FEMARA

I'm curious about what determines which AI we're taking. My MO told me to choose one. I went with Arimidex because he said it was the least expensive. After reading anecdotal evidence that name brand Arimidex may cause fewer SEs, I'm paying out of pocket to try it. Too early to tell as I just started.

Regarding comparative efficacy, I am aware of these head-to-head studies of aromatase inhibitors in the adjuvant setting of early (invasive) breast cancer, which may be of interest. There are caveats and limitations as usual. Those with pending treatment decisions should be sure to confirm understanding and applicability of any outside information with their medical oncologist:

(1) "FACE" - Letrozole versus Anastrozole

Smith (2017): "Comparative Efficacy and Safety of Adjuvant Letrozole Versus Anastrozole in Postmenopausal Patients With Hormone Receptor–Positive, Node-Positive Early Breast Cancer: Final Results of the Randomized Phase III Femara Versus Anastrozole Clinical Evaluation (FACE) Trial"

FACE Trial Results (2017): http://ascopubs.org/doi/full/10.1200/JCO.2016.69.2871

(Free pdf version available for downloading under PDF tab)

Note: Patients in this study had node-positive disease.

(2) NCIC CTG "MA.27" - Anastrozole versus Exemestane

Goss (2013): "Exemestane Versus Anastrozole in Postmenopausal Women With Early Breast Cancer: NCIC CTG MA.27—A Randomized Controlled Phase III Trial"

MA.27 Trial Results (2013): http://ascopubs.org/doi/full/10.1200/jco.2012.44.7805

(Free pdf version available for downloading under PDF tab)

See also, this more recent 2016 ASCO Meeting Abstract looking at ductal versus lobular histology:

Strasser-Weippl (2016): "Outcomes of invasive ductal (ID) or invasive lobular (IL) early stage breast cancer in women treated with anastrozole or exemestane in the Canadian cancer trials Group MA.27"

http://meetinglibrary.asco.org/content/165026-176

Findings in abstracts may be preliminary in nature.

[EDIT 1/2018: See also, Strasser-Weippl (2018): "Outcomes in women with invasive ductal or invasive lobular early stage breast cancer treated with anastrozole or exemestane in CCTG (NCIC CTG) MA.27"

http://www.ejcancer.com/article/S0959-8049(17)31411-9/pdf]

BarredOwl

ndgrrl - all three AIs have been found to cause bone loss and increased cholesterol as possible side effects. I can only share my personal situation. I started taking arimidex this week and wiil begin Prolia injections next month because I'm borderline osteopenia. You can find articles on aromatase inhibitors on this site which will give you more information. Since I'm also post menopausal my MO wants me to go with an AI. It's like BC dominoes with one med sometimes leading to another.

ndgrri - from my readings and research aromotase inhibitors are typically offered to ER+ post menopausal women. I can't speak to the higher cholesterol levels and effectiveness of statins since elevated cholesterol is not presently an issue for me. As with any medication there are potential side effects. We have to weigh risks over benefits. If it were me, I would speak to my MO to discuss your specific medical stats and the risks and benefits of Tamoxifen, which is a SERM, over an aromatase inhibitor (Arimidex, Aromasin,or Femara.)

Hi, I have asked about the breast cancer index test and it is not available in ND yet. I am hoping in 1.5 yrs when I need it, that it will be available. Does insurance pay for it?

Lala I see your Dr gave you a percentage of how much more an A1 would protect you over Tamoxifen, I e-mailed my MO as she was gone when I was at the cancer center and had to see an NP who told me to just take statins for the cholesterol and when my bones thinned enough I could be treated for that too. My MO told me in the e-mail that there was no way to know the percentage that an Ai would benefit a person over Tamoxifen. I knew there was as my old MO told me the percentage that is why he talked me into going on Arimidex when I wanted to stay on Tamoxifen. Is that percentage based on a persons own risk or is it a general percentage? I am sooooo frustrated!!

I am currently not on anything as I was taken off Letrazole because of ear ringing- My ENT suggested I go off it, MO agreed, 2 weeks later still ear ringing. I been trying to get my MO to give me her opinion on what I should do not tell me it is up to me and there is no way to tell me what the percentage of benefit it would be to stay on an Ai.

UFFFF...

Butterfly, I wish they would I did well on Als for about a year and then suddenly things went down hill fast. I switched to Femara and that added back and hip pain to my other issues. Don't know what I am going to do next. I did have an allergic reaction to one brand, tounge and throat swelling. I don't feel like I have a choice right now but to stop the Als.

I did well on tamoxifen but changed to letrozole because it has slightly better efficacy. My thought process was that I could always go back to tamoxifen if I develop issues with letrozole, but so far, I haven't. Yesterday I ran and lifted weights. Today I rucked for an hour. Point is, not everyone "suffers" for five years on AIs. Some people do ok. So far, the only thing I've notice is occasional trigger finger and occasional difficulty with word retrieval or spelling. Basically nothing. And not everyone's MO strong armed them onto AIs or discouraged coming off if they are having issues. My MO gave me the information and full agency to make the decision with no pressure either way. He also agreed to switch me back if I ask, so I know it is entirely up to me and how I feel.

Susan have you noticed any change in your Cholestrol, BP or bone thinning while being on Femara?

ndgrrl - I've been on Femara/letrozole for 7+ yrs and have had no changes in my cholesterol or BP.

My total cholesterol is high (has been for 20+ yrs) but is high because of the HDL level being quite high. The LDL is well within the normal range. Has remained stable since being on Femara/letrozole.

BP - Quite normal.

Osteoporosis - well, since on Femara/letrozole my osteopenia did progress to osteoporosis. Had been osteopenia for yrs so the progression to osteoporosis was expected anyway. (I have a huge family HX of osteoporosis on both sides of family. . Thus I can 'blame' Femara/letrozole on what would have happened anyway. I was 63 when DXd and now 70 so the body would have aged during those years anyway. Fosamax is apparently doing a good job of keeping 'it' from progressing.

I didn't have chemo either. Been 17 mos. for me on letrozole. Seeing my PCP tomorrow. At 8 mos. in, my LDL had soared and my HDL dropped (from 95 to 70, still considered “good" but not as protective). Triglycerides down, total chol. about the same. BUT weight gain has been my worst symptom. (I deal with insomnia by taking melatonin and alternating between Xanax & Benadryl, and using blue-blocking glasses for nighttime computer work & TV watching in order to have a more normal biorhythm).

Tamoxifen is not an option for me—I'm long past menopause, need Wellbutrin for depression (none of the Tamox-safe antidepressants work well for me, and especially Effexor, which was a nightmare. They don't call it “side-Effexor" for nothing). And heart disease runs rampant on both sides of my family—in fact, by the time my paternal grandma and maternal grandpa were my age, they were dead from heart attacks (it was grandma's second). My dad had two at 50, and the third one killed him at 72. Do I really want to take something that doesn't protect against recurrence as well as an AI and can cause fatal blood clots (not to mention endometrial cancer)? Nope. I'll deal with being fat on letrozole. As to bone loss, I was already osteopenic pre-rads. Can't take Fosamax because of GERD so bad that it'd put me at risk for esophageal cancer. Had one Zometa infusion, then switched to Prolia. Next Prolia is due in Sept., next density scan Nov. Hopefully, though letrozole can cause bone loss, it’ll show the two (by then three) treatments I’ve had will cancel it out.

I had heard that letrozole can raise cholesterol levels, affect/effect(?) thyroid and cause weight gain. I was off my statin for almost a year (surgery & rads, then liver levels went way up). I was put back on last November because cholesterol was high. MO wants a bone density annually because I have osteopenia which is supposedly normal for my age. He also has me on calcium with D3. I am having labs on Monday. I'll see how the cholesterol is doing and if my thyroid is still normal. Will have my PCP order the bone density.

HI- Thanks everyone for the replys.

I have had two infusions of Zometa. THe first one was the worse, I felt like I had the flu. I am not sure why the CC does not warn a person this could happen. 2nd time I took Benedryl before and after the Infusion plus loaded up on water and they gave me some though the IV before and after that infusion- My side effects were much much less. I do not have Osteoporosis yet thought my bones are thinning from the Femara. I take Zometa infusions every 6 months for 3 years because of a study my MO had heard about that it would help prevent cancer from moving to my bones. I have not heard of many people doing this.

I have had sleep issue for years and tried various medication for it. Took a low dose of Elavil/amitriptylline for years before that quit working. Two months ago, my doctor gave me a prescription for hydroxizine, which is actually an anti-histamine, but it doesn't leave you feeling sluggish like benadryl, which also didn't work for me. For the first time in I can't remember when, I've been able to sleep well, and when I wake up early,easily go back to sleep. I've been getting 7-8 hours of sleep, have a clear mind, not tired during the day and have energy. However, since starting Femara, that has all gone to hell. I now wake up and can't fall back to sleep, my mind racing, and only getting 5-6 hours of sleep. This also causes brain fog and fatigue.

Has anyone else experienced sleep disturbances with Femara? Has anyone switched to a different AI and NOT had this issue? I've only been taking it for 10 days....so, do the SEs get worse? Or do they even out? I'm willing to give it a couple more weeks, but the disturbed sleep is a big thing for me.

Of course, I'm going to be starting radiation next week sometime, so I guess I'll be fatigued anyway, but I sure would like to sleep more than 5-6 hours a night.

I get sudden onsets of fatigue even being very active. Will need to sit in recliner and close my eyes and stop moving or i feel like I'm crawling through molasses

Also now need 9 hours sleep at night to function. On this stuff 22 mos now

Thank you Sandy. Working through sleep issues now. I was taking Cannabis to sleep, but going off of it this month. I was sleeping but still tired. Complementary oncologist says it interferes with REM sleep so that although you sleep like a log, you feel tired anyways.

Switching to Regenerest which is much weaker but works if I practice excellent sleep hygene. Takes a bit of discipline and the transition is not fabulotastic. But starting to sleep again.

>Z<