am having better athletic performance (I'm a runner) and my sex life is amazing.  Honestly, I am sorry that I will only be able to take this drug for 5 years.  Now I know that not everyone has the positive experience I am having, but its there and should be considered as part of the mix.

Wendy

thank you for posting the valuable information you have - I really appreciate it.   I tooam taking Arimidex - and the reason so many of us keep posting on the threads about the possible side effects - is because we've all been able to help each pther find ways of HEALING them!!!!!  It is so wonderful to have this kind of support to continue taking a medication we CHOOSE to take, for it's proven track record of preventing a reoccurance.  Every SE I've encountered has been dealt with by advice from the other women who have experienced them.

I am so grateful that I have the type of bc that can be treated with medication.  Good luck to all who CHOOSE to take an AI.

in response to a comment about hearing from stage III women who have taken arimidex with no to little side effects  -

i'm seriously stage III, have taken arimidex for 5+ years - little to no side effects

Emma: But I don't want to continue a treatment out of fear rather than out of conviction of its benefits.

That is exactly how I feel - and now that you've told me that some of us do recur on AIs - and that a recurrence if it happens is likely to be er- (more aggressive) - it only adds to the problems of AIs. I am not against AIs, I just want certainty that they will be doing me more good than harm - especially if we must take them for the rest of our lives (as seems to be the current thinking because of the spikes in recurrences after stopping them at 5 yrs).