Switching Tamoxifen for an aromatase inhibitor
Hi! I was premenopausal before bc treatment. After chemo I just have had a couple of periods. My oncologist mentioned I might switch Tamoxifen treatment for an Aromatase inhibitor if I haven't got periods for a year. She didn't mention which type of aromatase inhibitor it would be. It seems there is a study that says that an aromatase inhibitor offers a better survival rate, that is a 40 % than Tamoxifen, which offers just a 30% . Questions: have you being switched to an aromatse inhibitor? which one? How long had you been taking Tamoxifen before the change? Do you have any different side effects with the aromatase inhibitor med? Which ones? What do you take or do to lessen the side effects? What about the bone mineral density lost that this med can produce? Thank you. http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)61074-1.pdf
Comments
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I'm not sure where you are seeing a survival rate of 30% vs 40% that seems really low. Do you have the stage you are talking about?
I was on tamoxifen and the SE were too much for me. I was switched to an AI that I just started. I;m on generic Femara. So far I feel much better, but I know an AI can take longer for the SE to show up. But I actually do better with less estrogen in my body, so I'm hoping I'll be ok.
I am going to have my DR order bone density scans.
I wonder if after the 5 years on an AI if your bone density would come back or if what is lost is lost. I'm going to ask my MO about that.
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Thanks for your reply. You can read the study and percentage of survival here: http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)61074-1.pdf
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Tamoxifen can keep your periods away for more than a year. On page 1346, graph "D", it gives you a 2.9%(overall) if you switch to an AI ."Death from any cause"
http://www.thelancet.com/pdfs/journals/lancet/PIIS...
Here's a hot link to the Lancet article
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Thanks for answering Coraleliz! XX
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Hello, yes, same as you, I went into chemopause, and then after my estrogen levels were at meno levels (tested) for a year I was changed from tamox to arimidex, which gave me horrible mood swings, weight gain and joint/pain issues. My MO then swapped me to aromasin--so far none of the problems I had on arimidex. I've heard the post-meno higher survival rate if we switch from tamox argument before, and actually reminded my doc about my lack of ovulation and sent her the reports from my gyno; then she switched me.
When I went on arimidex, my MO ordered a bone density scan as a baseline. That was nearly two years ago so when I see her again I'll ask her if it's time for another, although I dislike scans and think we overuse them. I don't take extra calcium but eat tums whenever I remember.
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I was on Arimidex for almost a year and worked through most of the side effects but continued to have insomnia and capillaritis (right leg). My MO switched me to Tamoxifen and felt the difference in risk was very small since I am stage 1C. I am also post menopausal and he said that Tamoxifen used to be prescribed for prevention of bone loss. I feel I gave up some cancer protection but at least can sleep once again.
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I did Tamoxifen for two years then had an ooph and went on Femara. After seven months I'm done. I just can't do the joint pain, the claw hands, feeling like a slug. I'm not generally a whiner but I am much too young to feel this damn old. I'll take the uterine issues. I'm going to talk to my gyn and if she's fine with it I'm going back to Tamoxifen. Comparatively I found it much easier. Hopefully now that I am post menopausal I won't have any uterine issues either. Many women do just fine on AIs - I'm just not one of them.
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farmerlucy---I had a total hysterectomy in Jan because Tamoxifen was causing uterine issues. They weren't bad but slowly getting worse (fibroids, cysts, thickened lining). It was a very easy surgery to recover from. I did it early enough that my uterus wasn't too big to remove vaginally. I had 3 tiny cuts in my belly and spent one night in the hospital. Within 10 days I felt perfectly normal but followed my doc's advice and took it slow. I walked every day and was back at the gym at 2 weeks. I did get tossed into surgical menopause but the hot flashes are well controlled with my iCool. Have to say, I thought it was one of my best decisions. And I'm staying on Tamoxifen because I do so well on it. My BS said he thought an AI would give me more pain than benefit.
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Lala - Good to hear. In retrospect I prob should have done the hx. In hindsight T seems like a walk in the park vs AI.
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Thanks for your replies ladies. I'd love to hear more anwers from survivor who have gone through the same thing. Hugs to all!
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My oncologist will switch me from arimidex back to Tamoxifen to prevent bone loss. I had hysterectomy and ooph last week. He said the only side effect for my situation could be blood clots using Tamoxifen since the uterus and the ovaries are gone.
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new2bc---did your MO give you any statistics on recurrence depending on being on an AI or Tamoxifen? I had a hysterectomy and ooph last Jan and have decided to stay on Tamoxifen. My BS said he thought the increased muscle and joint pain wouldn't be worth the small decrease in recurrence and my MO kinda just waffled back and forth and then finally said that since I manage pretty well on Tamoxifen he didn't want to switch me to an AI for what might be a half percent reduction in recurrence rate. I'm just wondering if your guy gave you any statistics as well. I'm assuming your switching back for the bone loss issue as opposed to any other reasons?
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I'm 4 years out from DX, 3 years out from finishing chemo/BMX/rads & starting Tamoxifen. I took it for 2 years and did fine on it except for hot flashes, which I managed with Effexor. After 2 full years on Tamaxifen, my MO switched me to an AI, starting with Femera (letrozol). It was awful - leg cramps, headaches, nausea, mood swings, frequent urination (to the point of being annoying). I hated it. I stuck with it for a few months, until my next regular 6 mo. oncologist appointment. When I told her how much I hated it, she asked me to try Aromasin (examestane). Within days of switching, I was fine again! Over 3 months in, and except for minor hot flashes, I have no other bothersome side effects.
MO wants me to stay on the AI for 5 years (after 2 on Tamox). She's a firm believer that AIs are better at preventing recurrence in post-meno women, and even told me this is the most important part of my treatment.
After chemo & tamox, I have some osteopenia & Vitamin D deficiency, so I do worry about bone density. I don't tolerate oral calcium & Vitamin D supplements, so I have a feeling Boniva injections are in my future.Good luck to you, Rose_Aurora!
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lala1,
My oncologist said AI will protect more than Tamoxifen for recurrence but I don't remember the statistics. Arimidex caused a big cyst on my right ovary and increased my estradiol level to 153. I will ask the oncologist about Aromasin but I assume it will still cause bone loss. How long did it take for you to start having hot flashes after your ooph?
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new2bc--I started having hot flashes about 4 weeks after my ooph. I'd have about half dozen during the day and another half dozen at night. My holistic doctor suggested Peridin-C which did help a little. Then my MO suggested iCool which has helped alot more. I have 1 or 2 during the day and another 1 or 2 at night. I actually take both. I take 1 Peridin-C am and pm and 1 iCool am. This formula is keeping the HF manageable for me.
I have a question....I know that on the Bottle o' Tamoxifen thread there is a general consensus that the Teva brand of Tamoxifen seems to have the fewest SEs followed by Watson and then others. Is there the same general consensus on AIs? I mean like is Aromason better over Arimidex which is better over something else? I'd like to talk to my MO about switching but I'd like to try whatever seems easier to take for most people first. He never told me there were different brands of Tamoxifen. It was only here on the boards that I found out so I could experiment. TIA for your opinions.
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My oncologist tried me on Femera first mainly because it's cheaper than Aromasin. (Considerate of her, I thought!)
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lala1,
Thanks for your update.My experience with both Tamoxifen and Arimidex was that TEVA brand had less side effects. Generic Arimidex is made in different countries and it was advised to stay away from the ones made in India because of different fillers. I just saw this regarding the outcome of recurrence for both Tamoxifen and AI for DCIS for post menopausal women. But they also mention invasive cancer in the article:
http://www.breastcancer.org/research-news/arimidex...
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Thank you for your replies ladies. GeorgiaRai, I'm glad to hear you don't have almost strong side effects. Best wishes to you too.
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