Ovarian suppression only as adjuvant treatment?

orangeflower · June 2021

Hi there. I know that ovarian suppression alone is generally not used as adjuvant treatment because there will still be too much estrogen being produced by the body, requiring the use of a SERM or an AI. But what if you can't tolerate SERMs or AIs. Would doing ovarian suppression alone reduce the risk of metastatic recurrence at all and perhaps be better than nothing?

I'll talk to my oncologist when I see her again but my appointment is weeks away. It looks likely that I can't take AIs or SERMS because both have caused intolerable side effects. For a short time I was on only the Lupron and didn't feel too bad during that time. I'm 43.

Esther01 · June 2021

Hi Orangeflower,

I am premenopausal and did neoadjuvant hormone therapy for a few months ahead of my surgery a few days ago. I was on both tamoxifen and Zoladex monthly injection for ovarian suppression.

I didn't like being on tamoxifen. I started to have a little spotting, so they pulled me off of tamoxifen last month ahead of surgery.

I read a study that said both Tam and ovarian suppression are equally successful to prevent recurrence, but the ovarian suppression alone without Tam could cause osteoporosis which I don't want.

I am going to ask my integrative doctor what she recommends that might be natural. I have great oncologists, but I know they are limited to mainstream top-down side-effect causing drugs while my doctor is a biochemist/scientist/researcher practicing 40 years and offers a lot of natural alternatives.

I'll post again if she tells me anything that I can pass along.

Blessings,

Esther

ShetlandPony · June 2021

This is indeed a question for the medical oncologist, but fwiw I remember my surgical oncologist saying oophorectomy was how they used to treat premenopausal women before they had tamoxifen.

ElaineTherese · June 2021

Hi!

What percent were you re: estrogen? 95% of my cancer cells tested positive for being estrogen receptive. For me, OS + AI felt worth it. However, my side effects have been tolerable for the most part. Now that I'm in my sixth year, I'm looking forward to stopping these meds, as they have made it more difficult to exercise (annoying joint pain).

What was your oncotype score? If it was low, then maybe forgoing adjuvant therapy isn't a big deal.

orangeflower · June 2021

Hi. The percent ER+ was 87.8%, and my Oncotype score was 7. The bigger tumor was 1.6cm, and the smaller one was 0.3cm. There was extensive DCIS. My oncologist used the RSPC tool to determine that with 5 years of tamoxifen, my distant recurrence rate is 5% at 10 or 15 years (I can't remember which). I was almost 42 when I was diagnosed and am 43 now.

ElaineTherese · June 2021

A 7 sounds pretty good to me. I guess the only thing that is slightly worrisome is that your cancer was Grade 2. If you ask your oncologist about OS alone, let us know what she says. I'd be interested to hear her thoughts.

ShetlandPony · June 2021

You are young and have a lot of years to live ahead of you, and you tolerated Lupron well. In your shoes I would be very interested in continuing with ovarian suppression.

kathabus · June 2021

You may want to read up on the SOFT (Suppression of Ovarian Function Trial) and the TEXT (The Tamoxifen and Exemestane Trial). They were trials that compared data about ovarian suppression/Tamoxifen/AIs in premenopausal women.

I am on OS(had an ooph) and AI, but I had a positive lymph node. Like Elaine above, my side effects have been tolerable so far.

It's a very interesting discussion, especially for stage IA. Please let us know what your MO says about this. I'm very curious.

orangeflower · June 2021

Hi there. I think those trials looked at adding OS to tamoxifen or AI, not OS alone. I did find this information on BCO. It seems to suggest two years of Zoladex is equivalent to two years of tamoxifen. The study is from 15 years ago, only looked at 2 years of endocrine therapy not 5 or more, and only followed the women for 10 years. Still, it sounds like OS alone does provide a benefit:

https://www.breastcancer.org/research-news/2009022...

I have kept a detailed diary of my experience with endocrine therapy, and during the few weeks I was on OS alone, I did write things like "nausea, poor appetite, fatigue for days, irritability, sensitivity to light and sound." Ugh...I seem to remember it not being as bad during those weeks, but several changes were made over the past year, so I can't quite remember. I did go in and out of menopause on it because they were giving me the 3 month shot at first, and it wore off! Maybe if I was on the one month shot consistently for awhile, it wouldn't be so bad. I'm probably grasping at straws because I don't want to give up on endocrine therapy. I do feel that the past year of my life got thrown away because of my struggle with all the side effects.

ElaineTherese · June 2021

orangeflower,

Even though I've called OS + AI "tolerable," I've had to take meds to address the side effects of OS + AI. I'm on Celexa for moodiness, and Prolia for bone density loss. I am on the monthly shot by the way.

Ovarian suppression only as adjuvant treatment?

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