My MO wants to start Zometa about 1 month after starting AIs

Options
chtease
chtease Member Posts: 24
edited January 2015 in Hormonal Therapy - Before, During, and After

After finishing radiation on March 5, I'll be starting on an AI. My MO's standard protocol is to check bloodwork at 30 days and if the liver enzymes are OK, to start zometa infusions immediately and continue zometa every 6 months from that time on. Part of the rationale is that zometa may help prevent mets in post-menopausal women and that pre-emptive use of bisphosphonates may be more effective in managing bone loss. It looks like the research is pretty mixed on the met issue, but the prevailing opinion seems to be that it is not helpful. I was ready to decline zometa, but this article has me re-thinking it. Has anyone else had this recommendation?

http://www.cancerresearchuk.org/about-cancer/trials/a-trial-looking-at-zoledronic-acid-to-try-to-stop-breast-cancer-coming-back

· Share on FacebookShare on Twitter

Comments

  • vlnrph
    vlnrph Member Posts: 1,632
    edited January 2015

    I assume you are already menopausal and had a baseline DEXA scan for bone density.

    If I were in your position and osteopenic, I might consider bisphosphonates. Does your oncologist have a plan for duration of therapy - perhaps 5 years or as long as you're on an aromatase inhibitor?

    I would also get any "elective" dental procedures out of the way prior to starting. With the risk of jaw damage and the amount of bridgework/crowns I already have, that might be another factor to think about should my doctors ever suggest this kind of treatment.

    · Share on FacebookShare on Twitter
  • Manu14
    Manu14 Member Posts: 153
    edited January 2015

    Each of us needs to make the best choice for us personally with advice from our doctors and our own knowledge and comfort level with the information we come across.

    I would approach a very serious medicine like zometa cautiously. Is your risk of cancer returning or bone loss sufficiently high enough to outweigh potential risks of zometa? I don't think there are long-term studies on zometa use while on AIs.

    For myself, I wouldn't agree to it unless my oncotype score had been higher than 18; or I had node involvement, or had grade 3 tumor, or had serious osteopenia scores bordering on ostoporosis when starting an AI. I would personally hold off on taking that step

    · Share on FacebookShare on Twitter
  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited January 2015

    Drs Coleman and Gnant each did studies on the use of Zometa. As the Azure study found, older women who had low estrogen (post menopausal) did see a small decrease in mets. Dr. Gnant's study saw a slight favor in women over 40, who were NOT menstruating,who also did Zometa infusions twice a year for three years. The benefit was small for both cohorts.


    Of course when deciding what is right for you, you need to be advised of the overall risks and benefits for you. That said, there are many of us, including myself who chose to have Zometa.

    · Share on FacebookShare on Twitter
  • chtease
    chtease Member Posts: 24
    edited January 2015

    One of my concerns is that this is his recommendation for all of his patients. I believe I am menopausal, but I had an endometrial ablation in 2006 and haven't had a period since, although I had hot flashes for a couple of years. I had FSH/LH levels drawn 2 weeks ago to confirm. My DEXA scan showed perfectly normal bone density. I had clean nodes, oncotype score of 18 and a grade 2 tumor.

    See, voraciousreader, that's exactly my point. I told myself that I would do anything within reason to prevent mets. Trying to decide if zometa is "within reason" is not an easy choice.

    At the end of the day, I am profoundly uncomfortable with my MO's blanket recommendation of immediately starting zometa for patients on AIs. That being said, I'm not sure it's the wrong choice for me.

    · Share on FacebookShare on Twitter
  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited January 2015

    ch....unfortunately, the way studies are designed, it is often very difficult to tease out info from the studies that directly affects each of us.....hopefully in the future, studies will be more genomically based and then we can all better pinpoint our risks and benefits of various treatments. Until then, most of us are in a gray area. I wish you well.

    · Share on FacebookShare on Twitter
  • Manu14
    Manu14 Member Posts: 153
    edited January 2015

    I just read through an analysis of Coleman's AZURE study presented in 2010 and it sure leaves me with doubts and questions regarding the conclusions as it also seemed to for some physicians in the field. An interesting read. Dr. Coleman is a consultant and on the speaker's bureau for Novartis which manufactures Zometa. Zometa's printed information of its inserts says Zometa "is not an anti-cancer therapy". I'm not saying it's wrong for a given person to take it who doesn't have mets or osteoporosis, but the use of it otherwise seems to vary a lot among oncologists.

    http://www.medscape.com/viewarticle/733978#vp_1

    · Share on FacebookShare on Twitter
  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited January 2015

    manu...if you go further back in time,you can follow the history of how the bone building drug studies were formulated. When the drugs were first used for bone building, there was an observation that fewer patients got breast cancer. Soooo, several studies were designed....among them, the AZURE study. Today, some physicians continue to recommend it off label.

    · Share on FacebookShare on Twitter

Categories