Aromatase Inhibitor and just walking away.

Juniper Cat, I think there are a lot of questions we'd all raise if we could go back to the beginning, minus the shell shock and knowing what we know now!

(PS - like you, I was on an AI prior to radiation and stayed on it throughout. I asked my RO whether RT would be more effective if I went off it - her response was that there were 2 schools of thought on that question and she was perfectly comfortable keeping me on it. You're right that there aren't many of us going that route.) I hope both you and your sister do very well on Arim. and that it does well by you!

Hi JuniperCat:

I have links to a couple of head-to-head studies of aromatase inhibitors in the adjuvant setting of early (invasive) breast cancer, which may be of interest to you and others above.

(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.

This much older (2007) article provides an explanation of the background and rationale of the FACE trial:

O'Shaugnessy (2007): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2001225/pdf/10549_2007_Article_9702.pdf

(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

[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

Please don't ask me any questions, because I read the 2007 paper a while back, and only skimmed selected sections of the trial publications.

BarredOwl

[EDIT: 2018 link added]

Thanks, Artista, for the GoodRX heads up!

Junipercat - my MO told me she would prescribe letrozole first because it'd most likely be the cheapest option for me (no small consideration when you're going to be buying it for the next 5 to 10 years). She made it clear, though, that I didn't need to put up with any bad side effects because there were other options available. I felt absolutely horrible on letrozole, but tolerate exemestane very well - it only hurts my wallet!

Georgia, thank you for your response. My insurance is so arbitrary in that it covers some things and is terrible about others. I'm fortunate in that my Arimidex is only $5 a month. Who knows what it will be if the ACA gets changed.

Wow. Just checked what Exemestane TAB 25MG would be since Letro was horrible for me and seems Arimidex would be the same as they are both using the same mechanism. Yikes! My Medicare part D would be $460 a mo! GoodRx lowest would be $150 a mo! So that's out. I guess Tamox is it. I don't see cutting the Letro in 1/2 wouldn't cause my hair loss to increase. It's ok now on Tamox, and that's big for me at 52 to not look like I'm 72 yet. Can't control how I feel but can do something about how I look.

It's up to you, not your MO. My MO had been telling me all along how I need every possible benefit % increase but when she saw me last visit in absolute misery, she said she's fine with Tamox. If generic Aromasin wasn't so expensive I would have tried it since they say it's different mechanism and hair loss isn't up at the top if at all on the se experience list. But I am very strapped. Letro and Tamox are free with my insur, thankfully. But I won't go back to Letro, even if it was reported to help with all cancers and not just bc.

Hi Ade:

Please inform your Medical Oncologist about all of your dental and jaw concerns and symptoms.

In parallel, please see your dentist to discuss all these concerns and other possible causes for tooth breakage. For example, stress can cause teeth grinding at night, although you may not be aware you are even doing it. If that may have contributed to your broken tooth, a guard might be a simple solution to that at least.

As far as continuing endocrine therapy beyond five years, this would be re-evaluated at the five-year point. This will be a discussion between you and your medical oncologist, in light of what the totality of available clinical evidence indicates at that point in time. You would always have the right to decline extended treatment if you don't feel the estimated risk reduction benefit is worth the quality of life impact.

From what we know today, the benefit of extended treatment is not as large as it is in earlier time-frames, so risk/benefit must be weighed carefully. Certain biomarker tests (e.g., Breast Cancer Index) are now being used to help inform decisions about continued treatment. Perhaps in a few years, we will also have the results of any translational "biomarker" studies from recent clinical trials of extended therapy, and we may have a better idea of which patients are likely to benefit from extended therapy and by how much.

BarredOwl

Thanks Ade! Did not know of such a way. You call Medicare or the drug company to get the reduction in price? I think I"m going to pass on it generic aromasin. Not sure my MO would want me back on any AI after hearing I have been dx'd with osteopenia since last visit with her.

Meow: If you're still on the site, would you be willing to expand on this a little? I am struggling with exemestane side effects now, after having horrible SEs with anastrozole. Any insight appreciated.

BeAlive, I hope that it can be said to have been from beginning so you don't have to second guess your decision. I know in 11 months I am quitting Anastrozole. QOL is my reason and of course I will not know anymore than you, what is ahead. Keep us posted though and hugs from me.

Been a while since anyone's posted so I may be talking to air...but I have an onc appt. next week and will discuss going off of Exemestane. However my DH has ordered a supplement he found in an online article that just may dim the se's enough that I wouldn't HAVE to stop the meds. Should get it tomorrow & will have one week's trial before the appointment - so we shall see. I am hopeful & have put much prayer into this. (If it works as many testify to I will share it with you!)

Have a great week!

Ade

My quality of life on these drug were so poor that I had to stop about 2 months ago. I am hitting my 2 year mark and now I am feeling anxious. I had my blood work yesterday and next Friday is my mammogram. I feel like no one understands how anxious I feel. What have others experienced when they have had to say no to drugs?

That was suggested. I haven't decided yet. I was so wiped out after about 9 months of little sleep, anxiety attacks etc. I put everything on the back burner until after my Mamogram, blood work, and visit with the surgeon.

Artisa928 I'm glad you're doing okay with tamoxafin. It was much easier for me too. Unfortunately my relapse occurred while on it. I'm hoping for an easier reaction this time around on Aromasin.

Brutersmom- I went through Tam, Femara, Arimidex, Tam over four years. I quit about a month ago. I feel like I am gradually recovering - HF are improving, as are joint/ligament issues. Sometimes I feel a little guilty, but not guilty enough to go back on. If my oncotype dx score can be relied on, the benefit is probably only a couple points at most. If not, it would suck, but what will be will be.