Chemo or Zoladex? Or neither?

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jessica13
jessica13 Member Posts: 22
edited June 2014 in Stage I Breast Cancer


Hi-


I'm a 35yr old with an Oncotype score of 22. My MO said that she would be comfortable not recommending chemo as long as I took Zoladex in addition to Tamoxifen. I got a second opinion who said that Zoladex and chemo would yield the same benefit but that she tended to prefer the chemo (4 cycles TC) as having less side effects. She also said she wouldn't fault me if I wanted to do Tamoxifen and rads only, but younger women tend to get more benefit from chemo and that if it had a 4-5% incremental benefit, it would be worth it. Has anyone else made this decision? I don't want the chemo side effects but I also don't want to go through menopause twice.


Thanks

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  • Leigh74
    Leigh74 Member Posts: 18
    edited November 2013


    My oncotype score was 24 and I am 38.  I was offered zoladex if I wanted it but my med onc also said with younger women they normally chose the TCx4 and tamoxifen for 10 years.  He also said if I chose tamoxifen only that he was okay with that.  I chose chemo out of fear for the most part.  I am also BRCA2 and got bc after a PBM.  I talked with many women with oncotype scores close to yours and mine and most under 45 went for the TCx4.  I think (if I remember bc I am having some chemo brain right now ha ha) zoladex has menopausal like side effects?  I could be wrong but I was thinking it was complete shut down of estrogen for ER+ cancers?  I was stage 1 and node negative.  

    Good luck. Making the decision was so exhaustive!  I have not had that much of an issue with TC.  I lost my hair, I have some hot flashes, i have not gained weight (as of 3rd treatment), I have some numbness in my finger tips, and some sleeping issues.  However NO nausea or vomiting and I am still exercising during treatment.

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  • jessica13
    jessica13 Member Posts: 22
    edited November 2013

    Thanks Leigh for sharing; it is so helpful to hear from people who haven't been sidelined by side effects! I am also stage 1 and node- but part of my tumor is Her2+ and part of it is Grade 3, so it seems less straightforward than just going with Tamoxifen alone although that's very tempting. I had read that chemo also can create menopausal symptoms which is what makes it so hard to decide... I don't want to have kids but I also don't want premature aging!! :)

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  • dlb823
    dlb823 Member Posts: 9,430
    edited November 2013


    Jessica, what do you mean part of your tumor is Her2+? Do you know your exact pathology? Do you know if your Her2 was determined by a test referred to as FISH? Deanna

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  • PoohBear-61
    PoohBear-61 Member Posts: 263
    edited November 2013


    http://www.dslrf.org/endingbc/content.asp?L2=4&L3=5&SID=130&CID=421&PID=27&CATID=0


    Hi All ....you may be interested in reading this article by Dr Susan Love....that compares the 2 choices you mention above .


    My oncologist had mentioned this to me when i was presented with the same 2 choices ....( i am 46 though )


    Keep in mind though that it is based on an old chemo regime of CMF .If link doesn't work ..type "zebra" in the search box...name of article isTwo New Studies May Change Treatment Options For Premenopausal Women

    January 23, 2003

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  • jessica13
    jessica13 Member Posts: 22
    edited November 2013

    Hi Deanna,

    The pathology calls the tumour heterogeneous and classified Her2 as focally positive. The MO is getting it FISH tested which - if positive - will make the question moot but even if not I feel like I should take it into account?

    Jessica

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  • jessica13
    jessica13 Member Posts: 22
    edited November 2013

    Thanks Pooh, If I understand this correctly it implies that the main benefit from chemo is the chemically induced menopause? Hmmm.... that's what I was trying to avoid and what my MO said was worse with Zoladex than chemo. How are you doing with it?

    Cheers

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  • PoohBear-61
    PoohBear-61 Member Posts: 263
    edited November 2013


    http://www.dslrf.org/endingbc/content.asp?L2=4&L3=5&SID=130&CID=421&PID=27&CATID=0


    Hi All and Jessica13


    You may want to read this article by Dr Susan Love ( link above ). that compares the 2 choices you've been offered .


    Keep in mind it is based on an older chemo regime of CMF.


    If the link does not work type in" ZEBRA "in the search area ( for zebra trial ) of her web site and it will bring you to the article entitled


    Hot Topics: Two New Studies May Change Treatment Options For Premenopausal Women

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  • PoohBear-61
    PoohBear-61 Member Posts: 263
    edited November 2013


    Jessica13


    Ive been on Zoladex and tamox for six month and the main side effects are hot flashes.....I actually have another article that I read which basically said that the side effects of zoladex where more tolerated than those of chemo ...ill try to find it ????.


    In the mean time ...my side effects are min.....I am older than you but I was highly hormonal and no where near menopause .ive been on zoladex and tamox for 6 month and I went from 3 to 4 hot flashes a day with 3 to 4 nights sweats .....down to one or no hot flashes a day ( that last under a minute ) ...I still have maybe 2 night sweats that wake me up temporarily ....but its no big deal for me ..i flip off the covers and i cool down real quick and fall right back to sleep . I find that a low glycemic index diet and exercise are KEY ...

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  • PoohBear-61
    PoohBear-61 Member Posts: 263
    edited November 2013


    Okay found the article comparing quality of life for zoladex vs chemo


    http://jco.ascopubs.org/content/21/24/4510.full


    "In summary, compared with CMF, goserelin improved overall QoL during the 6-month CMF treatment period. This is attributable to similar differences that were seen on dimensions of physical activity and effort to cope with illness. No significant differences in overall QoL were seen after 6 months. Differences seen in the hormonal dimension were worse during the goserelin treatment period but reversed in favor of goserelin after cessation of therapy. However, these differences in hormonal effects did not impact on overall QoL. Coupled with the equivalent efficacy in ER-positive patients, these early benefits in QoL support the use of goserelin as an alternative to CMF in this patient population. "

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  • Leigh74
    Leigh74 Member Posts: 18
    edited November 2013


    Hey,

    I should mention that I am in the US so I think the zoladex is more commonly used in other countries?  My doc said a few women who were adament against chemo did it and he had heard various side effects.  I am in a menopausal state now with some hot flashes (2-4 at night with little sweating), dry skin, and sexual side effects.  My med onc feels being 38 I will come out of this state but I am finished having children so other than being annoying it won't affect me if I don't come out.  I am BRCA2+ so in the 2-3 years I am facing an ooph or hysterectomy so I that will also put me in menopause :( but even with no OC history I need to have that surgery done.  I was only ER+ but I have a friend who had breast cancer and had 3 tumors and one was triple neg and one was HER2+!

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  • jessica13
    jessica13 Member Posts: 22
    edited November 2013


    Sorry to hear you'll need the ooph surgery, Leigh. I have put off BRCA testing for now because of the cost but you are definitely doing the right thing. Glad that your and Pooh's side effects seem minimal. I think I will have to weigh impact on career and coinsurance costs as well and try to decide this week. Thanks for your feedback!

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited November 2013


    Leigh,


    You mentioned you had a friend that had both her2+ and tn? I've been searching high and low for someone with a similar diagnosis. Does your friend participate on these boards? I just finished TCH x4 and will be having surgery next month. By far my biggest side effect on TC was constipation - it caused me all kinds of problems. However, I did have a pre-existing condition that contributed. Otherwise, I think I would have tolerated chemo pretty well.

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  • Leigh74
    Leigh74 Member Posts: 18
    edited November 2013


    I do not know that she has been on the boards ever.  She took carboplatinum, taxotere and herceptin but I don't know how long for each of them.  I think she had 3 tumors total.

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