hopeful case report--letrozole cleared up multiple brain mets

[Lani]

: Acta Neurochir (Wien). 2008 May 6 [Epub ahead of print]

Excellent response to letrozole in brain metastases from breast cancer.

Goyal S, Puri T, Julka PK, Rath GK.
Department of Radiotherapy and Oncology, All India Institute of Medical Sciences, New Delhi, India, drshikhagoyal@gmail.com.
Breast cancer with multiple parenchymal brain metastases carries an extremely poor outcome. Cranial radiotherapy improves survival by only a few months and the role of systemic therapy is marginal and largely unexplored. We report a patient with recurrent carcinoma of'breast presenting with multiple bilateral cervical nodes and brain metastases manifesting as a right hemiparesis and facial nerve palsy, who was treated with palliative whole brain irradiation and letrozole. At the follow up at 20 months, neurological function had fully recovered, and both cerebral and extracerebral lesions had completely resolved, with calcification of the cerebral lesions. This report suggests that letrozole has beneficial effects both in extracranial and intracranial disease in hormone responsive metastatic breast cancer.
PMID: 18458809 [PubMed - as supplied by publisher]

[Soccermom]

Had to look up Letrozole and for those of us that are novices...its Femara! Incredible news that taking a pill and radiotherapy can have such good results on hormone positive brain mets! I have a question...how do they ascertain that the brain mets are hormone positive? If one is hormone positive on initial diagnosis if one had mets to brain are they necessarily hormone positive? Thanks Lani
Marcia

[Jean]

Lani,
This Femara get better and better!

Once again dear Lani, we appreciate your updates.

Hugs,
Jean

[Gerri]

Arimidex or Femara? I have been taking Tamoxifen for 2 years now and am most likely in menopause at last (will get results of Anti Mellerian Hormone test today to confirm). I will be switching to an AI and my onc is leaving it up to me to decide which one, but clearly favors Arimidex due to the data. With all the current research out on Femara is this my best bet?

I would really appreciate some feedback.

Thanks!!!!

[Hopeful]

Gerri,

There have been some study results recently that show that Femara supresses aromatase to a lower level than Arimidex. That said, the difference dosen't seem to be all that much. The action of the two drugs is very similar, though their chemical structures are slightly different (would need to be, for patent purposes anyway). Some patients experience side effects on one drug and not the other. IMO, whichever drug you can tolerate best would be the one to use. FWIW, Femara was initially intended to be taken after Tamoxifen therapy, so you could look up the studies that give the results on that specific protocol for some guidance.

Hopeful

[Gerri]

Thanks so much Hopeful for your response. That is pretty much what my onc said which is why she is comfortable with letting me choose. I will look for some studies on Femara and Tamoxifen and see if that sways me in that direction.

All my best,

[hutchibk]

hmmm I wonder what Femara and Tykerb might do together...

[Hopeful]

Geri,

You can look here for info on Tamoxifen followed by Femara: http://www.pharma.us.novartis.com/pr...e&source=01030

BTW, I recall reading that the brain is one of the largest sources of aromatase production in the body (stands to reason, there is a lot of fatty tissue). This study Lani posted may show that Femara crossed the BBB and inhibits aromatase in the brain - wouldn't that be great?

Hopeful

[Gerri]

Hopeful,

Thanks so much for that link, it really helps me with my decision. I'll send it off to my onc and maybe that will trigger a reminder that my results are in and she should call me :-).

Yes, the study Lani posted is very interesting!