Ovarian Suppresion for Pre-Menopausal Women - What is the Latest?

[bejuce]

Hi everyone,

I had my original biopsied tissue retested for its ER status and I found out that I am 30 % ER+ (2+) instead of 5 %. My oncologist had already put me on Tamoxifen as soon as I finished my radiation treatment, and I'm glad that she did so.

My question is whether I should consider adding Zoladex shots to my treatment. I finished chemo at the end of July, had my surgery in August, started radiation in September, and had a period in October (hasn't returned yet on the Tamoxifen). I'm also on Herceptin and I've had 7 infusions so far (one before my surgery).

Can anyone point me to studies/papers that have looked at the combination of Tamoxifen/ovarian suppression vs. Tamoxifen alone for pre-menopausal women (and especially HER-2+ ones?) My oncologist mentioned the SOFT trial but that is still ongoing.

What is the latest recommendation on ovarian suppression with Taxomifen?

Thanks!!!

Marcia (bejuce)

[Becky]

http://theoncologist.alphamedpress.org/cgi/content/abstract/9/5/507

http://www.guardian.co.uk/lifeandstyle/besttreatments/breast-cancer-treatments-ovarian-ablation-for-early-breast-cancer
http://jnci.oxfordjournals.org/cgi/content/full/95/24/1811


I attached some articles for you to review. At SABCS 2007, this was a hot, hot topic and alot of posters and presentations saying it is better to suppress the ovaries and give Tamoxifen or an AI. Theoretically, if you are truly suppressed, then you could take an AI versus Tamoxifen as you truly would be deemed postmenopausal.

There are also the BRCA studies of having the ovaries propholactically removed (as BRCA mutations cause breast and ovarian cancers). They found that BRCA 1 women who removed the ovaries first and then just did surveillance on the breasts got far less bc's than BRCA 1 women who did not remove the ovaries.

There are studies (old time prior to "abalation drugs" that state that ovary removal reduces new bc rate by 68% but it studied rate of a new bc not recurrence rate of bc.

There is alot of info out there and it is a hotly researched topic. I think the overall concensus is that ablation does improve the odds overall (and that does make sense).

[bejuce]

Thank you, Becky! My oncologist had mentioned Dr. Davidson's work and this is exactly the article I need to read. I'll review and think about whether to go the ovarian suppression route.

Thanks!

Marcia (bejuce)

[Jackie07]

Didn't remember if I had posted this '2nd opinion' from my 2nd Sister-in-law's breast cancer oncologist. I had e-mailed him about my planned hysterectomy/oophorectomy in January. And here was his reply:

Since your breast cancer is ER (+), although the percentage of ER is 5-10%. Hormonal therapy with tamoxifen or AI (arimidex) is the treatment of choice.

The disadvantage of tamoxifen: Uterine myoma, uterine carcinoma...etc. but less osteroporosis.
The disadvantage of arimidex (AI analogue): severe osteroporosis..

Conventionally, chemotherapy will destroy the ovarian functions, oophorectomy, therefore, is not necessroy.
But if you still have menstration indicating the normal ovary function, oophorectomy and hysterectomy (to avoid uterine tumors) followed by
tamoxifen treatment are treatments of choice.

According to your questions below, my answer is:

If you have still menstration now, surgical removal of ovary and uterus is advised, provided chemotherapy did not destroy ovary functions.
Both tamoxifen for 5 years and tamoxifen 2 years followed by arimidex 3 years are fine for your condition.

Please remember that the above-mentioned information is my 2nd opinion.
You should consult your attending doctor for final decision..

[Unregistered]

I got two medical opinions (two different oncologist) when I was debating whether to take Tamoxifen or just do ovarian suppression (Zolodex). Both told me that T and Z would give me an equivalent benefit, but that doing both together would give me a slightly greater benefit.

Good luck.

[Lien]

I did Zoladex and Arimidex for 5 years and didn't have too much trouble with side effects.

Some more info can be found at: http://www.medscape.com/viewarticle/704792

Love

Jacqueline

[bejuce]

Well, ladies, after my period in October, I got one in January and another one yesterday. Is this spacing between them normal for someone on Tamoxifen? As you can tell, I have not done anything on the ovarian suppression/ablation route...

Thanks!!