First Post/Strange Question

[Gary]

Hello all...

First post ever. What a great resource! I admire each of you for your support, courage and insight. Thanks!

My wife was diagnosed in January, 2004 with Stage IIIa breast cancer. Her tumor was 7 cm. She had a mastectomy with tram flap reconstruction. She was her2+ and er+. Her pr number was 30%...not sure whether this means pr+ or pr-(maybe someone could help me with this one). She participated in the Herceptin trials for 16 weeks but had to withdraw because her injection fraction dropped to 40% (it has bounced back to 60%). She was taking Arimidex. Her last ct/bone scans were in April, 2007 and she remains cancer free.

Here's my "strange question". Last week, my wife's period returned after 3 1/2 years. Her oncologist was quite surprised since they have monitored her menopausal status every six months through blood tests. She had another blood test last week after her period...sure enough her menopausal status had changed from post to pre.

Given this turn of events, her oncologist provided two options. First, my wife could get "the shot" that shuts down her estrogen production and remain on Arimidex. Or, she could simply switch to Tamoxifen. Her oncologist suggested that she switch to Tamoxifen. She said that, while Arimidex has proven superior to Tamoxiven for post menopausal women, it has not been proven superior for women who are artifically placed in a post-menopausal phase.

I am not second-guessing her oncologist...she is absolutely wonderful! She has been on the leading edge of technology throughout my wife's treatment. Just wondering if anyone has had a similiar experience?

Thanks,

Gary

[trixkit]

Hi Gary,

Don't have an answer to your question, but have one for you.

How long did it take for you wifes ejection fraction to bounce back? My wifes went down to just under 40 a few months ago, it's not getting any worse, but has yet to come back.

Thanks
John

[Gary]

Hello John...

I don't recall the exact time frame...I would guess around 4 to 5 months.

Good luck,

Gary

[Becky]

Dear Gary

You do not mention your wife's age. My period also came back and I had my ovaries removed to stay on Arimidex. AIs are proved superior if you are not highly ER+ and PR+. Your wife is PR+ but just moderately so. Highly positive is in the 70%+ range. Also, since she is only moderately + on at least PR, she is also Her2+ which is another indicator that an AI would work better. However, age does play a factor here too. I was 46 when I had my ovaries removed and would be 47 in a couple of months from then.

Lupron or Zoladex shots work well but are not as good as oophorectomy but it is an option in those under 40 or if you want to consider having a baby.

[Gary]

Hello Becky...

Thanks for the reply. She was 44 when she was first diagnosed and she is now 48. Her er number was 90% (highly positive). No plans for more children.

Gary

[Becky]

Then your wife and you should seriously consult with not only her oncologist but others on her healthcare team - to include a gynecologist and possibly an endocrinologist (as well as a second opinion oncologist) on what exactly to do. For me, there was no question as I am moderately ER+ (50%) and PR neg.

I believe my choice was right for me after research and consultation and I believe you should do the same.

[Joanne S]

I can only speak from my personal experience. I was having periods prior to my cancer diagnosis. Since chemo, radiation, herceptin, I have not had a period. My oncologist has put me on Tomaxifen and advised me if I started a period to notify her immediately for a shot. She does not want the risk of allowing the body any generation of estrogen that can be controlled. She has encouraged me to have my ovaries removed as studies have proven that Tomaxifen does not work as well with women that ER+ with HER2+. I found the same info somewhere on the internet. My doctor feels that Arimidex is the better choice for ER+ women with HER2+. Perhaps you could research this area before making any decisions. Please keep us posted. Best to you and well wishes to your wife.

[madubois63]

While on Tamoxifen, my period came back. I truly believe I should have had my overies removed then (various other problems came about that have made it difficult for me to have any unnecessary sugeries for a while). I had a relapse and was then switched to Femara and Lupron shots were added to my treatment plan. I am a big beleiver in getting rid of it if your not going to use it! Just my opinion. Lupron shots are given every 3 months and are a very easy solution too...Good luck on the decision.

[TSund]

We are soon to face the same dilemna. Ruth was also having regular periods pre-dx/chemo.

Did I read someplace on this site that there was a trial combining tomixifen and then AI's?

TRS

[Susan]

Hi All: I'm going to the gyn. on Monday for an eval. My periods started back up again after 1 year. I guess we're going to talk about ooph. I'll know more next week.

[saleboat]

You may want to check this out:

http://breastcancerupdate.com/bcu2007/4/perez.asp

Dr. Edith Perez says that for those hr+ women who have had adjuvent Herceptin, there isn't (yet) any DFS difference between those who took Tamox and those who took an AI. Time may tell a different story, but there is a lot of data out there that does not account for the adjuvent use of Herceptin.

Me, I'm happily on Tamox. I was highly both ER and PR positive. I am too young for menopause and after consulting with three different Oncs, they all recommended the Tamox, so I let it go at that. Shutting down or removing the ovaries at a young age can have serious health consequences that should be considered.

Jen

[Joanne S]

Jen, This is so confusing for me. I clicked on the site: http://breastcancerupdate.com/bcu2007/4/perez.asp

http://breastcancerupdate.com/bcu2007/4/images/1_1.gif
I didn't understand the chart so I clicked on Abstract 48: which opened a new window: http://www.abstracts2view.com/sabcs06/view.php?nu=SABCS06L_406


[48] Relationship between quantitative ER and PgR expression and HER2 status with recurrence in the ATAC trial.
Dowsett M, Allred DC, on Behalf of the TransATAC Investigators.. Royal Marsden Hospital, London, United Kingdom; Baylor College of Medicine, Houston, TX

Purpose: To determine the relationship between quantitative estrogen receptor (ER) and progesterone receptor (PgR) expression and human epidermal growth factor receptor 2 (HER2) status with disease recurrence, in primary ER+ and/or PgR+ breast cancer patients treated with adjuvant anastrozole (A) or tamoxifen (T) in the Arimidex, Tamoxifen, Alone or in Combination (ATAC) trial (ISRCTN18233230).

Background: The ATAC trial randomized 9366 patients to 5 years treatment with A or T or the combination. Following analysis of the results of the main ATAC trial at a median follow-up of 33 months, the combination arm was discontinued since it was no more effective than T alone. After a median follow-up of 68 months, it was found that A prolonged disease-free survival significantly compared with T in ER+ and/or PgR+ patients (hazard ratio 0.83; 95% confidence intervals 0.73, 0.94; p=0.005). ER, PgR and HER2 expression have each been reported to influence responses to aromatase inhibitors and T differentially.

Materials and Methods: Retrospective consent to tumor block collection and biomarker analysis was sought from patients with ER+ and/or PgR+ tumors in the A or T arms (total number eligible: 5880). Tissue sections were cut and tissue microarrays (TMAs) were constructed. Immunohistochemical stains for ER (Novocastra 6F11 on TMAs), PgR (Novocastra 312 on sections) and HER2 (DAKO HercepTest on sections) were performed. Scoring systems were ER: H-score; PgR: percentage of positive cells; HER2: staining classification on a scale of 0 to 3+ (positive status 3+ or 2+ if confirmed by FISH). Relationships between biomarker expression and recurrence will be assessed by proportional hazards analysis.

Results: 1792 blocks (30% of total eligible) have been collected and are being tested. All blocks collected by the end of September 2006 will be analyzed. A total of >2000 blocks is anticipated at that time. Acknowledgements: We are grateful to the many investigators and pathologists who have collaborated in this work. Financial support was provided by grants from AstraZeneca and Breakthrough Breast Cancer.
Sunday, December 17, 2006 11:15 AM
General Session 7 (9:00 AM-11:30 AM)

Anastrozole and Arimidex are the same thing so I don't think I'm missing the boat???????