Femara or tamoxifen

Dear trigeek!

For aromatase inhibitors you need to be postmenopausal, which means you do not have a period for at least 12 months.So, I suggest you to go firstly with tamoxifen, for nearly 2 years, then if you are postmenopausal still after 2 years of tamoxifen(what I suppose you will be), switch to Femara or maybe better Aromasin for 3 years and then for 5 years of Femara. I believe this is going to be the best treatment choice of hormone sensitive breast cancer in the future.So, hormonal therapy for 10 years.

Femara is better to start with after 5 years of some other hormonal therapy.

Kind regards!

MATIC

I believe it is the BIG 98 study that shows Femara to be slightly more effective  than Tamoxifen as first hormone therapy after surgery .  The MI17 trial also shows Femara to be more effective but that is after 5 years of Tamoxifen. [

Dear LizM!

Well , I have one comment on your report.It is all true what you have written down but an oncologist Tanja Čufer,who is a worldwide known oncologist, told me that Femara was slightly better than tamoxifen when given after surgery ONLY in patients with aggressive tumours(those with ER+ PR- or HER-2 +), but not in patients with non-aggressive tumors.Tumors that express both ER and PR receptors need to be treated with tamoxifen if you are premenopausal at the beginning of the treatment and not with an AI!!!

Kind regards!

There seems to be more to it than just having low levels of estradiol. My gyn said some time ago, she had just been to a workshop about the topic - AI versus Tamoxifen for women who had been put into menopause through chemo. She said discussion about this was controversial but that as a matter of fact, researchers and doctors felt very uneasy of giving AIs in that stage. I asked why  and she said that for example even though I am in chemopause, it is obvious that my body and its functions couldn´t really be compared to those of a woman who had undergone menopause naturally (I am 46)  and that therefore they couldn´t be sure how the AIs would work and which side effects to expect because the AI-research had been done on truly postmenopausal women. I would have liked a slightly more scientific explanation, but I guess I trust her because I am not keen to be a guinea pig (especially since I am not part of the risk group with aggressive tumors mentioned by matic further up). 

There is another reason for me to be in favor of taking tamoxifen for the first two or three years and then switch to an AI rather than start off with an AI: It looks like they will recommend hormonal therapy to go on longer than the usual 5 years, as matic says further up, too. So far nobody seems to know how  long AIs actually work or whether they will stop to work eventually like they found out about tamoxifen. So the right sequence seems to be important in order to "survive" those ten years. 

On my German board there was just this case of a lady who had had ILC in 1993 (large tumor and many nodes affected)  and who had been fine until 2005 but deteriorated since. For the past three years they couldn´t find anything  but now finally they diagnosed  metas - apparently all of her organs show what they called a "thin metastatic coating" (Sounds very much like ILC to me) and her bone marrow had basically been completely destroyed . . They can´t do chemo or anything because of her blood situation but they start her off on an AI now. Imagine, this took 12 years to develop 5 of which she´d been on tamoxifen. 10 years of Anti-Hormone-Therapy might have bought her another five years!!

Then again, imagine taking these pills for such a long time without recurrence - what kind of effect will the long-term deprival of estrogen have on our health, on our life expectancy, on our quality of life? I guess we are all guinea pigs after all.....