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Debbie L. · 03-07-2011, 08:07 AM

Hi all,

There's one more (incomplete) piece to this question about lower doses of AI's, and it does (to me) signal a little caution. Last year a report came out, a sub-analysis from ATAC, that noted that although obese women did have a poorer prognosis overall, the ones on AIs (Arimidex as opposed to Tamoxifen) seemed to do even worse. Thus raising the question that the AI dose might be just "barely" enough for normal weight women and that obese women might need more. More study is needed of course, but in the meantime it's something to consider. (Not that I'm saying anyone is obese, but just that if it's that close, it could be argued that the usual dose for the usual-sized body might be just barely enough.)

http://jco.ascopubs.org/content/28/21/3411

Also, as for testing estrogen levels -- female hormone levels are notoriously difficult to pin down because even in perimenopausal women they fluctuate a lot. In addition, it seems from studies done on the breast vs. the body, that levels of estrogen and other players may be quite different within the breast than is measured systemically. Plus, when a breast cancer survivor is said to be "estrogen positive" -- that is referring to the estrogen receptors on the cancer cells and cannot be rechecked unless more cancer appears (recurrence or progression) to re-do the assay upon.

MJo, if you and your providers think you need more endocrine therapy after 5 years of an AI, why not give Tamoxifen a try? It's better tolerated in some ways, and as more studies report in, it seems its benefit over Tamoxifen becomes even more marginal. Also, early concern that it may be less effective for HER+ cancers has been refuted, so that's no longer an issue. HER+ cancers are more likely to have some resistance to all endocrine tx, not just Tamoxifen (but that does not mean they don't respond at all -- endocrine therapy is still an important part of treatment for triple-positive cancers).

Let us know what you decide to do, okay? I'm impressed that your brain fog lifted with a lower dose. I blamed Arimidex for my cognitive issues, but they did not improve (at all) when I stopped it after 2 years). So maybe for me, it was the chemo after all.

Debbie Laxague

03-07-2011, 08:07 AM	#8
Debbie L. Senior Member Join Date: Jul 2006 Posts: 463	Re: Lower dose of AI revisited Hi all, There's one more (incomplete) piece to this question about lower doses of AI's, and it does (to me) signal a little caution. Last year a report came out, a sub-analysis from ATAC, that noted that although obese women did have a poorer prognosis overall, the ones on AIs (Arimidex as opposed to Tamoxifen) seemed to do even worse. Thus raising the question that the AI dose might be just "barely" enough for normal weight women and that obese women might need more. More study is needed of course, but in the meantime it's something to consider. (Not that I'm saying anyone is obese, but just that if it's that close, it could be argued that the usual dose for the usual-sized body might be just barely enough.) http://jco.ascopubs.org/content/28/21/3411 Also, as for testing estrogen levels -- female hormone levels are notoriously difficult to pin down because even in perimenopausal women they fluctuate a lot. In addition, it seems from studies done on the breast vs. the body, that levels of estrogen and other players may be quite different within the breast than is measured systemically. Plus, when a breast cancer survivor is said to be "estrogen positive" -- that is referring to the estrogen receptors on the cancer cells and cannot be rechecked unless more cancer appears (recurrence or progression) to re-do the assay upon. MJo, if you and your providers think you need more endocrine therapy after 5 years of an AI, why not give Tamoxifen a try? It's better tolerated in some ways, and as more studies report in, it seems its benefit over Tamoxifen becomes even more marginal. Also, early concern that it may be less effective for HER+ cancers has been refuted, so that's no longer an issue. HER+ cancers are more likely to have some resistance to all endocrine tx, not just Tamoxifen (but that does not mean they don't respond at all -- endocrine therapy is still an important part of treatment for triple-positive cancers). Let us know what you decide to do, okay? I'm impressed that your brain fog lifted with a lower dose. I blamed Arimidex for my cognitive issues, but they did not improve (at all) when I stopped it after 2 years). So maybe for me, it was the chemo after all. Debbie Laxague __________________ 3/01 ~ Age 49. Occult primary announced by large (6cm) axillary node, found by my husband. 4/01 ~ Bilateral mastectomies (LMRM, R elective simple) - 1.2cm IDC was found at pathology. 5 of 11 axillary nodes positive, largest = 6cm. Stage IIIA ERPR 5%/1% (re-done later at Baylor, both negative at zero). HER2neu positive by IHC and FISH (8.89). Lymphovascular invasion, grade 3, 8/9 modified SBR. TX: Control of arm of NSABP's B-31 adjuvant Herceptin trial (no Herceptin, inducing a severe case of Herceptin-envy): A/C x 4 and Taxol x 4 q3weeks, then rads. Raging infection of entire chest after small revision of mastectomy scar after completing tx (significance unknown). Arimidex for two years, stopped after second pathology opinion. 2017: Mild and manageable lymphedema and some cognitive issues.