Tamox vs AI????

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Flamin_nora
Flamin_nora Member Posts: 52
edited June 2014 in Stage III Breast Cancer
Tamox vs AI????
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  • Flamin_nora
    Flamin_nora Member Posts: 52
    edited February 2012

    Hi ladies---am posting here because are a sharp bunch of cookies who provided me with great info on Zometa, metformin, etc.....

    Need your words of wisdom as I have been told three different opinions by 3 different oncologists  as to what hormone therapy I should be taking.....

    I was originially told I would have Tamox for 5 yrs  and was subsequently told that I would have Tamox for only 2 yrs and then switch to an Aromatase Inhibitor (TBD) as I was post-menopausal.  

    The latest oncologist is suggesting that I forego the AI and stay on Tamox for the 5 years.  The reason being the latest studies (sorry but I have nothing specific) and mostly because I am athletic and he believes staying on Tamox will have less of a negative impact on my active lifestyle (I took that to mean that AI would cause problems with my joints, etc).  My gynocologist mentionned the same thing to me (but admittingly, it's  not his area of expertise).  My bone density is good (thank you Zometa?)

     So is the latest standard of practice to keep us post-menopausal ladies on Tamoxifen????  I'm sooooooooo confused!!!

     any info or suggestions are greatly appreciated!

       

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  • jennyboog
    jennyboog Member Posts: 1,322
    edited February 2012

    I don't know how much help this will be, I can tell you what I'm on....although that might confuse you more :)  But I'm on Aromasin, I was never asked about how active I am and Tamoxifen was never even mentioned to me.  I was told from the beginning I'd be on an AI and I was started on one right after my last chemo and have continued on it.  I did my ooph last June and I was 34 at dx.  Aromasin is easier to me than Arimidex was,  I can be stiff at times but it has not slowed me down and I am very active.  We're both C and ER+ so, I don't know if it's the age along with pre/post meno is what they use to decide what we take or not.  I don't know if this is much help.

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  • pupfoster1
    pupfoster1 Member Posts: 1,484
    edited February 2012

    I was kicked into menopause right when I was dx.  I have been on Tamoxifen since finishing chemo and my onc wants me on it for 5 years before switching.  Don't know if that protocol will change, but at last visit that's what she told me again.

    Take care,

    Sharon

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  • AnacortesGirl
    AnacortesGirl Member Posts: 1,758
    edited February 2012

    From a data standpoint, the best stats are using Tamoxifen and then switching to an AI.  But those numbers don't mean anything if you have SEs from drugs that affect your quality of life. 

    Unfortunately there is no way to predict how you will react to Tamox or the 3 AIs until you take them.  There are women who have done better on an AI than Tamox which is not what one would expect.  Personally, I took Aromasin for 9 months and then I had to get off because of the joint pain, headaches and other minor stuff.  So I'm on Tamoxifen and it has been much better for me.  I'm not sure if we'll try for 2 or 5 years.  But when I go back to an AI it will be one of the other two.

    If you haven't yet, take time to look up the SEs.  They each have their own set of significant issues.  It could be your health history or even your family history might influence the decision.  Tamoxifen does have problems with blot clots and uterine issues.

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  • MaxineO
    MaxineO Member Posts: 555
    edited February 2012

    My onc said 5 years tamoxifen, then 5 years arimidex (I am premenopausal and 39).  I just started zoladex also (ovarian suppression) and will have that at least 10 years (unless I do the oophorectomy).

    I have tolerated the tamox and zoladex very well, but I know a lot of women don't, so that may need to be part of your decision.  My only issue is hot flashes.

    I get confused by all of this too. (I'm not even sure what metformin is!)

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  • faithfulheart
    faithfulheart Member Posts: 544
    edited February 2012

    My MO put me on tamox first. His therory being, after my ooph, my body will still make est right?

    If we start on an AI first, I will only get 5 years total on hormonal blocking therorpy. However, if I do the tamox first, you can switch to an AI from tamox after 5 years. You can not go from an AI to tamox. The trreatment on an AI ends  at 5 years. Starting us on tamox in the begining gives us 10 years of protection. That is part of the new study on doing tamox first, post meno or pre. So I will do tamoxifen for 5 years  and then go to arimidex or femara, what ever I can tolerate...........

    I hope this helps,

    Steph

    Hugsssss

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited February 2012

    Hi FN,  This was my experience.  My Onc put me on Arimidex after chemo.  I just couldn't tolerate the joint pain and issues with vaginal atrophy, which was also very painful and did nothing to help my sex life.  For those reasons my Onc switched me to Tomoxifen.  After almost a year on it,  I felt it was more intolerable than the Arimidex.  I was very emotional and depressed while taking it.  Like being in a constant state of pre menstrual depression and tension, adding to this, was the seignificangt weight gain of 35 lb.  No matter how often I worked out and how many miles I fast walked a day, just couldn't get the weight off.  Told my Onc these two side effects were totally intolerable and could not do it.  He then told me to try the Aromosin, because I might tolerate it better, and would prefer I not stay off AI's.  That was in June.  During that time last summer I tore my meniscus in my knee, which resulted in a lot of pain and limited mobility.  I've been in phsyical therapy since, just had knee surgery 2 weeks ago, and will be starting the Aromasin now that all problems are resolving.  I'm really nervous about goinng back on hormonals again, especially since this last year has been so painful, but I just want to get back to being and feeling normal and active again, so I am resolving to do it.

    image

    Barb

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  • faithfulheart
    faithfulheart Member Posts: 544
    edited February 2012

    Hey Barb,  I hope your doing better................ I feel really bad that you have dealt with such pain, BC was bad enough!!

    Prayers going out to you...................

    Steph

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  • financegirl
    financegirl Member Posts: 114
    edited March 2012

    I just finished 10 months of chemo and radiation and was put on Arimidex lilttle over a month ago.  The oncologist said I'd go to Arimidex since I was postmenopausal.   Said they are getting slightly better results on Arimidex but not everyone can tolerate it and you must definitely be postmenopasal to go on it.  I came home and googled the difference between Tamoxifen vs Arimidex.  From what I was able to understand is that Tamoxifen by it's nature still allows a small amount of estrogen to get thru whereas Arimidex blocks more or gets it all (I wasn't able to determine that with the language used).  I asked the oncologist and he said that our fat cells can hold or produce a slight bit of estrogen and Arimidex will suppress that whereas Tamoxifen doesn't.  So maybe that's the slight difference.    

    As for its SE, yeah, I have only been on Armidex for a little over a month and already have achy joints and bone pain but at this point it would have to get much worse because my fear of stopping it and having a recurrence are more than these problems presently pose right now.  I may have to change my mind if the situation gets much worse but so far I'm willing to deal with it.  Hope whatever you decide, it works for you. 

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  • Outfield
    Outfield Member Posts: 1,109
    edited March 2012

    Financegirl,

    It's actually more complicated than that.  

    After menopause, most of the estrogens in the body aren't made by the ovaries.  They are made by conversion of other hormones using a type of enzyme called an aromatase.  A lot of the precursor hormones come from the adrenals, and lots of tissues have aromatase.  

    Medicines like Arimidex work by blocking the action of aromatase, dropping estrogen levels very, very low.  

    Women who are premenopausal will not benefit from aromatase inhibitors because most of their estrogens are being made by other processes in the ovaries.  So you can remove or shut down the ovaries and use an aromatase inhibitor, or you can use tamoxifen.  

    Tamoxifen does not directly change the body's production of estrogen.  It competes at the receptors where estrogen binds on cells.  Estrogen receptors are really complicated.  They don't even respond the same way to different kinds of the body's own estrogens.  Tamoxifen does not stimulate the growth of estrogen-receptor postriive cells the way estrogen itself does.  When it binds to the receptor it causes the cell to do other things (basically to settle down).

    Think of the estrogen receptor as a keyhole in a door.  Both tamoxifen and estrogen are keys that fit the keyhole, but the door opens onto a different room when you use each of those keys.  Arimidex destroys your keys. 

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