Kind of confused. Please help

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Mama1416
Mama1416 Member Posts: 26
edited March 2018 in Hormonal Therapy - Before, During, and After

I'm not clear about hormone therapy recommendations. Why do some women take Tamoxifen only, and some have ovaries removed and switch to AI's? I just started Tamoxifen three weeks ago. I'm 48 and still pre menopausal. I really want to choose the best option. I think this has been the most confusing phase of treatment so far. I've had no side effects other than occasional hot flashes.

Thanks

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  • Icietla
    Icietla Member Posts: 1,265
    edited March 2018

    Hi Mama. The medicine types work by different means. As I understand it, Tamoxifen blocks estrogen from the estrogen receptors of the cancer cells. As I understand it, Aromatase Inhibitors inhibit the production of aromatase, which makes estrogen from some other substance in our fat. The AIs are believed to be a bit more effective for preventing recurrence of some cancer types.

    http://www.breastcancer.org/treatment/hormonal/aromatase_inhibitors

    As to all the difference Endocrine Therapy can make, see this post by BarredOwl and the material linked therein__

    https://community.breastcancer.org/forum/121/topics/854627?page=1#post_5102678

    Aromatase Inhibitors do not work for premenopausal women because their ovaries are still producing estrogen, defeating the purpose of the AIs (the AIs being intended to minimize estrogen).

    I believe the men having hormone receptor positive breast cancer take Tamoxifen for continuing treatment.

    Some undiagnosed but high risk women take Tamoxifen to reduce their risks for breast cancer. Some premenopausal women patients are dreadful of menopause. Some premenopausal women take injections to shut down the function of their ovaries so they can take AIs instead of Tamoxifen. Some perimenopausal women take Tamoxifen for a time, then switch to AIs when their menopause is confirmed. Some postmenopausal women patients take Tamoxifen instead of AIs because of the condition of their bones. Some postmenopausal women patients may start with AI therapy, then switch to Tamoxifen because of intolerable AI side effects.

    Each medicine type affords very substantial benefit. Each medicine type has side effects and risks. Tamoxifen puts one at increased risk for abnormal clotting, also for uterine cancer -- increased risks, but not hugely increased risks. Some have mood/disposition changes with Tamoxifen. The AIs tend to thin the bones, making them more prone to fracture.

    Take a look through these linked pages__

    https://www.drugs.com/sfx/tamoxifen-side-effects.html

    https://www.drugs.com/sfx/letrozole-side-effects.html

    Just because of their having cancer, cancer patients are at increased risk for abnormal blood clotting. Some cancers are discovered because of abnormal blood clotting being known as a possible sign of cancer.

    https://www.stoptheclot.org/faq_blood_clots_cancer.htm

    http://blog.dana-farber.org/insight/2014/04/does-cancer-cause-blood-clots/

    https://www.ncbi.nlm.nih.gov/pubmed/12407439

    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(97)10018-6/fulltext


    Do speak with your Oncologist about which medicine type would be best for you.







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  • ShetlandPony
    ShetlandPony Member Posts: 4,924
    edited March 2018

    It depends on the characteristics of the cancer, and also on the patient’s age and any other health issues.

    The SOFT trial was conducted to answer questions about anti-estrogen therapy for premenopausal women. It concluded that “Adding ovarian suppression to tamoxifen did not provide a significant benefit in the overall study population. However, for women who were at sufficient risk for recurrence to warrant adjuvant chemotherapy and who remained premenopausal, the addition of ovarian suppression improved disease outcomes. Further improvement was seen with the use of exemestane plus ovarian suppression.” Also, for women under age 35 “The results observed in this subgroup in SOFT add to the evidence that ovarian suppression plays an important role in younger premenopausal patients.”

    Also, my research suggests that for some ILC and for Luminal B cancers (ER positive but PR negative or high ki67) ovarian suppression/removal plus an aromatase inhibitor may be superior. Also, if a women has a genetic alteration that makes the CYP2D6 enzyme inactive, tamoxifen may not be metabolized properly. There has been controversy about how much this matters, but I think it does.

    Mama1416, if you would like to provide your pathology results and/or Oncotype score, we might be able to direct you to relevant research or suggest questions to ask your onc.

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  • Peregrinelady
    Peregrinelady Member Posts: 1,019
    edited March 2018

    Typically if you are premenopausal most doctors start you on Tamoxifen. I was 52 at diagnosis but not even close to menopause so I started with Tamoxifen. Then after second step of reconstruction I had a blood clot. Fortunately my surgeon had recommended oopherectomy because of family history so I could switch to an AI right away.
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  • gb2115
    gb2115 Member Posts: 1,894
    edited March 2018

    You can also ask your oncologist, "I see there are multiple treatment options. Why do you prefer tamoxifen for me?". But yes, premenopausal generally means tamoxifen. Makes sense. It's one pill instead of a pill plus shutting your ovaries down or taking them out.

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  • Mama1416
    Mama1416 Member Posts: 26
    edited March 2018

    Thank you all for replying. I have an appointment on Wednesday to review the hormonal therapy. Now I'm ready to ask the right questions. I am so happy to have women who share their experience and knowledge. Thanks agai

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  • Lula73
    Lula73 Member Posts: 1,824
    edited March 2018

    mama-did you have genetic testing done? Testing positive for one of the many gene mutations related to ovarian cancer is another reason many premenopausal women have oophorectomy. I’m in that group. Tamoxifen giving me blood clots was the event that sealed the deal on removing them sooner rather than later. The SEs I’m experiencing on AI are MUCH milder than the ones I had on tamoxifen even if you took the blood clots out of the equation.


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  • Mama1416
    Mama1416 Member Posts: 26
    edited March 2018

    Hi Lula, The only testing I had was for the BRCA 1 and 2 mutations which came back negative. My oncologist did not order an Oncotype either. She said it would not have made a difference in her recommendation for treatment. She did admit she was probably over treating me to some extent as the chemo was only giving me a 3%-4% advantage. I'll take whatever I can get :)


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