Femara Compared to Aromasin?

Options
Hopeful82014
Hopeful82014 Member Posts: 3,480
edited August 2016 in Hormonal Therapy - Before, During, and After

After 21 months on Femara (with a very strong neo-adjuvant response) my MO has switched me to Aromasin folowing an AI break, due to mounting side effects.

I know that the two achieve the same effect but through slightly different chemical pathways. I'm curious whether anyone else has made this particular switch and whether you noticed any differences between the two? TIA.

· Share on FacebookShare on Twitter

Comments

  • BarredOwl
    BarredOwl Member Posts: 2,433
    edited August 2016

    Hi Hopeful:

    No, but bump.

    BarredOwl

    · Share on FacebookShare on Twitter
  • Hopeful82014
    Hopeful82014 Member Posts: 3,480
    edited August 2016
    Thanks, BarredO.

    Maybe I should just take this to the Aromisin thread. It's also possible that this isn't that common a change...
    · Share on FacebookShare on Twitter
  • exercise_guru
    exercise_guru Member Posts: 716
    edited August 2016

    hopeful I too have the palb2 mutation and I am in a similar conundrum. I has some very extreme difficult side effects on arimidex and then Femara. I am currently on tamoxifen until I can have carpal tunnel surgery from the arimidex.

    In the fall my MO wants to switch me to Aromasin. I am sorry I am not help but I would very much like to hear how this goes for you.

    · Share on FacebookShare on Twitter
  • ErenTo
    ErenTo Member Posts: 343
    edited August 2016

    Hi hopeful, I haven't made the same switch (I switched from Tam), but I'm also curious what the difference is in their mechanism is action and effectiveness. I read that exemestane has less severe impact on bone density compared to the other 2 AIs and is steroidal. Exesmtane permanently inhibits aromatase while it's reversible in the othe two, what the implication is for us, I'm not sure. My MO picked this one as it's the AI used in SOFT trial.

    · Share on FacebookShare on Twitter
  • Hopeful82014
    Hopeful82014 Member Posts: 3,480
    edited August 2016

    Hi, Exercise Guru and ErenTo - thanks for chiming in. I'll certainly let you know how it plays out. I'm really sorry to say farewell to femara, as it did very well by me for a long time and then bam! side effects started piling up.

    It's interesting that it has less bone toxicity than the others; what I haven't been able to find is any info on how much of a difference it is. And I'm not sure that the aromatase inhibition is permanent (as in a lifetime effect) but I need more clarification on that. I've got a call in to our oncology pharmacist and that's one of the questions I've noted for her. I'll let you know what she has to say.

    Because my MO and I had several issues to cover, I didn't drill her on why the selection of exemestane in particular as I normally would have. I suspect it's due to the fact that it's more effective (by a point or two) at suppression than arimidex although not quite as much as femara.

    At any rate, I'll let you know what I hear back and how it goes. In the meantime, I'd be interested in how you've fared with it, ErenTo.

    Exercise Guru - it's always interesting to see another PALB2 mutant around here :) So far, I'm the ONLY one in my large, extended family who's tested positive, and there isn't an awful lot of definitive research available for us to draw from, so it can feel a bit like I'm the only one! (Not that I'd wish it on anyone else, of course.)

    Have a great weekend you two!


    · Share on FacebookShare on Twitter
  • ErenTo
    ErenTo Member Posts: 343
    edited August 2016

    I'd be interested in what your pharmacist has to say about the difference between these 2 types of AIs. I'm a bit of a geek when it comes to these things :)

    Exemestane has been ok for me so far, but I'm only in my 3rd month so we'll see how it plays out longer term. My main symptom is hot flash and considering that I've been induced in almost instant menopause (with Zoladex, I'm 40 and my period came back 9 months after chemo), it hasn't been too bad. I have stiff fingers, especially in the morning and the last 2 fingers are more stiff during the day as they're moved/used less compared to the other 3, I'm trying to use them more now in typing so they get some exercise too! I haven't had joint pain yet, only very mild and occasional elbow or knee pain. I'm very active and exercise regularly, take vitamin D3 and Omega 3 and eat healthy with minimal sugar. Not sure if lifestyle factors have any effect on side effects, but I'm keeping at it.

    · Share on FacebookShare on Twitter
  • JanisStonier
    JanisStonier Member Posts: 5
    edited August 2016

    Hi ladies,

    Adding my feedback here as I have almost 5 years history on these drugs and they all have given me side effects. First Tamoxifan which thickened my uterus wall and made me bleed, and then I started having skin reactions where I would get itchy boil like hives all over. Switched to Femara and did okay on that for awhile but started getting the skin reaction after 6 months again, tried Armidex and that gave me immediate skin reaction. Have been on Exemestane now for over a year and my skin break outs and dermatitis has been so bad I am telling the doctor that I have to go off of it. She doesn't believe me that these drugs are causing me these skin break outs and thinks it's something else. I know my body and the one thing through all the drugs has been this constant skin break outs so I am absolutely certain it's the drugs. It seems these drugs build up in the body and after a longer duration you have the worsening side effects. Can anyone offer help or direction on this? My doc wants me to stay on these for another 5 years and I don't know how I can tolerate them!!

    · Share on FacebookShare on Twitter
  • ErenTo
    ErenTo Member Posts: 343
    edited August 2016

    Janis, sorry to hear that. My fear is also the long term buildup, that's why I'm hesitant to claim I'm side effect-free after only 3 months. Is it possible to take a short break and go back on one of them and see what happens?

    · Share on FacebookShare on Twitter
  • JanisStonier
    JanisStonier Member Posts: 5
    edited August 2016

    I was fine on Exemestane for about a year and a half and then wham--the skin issues are worse than ever, I itch all over and have these break outs and dermatitis condition all over my skin. Hopefully you will do okay

    Smile


    · Share on FacebookShare on Twitter
  • ErenTo
    ErenTo Member Posts: 343
    edited August 2016

    I've been warned about hair loss by my MO (not acne)that's why as a preventative I'm taking occasional biotin and use minoxidil. Exemestane is known to have androgenic side effects which includes acne and hair loss.

    · Share on FacebookShare on Twitter
  • JanisStonier
    JanisStonier Member Posts: 5
    edited August 2016

    My oncologist is acting like my skin condition isn't from the drugs and that is frustrating, because I know it is. Can you direct me to where I can read more about this drug and the known androgenic side effects? She has "allowed" me to go off of it for 2 weeks and then discuss our game plan, as she doesn't want me to discontinue treatment.

    · Share on FacebookShare on Twitter
  • ErenTo
    ErenTo Member Posts: 343
    edited August 2016

    Few things I found:

    http://jco.ascopubs.org/content/19/7/2107.full

    Although the first reports of steroidal androgenic side effects were reported using a dose of 200 mg daily, these side effects were also reported with the 25 mg daily dose.... a 10% incidence of steroidal androgenic side effects among 78 patients treated with exemestane 200 mg daily as a third-line treatment: hair loss (10%), hypertrichosis (5%), hoarseness (5%), and acne (4%).... two cases of hypertrichosis and acne among 91 patients treated with exemestane 25 mg daily as a third-line treatment. In a randomized phase II trial against tamoxifen.... 8.1% of grade 2 and 3 skin reactions in the exemestane 25 mg/d arm versus none on tamoxifen; grade 1 toxicities were not reported.

    http://www.breastcancerupdate.com/audio_archives/3...

    STEROIDAL EFFECTS OF EXEMESTANE

    Exemestane is a very active and impressive compound, but I have concerns because it is a steroidal substance with steroidal side effects. In some patients, this agent causes viralization, which may be very subtle. I use exemestane quite frequently as a second- or third-line therapy, and I have seen subtle changes such as deepening of the voice and acne.

    · Share on FacebookShare on Twitter
  • JanisStonier
    JanisStonier Member Posts: 5
    edited August 2016

    Thank you for that! When we can go in to our doctors with knowledge instead of fear, it helps so much.

    · Share on FacebookShare on Twitter
  • Hopeful82014
    Hopeful82014 Member Posts: 3,480
    edited August 2016

    ErenTo, thanks for supplying that info. Janis, I hope that helps you get your MO's attention regarding your skin issues - those sound pretty miserable and having them cavalierly dismissed would add insult to injury.

    I heard back from the oncology pharmacist navigator with the following:

    Regarding the "permanence" of aromatase inhibition with Exemestane:

    "No, it would not be forever. Usually a drug is considered "out of your system" after 4-5 "half lifes". Half life for exemestane is 24hrs, so theoretically 95% of the drug would be gone in 4-5 days. However, the effect continues to linger on beyond that, but I couldn't find any time period. I would guess not more than a month….

    Regarding difference in bone toxicity: "Bone changes/osteoporosis is quoted as 5-15% with letrozole and 5% with exemestane, so a bit lower and perhaps a better choice in a woman who already has osteoporosis or a very strong family history of it"

    I also asked her about the need to take it with food - my question and her response are below.:

    "One very practical question concerns the instructions I received from the pharmacist (and the printed patient materials) to take it with/after food. Is this really necessary? Can you explain what it's based on? If it's required, would something such as V-8 juice or herbal tea be o.k. rather than solid food? "Your pharmacist was right! Absorption of exemestane is 40-60% higher if taken after a "high fat breakfast". So V8 or tea would not be enough. You want as much absorbed as possible to "do its thing". If you are not a breakfast eater, then I'd suggest taking it after lunch instead. Not sure that "high fat" is necessary, but maybe a little healthy fat J"


    I hope all this is as useful to others as I found it. I'm pretty much on these drugs for the next 8+ years, so I hope that Exemestane works out. As stated earlier, I was really fine with femara for a long time and would go back to it in a heartbeat if we could get even one of the side effects under control. If I have to take something of this sort, I'm glad to have options. I do wish that I saw a better option on the horizon but it's unlikely that anything's under development or that it would become available (and at a feasible price) within the foreseeable future.

    · Share on FacebookShare on Twitter
  • doxie
    doxie Member Posts: 1,455
    edited August 2016

    JanisStonier,

    I have lots of problems with hives, rashes, and eczema, sores. Food dyes, food, topical creams, and meds have all caused me problems. I've had several problems since on AIs, but none of these from AIs.

    While it is possible that AIs are causing the problems, but it could be something else. An allergist might help pinpoint the problem or you can try eliminating food or products, even with your MOs permission take a break without changing anything else.


    · Share on FacebookShare on Twitter
  • ErenTo
    ErenTo Member Posts: 343
    edited August 2016

    Thanks for posting your pharmacist's comments, hopeful. Yes, I read about the fat thing for better absorption, I usually have a bunch of mixed nuts (with oatmeal or yogurt) in the morning. Hope it's high fat enough! Not sure I can stomach higher fat content in the morning.

    · Share on FacebookShare on Twitter
  • Hopeful82014
    Hopeful82014 Member Posts: 3,480
    edited August 2016

    Well, that would be one reason to switch to 2% or whole milk yogurt.... Or perhaps taking it after lunch? I'm with you, though; unless it involves bacon I really can't stomach fat with breakfast. In any event, I hope Aromasin serves you well and keeps you healthy for decades to come, ErenTo, with minimal SEs.

    · Share on FacebookShare on Twitter
  • ErenTo
    ErenTo Member Posts: 343
    edited August 2016

    Thanks hopeful, same to you!

    · Share on FacebookShare on Twitter
  • Nancy2581
    Nancy2581 Member Posts: 1,234
    edited August 2016

    Hopeful - can you tell me what side effects you are experiencing? I know everyone is different. My onc plans on switching me to Femara at some point. Have no idea why she chose this one over the other two.

    Nancy

    · Share on FacebookShare on Twitter
  • Hopeful82014
    Hopeful82014 Member Posts: 3,480
    edited August 2016

    Thanks, ErenTo!

    Nancy, I did really, really well on Femara until a few months ago. I had some sudden bouts of depression (1-2 days) and my hair was definitely drier; given how well it was working I had no problem accommodating those minor issues. And then over the late-winter, early spring of this year I hit the wall with fatigue, uncontrollable weight gain and then muscle pains and headaches.

    It could have been the change in generics, as my pharmacy switched from one to another around January but my MO decided to give me a 3-week break then go to exemestane to see how I fared. It's only been 9 days, so it's hard to say how it's working out. I will say that it felt good to be off of everything for 3 weeks but it's like any vacation - it eventually has to come to an end. ;)

    From what I've read, Femara's the most effective AI, by about 1-2 percentage points of aromatase suppression. I would have been happy to stay on it if we could have gotten the fatigue and weight gain under control and I'd be willing to give it another try, particularly if I don't see any improvement with exemestane. I hope it works out very well for you, Nancy.

    · Share on FacebookShare on Twitter
  • Nancy2581
    Nancy2581 Member Posts: 1,234
    edited August 2016

    Thanks Hopeful. I really appreciate you letting me know. I am currently on tamoxifen. I will stay on that for a total of 5 years and then my dr wants me to switch to Femara. So it won't be for a bit. You know, the AI's scare me. I've done well on tamoxifen. Well I have gained weight (didn't in the beginning), have awful hot flashes and leg cramps when I'm sleeping. All of this I can handle (maybe not the weight gain lol). I did ask if I could just stay on tamoxifen for 10 years and my onc said yes, but she said there was about a 15% increase in not reoccurring with femara (not wording that right) - something about a 15% increase in benefit I guess. Argh what do I know!

    Thanks again

    Nancy

    · Share on FacebookShare on Twitter
  • Twofer
    Twofer Member Posts: 39
    edited August 2016

    Hi Hopeful. My Onc changed me from Letrozole to Exemestane 10 days ago. I was supposed to go straight on to it, but took a 5 day break. The change from Letraccord to the new generic, Letrole, a few months ago did me in by ramping up the pain, headaches and bowel issues/diarrhoea. He made the comment that others have reported problems with the new generic and was quick to take me off it. I stuck with generic Letrozole for nearly 4 years despite the pain, weight gain, brain fade, hot flushes, hair loss, constipation/diarrhoea and headaches, as it seemed to be keeping things tidy - my two bone mets have healed. Reuben did consider Tamoxifen to help with bone density issues, but decided the risks were too high. I tried to find some original Femara to try, but its no longer available in NZ. Fingers crossed for Exemestane! Cheers, Anne

    · Share on FacebookShare on Twitter
  • Hopeful82014
    Hopeful82014 Member Posts: 3,480
    edited August 2016
    Hi, Nancy - you're most welcome. I'm happy to help. All of the studies demonstrate superiority of Femara over tamoxifen so I certainly hope if does well by you.

    Anne, thanks for your note. we must have started Exemestane pretty much at the same time. I hope it resolves your worst side effects (at the least) and keeps any further problems at bay.
    · Share on FacebookShare on Twitter
  • ShetlandPony
    ShetlandPony Member Posts: 4,924
    edited August 2016

    Janis, just thought I would mention that on the "Femara" and "For Arimidex" threads there is discussion about whether the inactive ingredients in a pill could be the cause of reactions, and some of the women suggest finding out all the ingredients, and trying generics from different manufacturers.

    · Share on FacebookShare on Twitter
  • BongKong
    BongKong Member Posts: 2
    edited August 2016

    Hi Ladies, I am new to this forum'; i've been IV since 2002 with a total 3 recurrences. Her2+++, Estrogen up & down last tested at 65%, and currently 0 Progesterone. I have been on Aromasin for 14 years & can't find anyone anywhere who has been on it that long. I was shocked to read about all the side effects my sisters are currently reporting, although having been off it for 1 week & now taking Femara, I wonder if I am going through withdrawal of the steroid piece of Aromasin, or something to do with Femara. I am much more lethargic, no energy, dull, & my stomach is queasy. Nothing dramatic but not normal. I did have 2 lung wedges removed 3 weeks & 2 days ago, but the (side) effects I refer to here did not arise until I changed from Aromasin to Femara.

    I have been & remain on Herceptin since 2006 and have never been on chemo. I am an Oligometastic case.

    Has anyone else been on Aromasin for so long?

    Thanks ladies!

    · Share on FacebookShare on Twitter

Categories