Changing to AI/OS from Tamoxifen after reviewing SOFT study?

I am on OS and AI, I began this w/o using tamoxifen first. I went into chemopause, so I have zero extra side effects from this combo. Effexor has all but completely erradicated my hot flashes flashes.

I am more tired than usual, but chempause did that too.

Well, my side effects are some nausea, dizziness and hot flashes, but I was having that before my ovaries were removed thanks to Tamoxifen! I have to say, I don't feel any different between my before and after except that I have alot less bloating from my enlarged uterus and ovarian cysts! (And my hot flashes are every day instead of every other day!)

Hi ladies if anyone can help that would be great. Three weeks ago I had my first zoladex injection the three monthly implant. I was in menopause from the chemo I'd finished the week before. Yesterday we re tested my estrogen levels as I'm due to start aromasin and they are back up to 455 !! I find this so frustrating as I'm not sure why the zoladecx is not working? How long after starting the ai did u have the injections? Thx. My oncologist has suggested an oopharectomy so maybe I need to do that soon after rads finish in a few weeks. Maybe that will get the estrogen levels down more. .....

I am clearly not champing at the bit to have my ovaries out, since I still got 'em (at the ripe young age of 51!). However, I would just note that breast cancers in women younger than 40 tend to be more aggressive than those diagnosed in older women. And, I think, that they are thought to be biologically different from cancers in older women. I am not advocating ovary removal! I am simply saying that young women (perhaps especially) (and here I mean, "actually young" not "fake young, like me!") face a difficult choice. I mean, giving up estrogen is hard at any age.

I had a TLH/BSO in Jan for Tamoxifen related endometrial issues. I was 51 and barely even perimenopausal but I was very worried about menopause and hot flashes. I am now 6 months out and find I am doing really well. HF were a little strong when they started about a month after surgery. I'd have 4-6 during the day and another 3 or 4 a night that would wake me. None were "drenched in sweat" type but more "film of sweat" type. My MO put me on iCool from Walmart and now I have a couple during the day and maybe one at night. And they are much shorter and milder than before. Took about a month for the iCool to kick in but it's working wonders for me.

Having gone through it naturally,  I am very against  menopause !  The changes it has brought to my body I am finally accepting several years after the whole process started taking place. But I really would prefer to return to being premenopausal,  even with a higher risk of breast cancer recurrence! The achy joints, insomnia, sexual difficulties,  more saggy skin,  have all impacted my quality of life. I feel that nobody should have to go through this any earlier than necessary Especially with the increased risk of other problems that oophorectomy can cause. My Oncologist was very pro tamoxifen only for early stage cancers like mine. And I don't understand these Oncologists who recommend this for early stage women especially.  If you feel uoset at the suggestion, I'd say get another opinion.  Every doctor sees things differently, and chances are you'll find one who is against the idea. Then you'll feel more at peace if you keep your ovaries. 

I'm there with you inks everyone keeps saying menopause isn't fun yah I understand that but if it's going to help in any way to see my 16 month and 5 year old grow up well it's a sacrifice I'm willing to mak

Hi John,

My oncologist started me on Tamoxifen, Lupron, and Zometa right after my BMX in February of 2014. I had an oophorectomy in March of 2015. I then switched from Tamoxifen to Aromasin. I am currently on a 2 week vacation from Femara. I will be trying Arimidex next. Side effect issues... if I have issues with Arimidex, I will go back to Tamoxifen. My oncologist definitely based her recommendations on SOFT.

http://www.thelancet.com/pdfs/journals/lancet/PIIS...(15)60908-4.pdf

JohnSmith-

it is not letting me give the correct link. Here is the text of the article:

Two Classes of Generic Drugs Can Reduce Breast Cancer Deaths

Two new studies suggest that two different classes of drugs, aromatase inhibitors (AIs) and bisphosphonates, can improve survival for postmenopausal women with early breast cancer (Lancet 2015 July 24. [Epub ahead of print]). Moreover, the researchers suggested that the combination of the two types of drugs increases the benefits while reducing some side effects.Most women are postmenopausal when they develop breast cancer, and breast cancer usually is found early, when surgery can remove all detectable disease, but might leave undetected micrometastases. About 80% of the 1.7 million breast cancers diagnosed each year are estrogen receptor (ER)-positive. Endocrine treatments, which act to stop hormones from stimulating cancer cells, can help protect these women against breast cancer recurrence and improve survival dramatically, the researchers said.

The two reports from the Early Breast Cancer Trialists Collaborative Group (EBCTCG) provide the best evidence yet for the effects of AIs and bisphosphonates on postmenopausal women with early breast cancer.

The first meta-analysis reviewed evidence from 30,000 postmenopausal women in nine randomized trials, showing that five years of treatment with newer endocrine therapy, such as an AI, produces somewhat better survival than five years of standard endocrine therapy (tamoxifen). Compared with tamoxifen, taking AIs for five years further reduced the likelihood of the cancer recurring by about one-third (30%), and the risk for death from breast cancer by around 15% throughout the decade after beginning treatment. The researchers estimated that, compared with no endocrine treatment, the risk for death from breast cancer for women who took AIs would be reduced by around 40% in the decade after beginning treatment.

"Our global collaboration has revealed that the risk of postmenopausal women with the most common form of breast cancer dying of their disease is reduced by 40%, by taking five years of an aromatase inhibitor—a significantly greater protection than that offered by tamoxifen," said Mitch Dowsett, FMedSci, PhD, a professor and head of the Academic Department of Biochemistry and head of the Centre for Molecular Pathology of The Royal Marsden and The Institute of Cancer Research, London. "The impact of aromatase inhibitors is particularly remarkable given how specific these drugs are—removing only the tiny amount of estrogen that remains in the circulation of women after the menopause—and given the extraordinary molecular differences between ER-positive tumors. But AI treatment is not free of side effects, and it's important to ensure that women with significant side effects are supported to try to continue to take treatment and fully benefit from it."

The second meta-analysis brings together evidence from another 20,000 women in 26 randomized trials, showing that two to five years of treatment with a bisphosphonate, which usually is used to treat osteoporosis, reduces the risk for breast cancer recurring in postmenopausal women, and significantly extends survival. However, bisphosphonate treatment appears to have little effect in premenopausal women.

Bone is the most common site for breast cancer metastasis, but tumor cells released from the primary breast cancer can remain dormant in the bone for years before metastasizing. Bisphosphonates have profound effects on osteoclasts, altering the bone microenvironment, which could make it less favorable for cancer cells, reducing the risk for metastases. Taken separately, previous clinical trials of bisphosphonates in early breast cancer have shown mixed results, but taking all their results together, a clearer picture emerges, they said.

The meta-analysis included patient data on 18,766 women in 26 randomized trials, comparing between two and five years of bisphosphonates versus no bisphosphonate. In the overall study population, the only clear benefit of bisphosphonates was a 17% reduction in recurrence of cancer in the bone. However, among postmenopausal women, bisphosphonate treatment produced a larger reduction in bone recurrence of 28% and reduced the risk for death from breast cancer by 18% during the first decade after diagnosis. The absolute reduction in the risk for death from breast cancer at 10 years was 3.3%.

This benefit was noted regardless of the type of bisphosphonate, treatment duration, tumor size, whether it had metastasized to the lymph nodes or whether it was ER-positive. However, bisphosphonate treatment did not reduce the risk for new breast cancers developing in the opposite breast.

"Currently, bisphosphonates are used mainly to reduce bone loss and fractures in postmenopausal women and to reduce bone complications in advanced cancer patients," explained Robert Coleman, MBBS, MD, FRCP, a professor of medical oncology and director of the Sheffield Cancer Research Centre and the University of Sheffield in the United Kingdom. "Our results show that adjuvant bisphosphonates in postmenopausal women prevent around a quarter of bone recurrences and one in six of all breast cancer deaths in the first decade of treatment. These simple, well-tolerated treatments should now be considered for routine use in the treatment of early breast cancer in women with either a natural or medically induced menopause to both extend survival and reduce the adverse effects of cancer treatments, such as the aromatase inhibitors, on bone health."

These studies provide solid evidence that both of these inexpensive, generic drugs can help to reduce breast cancer mortality in postmenopausal women, according to Richard Gray, MA, MSc, a professor at the University of Oxford, who was the lead statistician for both studies. "About two-thirds of all women with breast cancer are postmenopausal with hormone-sensitive tumors, so could potentially benefit from both drugs. The drugs are complementary, because the main side effect of aromatase inhibitors is an increase in bone loss and fractures, while bisphosphonates reduce bone loss and fractures as well as improving survival," he said.

Established 30 years ago by researchers at the University of Oxford, the EBCTCG is a worldwide collaborative that reviews all the evidence from randomized trials on the treatment of early breast cancer every few years.

- See more at: http://www.clinicaloncology.com/ViewArticle.aspx?ses=ogst&d=Web+Exclusive&d_id=245&i=July+2015&i_id=1209&a_id=33126#sthash.2CmSfHeJ.dpuf

Hi John

My oncologist just prescribed exemestane as he said this study which included ILC shows significant percentage points benefit

http://www.breastcancer.org/research-news/aromasin...

bump

Hi Molliefish -- The SOFT study (http://www.nejm.org/doi/full/10.1056/NEJMoa1412379) appears to be relevant only to pre-menopausal women.

As an update for others following this topic, after ~6 months of Lupron ovarian supression + Arimidex, I decided to have an oophorectomy because the monthly Lupron shots were literally a pain in the ass. My outpatient laproscopic surgery was on September 25. I was back to work the next day (working from home) and flew across the country on a business trip the following week. Two and a half weeks later, I still have some minor nerve pain near the right incision site when I laugh or sneeze, but it continues to improve. One very unexpected side effect of the surgery has been a significant reduction in hot flashes, which has been great. The hot flashes aren't gone entirely, but I'm only waking up 1-2 times/night now instead of 4-5 times. Ahh!

I am 42 with bilateral breast Cancer. I also have the PALB2 gene. My oncologist was fine with me having tamoxifen for 10 years but the gynecological oncologist wants to take out my ovaries as soon as I finish Chemotherapy. This would put me on AI. I am torn whether to request Lupron shots for six months so I can better understand the side effects or go straight for the oophrectomy.

You don't have to go on an AI when you have your ovaries removed. I'm staying on Tamoxifen with my MO's blessing because a) I tolerate it pretty well and b) the percentage increase in benefit to me was only about a half percent. I had a full hysterectomy with ovary removal due to some changes from Tamoxifen that concerned my gyn. Glad I did it. I feel great and now don't have to worry about that part of cancer. I am 52 so was heading for menopause anyway although I hadn't had any real symptoms yet. I currently just deal with hot flashes which have become more like warm flushes thanks to my iCool that my MO suggested.