Tamoxifin and Herceptin

[Laurel]

Thanks, Becky. I was tested initially upon dx for these and they were quite low. Will request testing again on Wednesday. Did you see this?

ARIMIDEX Offers Women Greater Protection Against HR+ Early Breast Cancer Returning In The 1st 2 Yrs

13 Mar 2009

"Anastrozole is the only aromatase inhibitor (AI) which has now been shown to prevent recurrences in women with hormone receptor positive early breast cancer both during the initial high-risk two years after surgery, and also well beyond the completion of treatment. In breast cancer there are no guarantees and we can't predict which women will experience a recurrence or when, so it is essential we have a treatment that has sustained efficacy against all types of recurrence that persists even after treatment is completed. If we can stop breast cancer returning, we can stop women dying from it." - Professor Tony Howell, Christie Hospital, UK

Macclesfield, UK, Friday 13 March 2009: A new analysis of the ATAC (ARIMIDEX, Tamoxifen, Alone or in Combination) trial, presented today at the 11th International St Gallen Oncology Conference, Switzerland, shows that during the first two years after surgery, anastrozole is superior to tamoxifen at reducing the risk of breast cancer returning in postmenopausal women with hormone receptor positive early breast cancer (n=5,216).1 Anastrozole has consistently demonstrated superiority over tamoxifen, both during the five-year treatment period and beyond treatment completion.2 This latest analysis provides further reassurance that prescribing anastrozole from the start protects women in the crucial first two years when the risk of recurrence is highest, meaning that fewer patients have to be told the devastating news that their breast cancer has returned.

When breast cancer returns, particularly outside the breast at distant sites such as bone, liver or lung, it is no longer curable. Therefore protecting women from recurrence is the number one priority for doctors and is imperative to saving lives. Although the risk of recurrence can persist for up to at least 15 years,3 the risk is at its greatest within the first two years following surgery, as seen in the ATAC study where over half of all excess recurrences and deaths among patients taking tamoxifen occurred in the first two and a half years.2

This latest analysis confirms that in women who benefit from treatment with AIs (84% of the total ATAC population) anastrozole is even more effective at preventing all types of early recurrence (32%; 2 years post surgery) than previously seen in the broader study population (17%; 2.5 years post surgery).1

Professor Howell continued, "It is now standard practice to assess the hormone receptor status of breast tumours to guide the best course of treatment. ATAC is a ground breaking study which has led to a significant change in treatment strategies in breast cancer with aromatase inhibitors, such as anastrozole, now replacing tamoxifen as the standard of care for postmenopausal women with hormone receptor positive disease in many countries. These new findings confirm that in the women who receive it in routine clinical practice, anastrozole offers reassuring protection against their cancer returning at the time of greatest risk, giving women the best chance of continuing their lives cancer-free."

The ATAC trial is one of the world's largest and longest-running clinical studies in postmenopausal women with early breast cancer. With a median follow-up of 100 months - significantly longer than any other adjuvant AI trial - ATAC provides further information on the safety profile of anastrozole which remains predictable, with no long-term safety concerns. As a result of the weight of efficacy and safety evidence for anastrozole, it is now the most widely prescribed AI worldwide, with over twice as many prescriptions as the next most widely prescribed AI and over 4 million patient years' experience.4 These new data will offer doctors treating hormone receptor positive postmenopausal early breast cancer further confidence that initial treatment with anastrozole offers women the best chance of staying recurrence free.

Anastrozole offers sustained protection against recurrence, demonstrating significantly superior disease free survival, time to recurrence, time to distant metastases and reduced incidence of contralateral breast cancer compared with tamoxifen - a benefit which increases over time and persists even after treatment ends.2

In ATAC, there were fewer recurrences in women with hormone receptor positive breast cancer treated with anastrozole (n= 2,618) than tamoxifen (n=2,598) at 2, 5 and 9 years post-surgery (91 vs 133; 245 vs 312; 385 vs 488 respectively).1

At a median follow-up of 2 years, compared to tamoxifen, anastrozole:1

- reduces the risk of all recurrences by 32% (HR 0.68 [0.52-0.88])
- reduces the risk of distant metastases by 21% (HR 0.79 [0.58-1.07])
- reduces the incidence of contralateral breast cancer by 78%.

ATAC Trial

The ARIMIDEX, Tamoxifen, Alone or in Combination (ATAC) trial is one of the world's largest and longest-running clinical studies in postmenopausal women with early breast cancer. ATAC is designed to investigate the comparative efficacy and tolerability of two adjuvant therapies: ARIMIDEX (anastrozole) and tamoxifen.

This analysis of ATAC reinforces the significant superiority of ARIMIDEX over tamoxifen at reducing the risk of breast cancer returning (also known as 'recurrence') in postmenopausal women with hormone receptor positive early disease.1 The ATAC data also show that, even approximately four years after treatment completion, the absolute reduction in the risk of disease recurrence continues to increase with ARIMIDEX compared with tamoxifen.2

[Gerri]

Hi Laurel,

I am triple positive (not as highly as you) and was premenopausal when dx'd at age 52. My onc put me on Tamoxifen and the plan was to be on it for two years and then switch to an AI. The assumption was that by that time I would be postmenopausal. I had my FSH, LH and Estradiol levels checked periodically during treatment - they always came back as premenopausal. Right about the two year mark I started getting antsy to be put on an AI, mostly because I had read that poor metabolizers of Tamoxifen do not have hot flashes - I got very warm at best. I was getting more frequent warm flashes so my onc ran the levels again. Two out of three (LH and Estradiol) came back as postmenopausal. My FSH was still in the premenopausal range. My onc consulted an endochrinologist who recommended that I have a more in-depth test called the Anti Mullerian Hormone Test. It is also a blood test but most often has to be sent out for the results. Mine came back as being definitely postmenopausal so I started on Femara. My side effects are basically the same as when I was on Tamoxifen. I guess I just don't overheat as much as everyone else...for that I am grateful.

Best of luck to you. I hope your results show that you are officially postmenopausal and can move on to an AI. Who would have thought (pre dx) that we would be wishing to be declared postmenopausal - something most women dread....Ah, the crazy mixed-up world of bc.

[Laurel]

Thanks, Gerri! Anti Mullerian Hormone Test for me! Anymore triple pos. gals/guys out there to weigh in? Perhaps I should post a call separately?

[sassy]

Laurel,

I am triple positive and have been on Arimidex from the start. I was 45 at dx, and nowhere near menopause. My onc began me on Lupron shots for estrogen suppression so that I could start Arimidex. At the time my surgeon did not want me to have my ovaries removed because of non-cancer related reasons.

When my surgeon was comfortable with moving forward with Oophorectomy, my onc had info from ongoing studies indicating that Lupron was beneficial in preventing recurrance, so he wanted to keep me on Lupron. I've been on both Lupron and Arimidex for 3 1/2 years. Both do have some side effects, but I feel that they are worth it if it helps keep the beast at bay.

Regards,

[Jackie07]

This thread has provided so much information - everything I wanted to know and needed to ask my doctor about in the next few days.

Since I am going to have my 3rd breast [cancer?] surgery - April 2nd - to remove a lump in the r. underarm/chest scar line, I am definitely going to (1) ask my surgeon tomorrow if I need to stop tamoxifen right now to prevent blood clot; (2) ask my surgeon if I could have a liver function test, protein (AFP) test, and an ultrasound for the liver; (3) ask the medical oncologist if I should switch to Arimadex after (4) (if I should take lupron or remove ovaries) confirming post menopausal status - haven't had the monthly stuff since a couple of months after starting chemo in late summer of 2003. (Never could quite distinguish/recognize post menopausal symptoms because of my very 'disturbed' brain.)

I will have my pre-operation assessment Wednesday morning - hopefully the echocardiogram will have good result - had to stop Herceptin in 2007 after just 22 weeks due to decreased MUGA score. (would it help if I start 'walking' hard next two days?)

I will start another thread 'solicitating' prayers on April Fool's (Ha! Ha!) just before the surgery date - could you believe I was scheduled to have it done on April 2nd? I wondered if there's surgery scheduled on April 1st at all. (might not be safe?