A warning, about ovarian suppression and AIs....
 

I've seen lots of posts here recently about ovarian suppression (which I am doing, zoladex shots) and women taking AIs. My oncologist has always refused to give them to me without my ovaries out, thus I've been taking the dreaded "T" drug being her2 positive, which has always bothered me.

Now, I'm actually glad.

I have a friend with metastatic BC in Kansas City who was on lupron for 15 months and AIs (forget which one). Well, in the 15th month her period started! They tested her estridol levels, and sure enough she was premenopausal. I didn't know that could happen. So the AIs were not effective, and her cancer had spread in those last few months. When she went to get her ovaries out the next month, they found cancer in BOTH of her ovaries.

Be very very careful if you are on AIs without your ovaries out. Check for any signs of ovulation and get those levels checked. Better yet, just have the surgery and be done with it.

Rose

Thanks Rose,

My gyn wants to do routine trans-v U.S every year or two because of BC. So this is something else to watch for. Bev

Rose,

I am on Lupron and AI (for 7 months now) and they continually check my estradol (sp) levels. They are staying where they should be for post meno. Surgery was not advisable for me for several reasons. I am surprised her levels where not checked continuously.

Sassy
________
WildCATblond

Hey Rosebud,
This stuff is over my head. Can you give me the "reader's digest" version please? What is the interaction between lupron and AI's?

Thanks,
Al

ovarian suppression
 

In the past this has been a much more common strategy in Europe, where Zoladex shots have been given to premenopausal women in conjunction with Tamoxifen, and now the AIs. Basically the AIs only work for women who are postmenopausal, so many are now choosing to become postmenopausal, either through having ovaries taken out (some use to have them radiated) or having their function suppressed with Zoladex or Lupron. Once the Lupron or Zoladex is clearly working (and there is some debate about how to demonstrate this) then it is ok to begin on AIs. Lupron is more convenient for some because it can be given in a three month dose. This is what Rachel is doing, and has had no problem with.

There are a number of huge trials testing a variety of hormonal approaches, including ovarian suppression + AI that are going on right now. This has been of particular interest to women with her2 disease because of the notion that many are tamoxifen resistant (and there is some thought that what is really going on is that a larger than expected number of her2 positive women are er+ but pr negative, and that this might be the key).

Best to all,
Jeff

breaking ER drug resistance
 

It's also been demonstrated that HER2 women with ER drug resistance can reverse this with HER1 inhibitors such as tarceva or iressa. I always thought breaking that resistance was a no-brainer with the newer drugs. Or is this something that is not general knowledge?

Al

Al is right...
 

about Her1 inhibition if ER+ tumors are resistant (regardless of Her2 status) and especially if PR is neg or very low.

Becky

what are AI's?

Aromatase Inhibitors. Used for women who are post menopausal instead of Tamoxifen.
Marlys

Marlys, thank you for your answer. AI's are only given to women who are post menapausal and were estrogen and/or progestin positive though right? I was er/pr negative but her2+ node negative stage1 grade3.