Aromasin better bet than Arimidex/Femara?

[Rich]

I have read that non-steroidals may be more vulnerable to hormonal therapy resistance than the steroidal Aromasin. Yet, it seems that non-steroidals(esp Arimidex) are far more often prescribed. Any thoughts?

[SusanAnne]

Hi Rich,

My guess is that since Aromasin is the newest of the AI's and therefore has the least amount of data out there regarding it, the docs want to wait before prescribing it widely. That way they can also keep it in reserve until the others fail someone.

Susan

[jojo]

Honestly, I have never learned that some of AI's are non-steroidal, some others steroidal -- this is new to me. Also, I am not too sure that Aromasin is the newest AI; I have thought that Femara was the newest....

To my knowledge: for the hormonal therapy (on AI's), Femara is known to be the first-line therapy, due to its such successful study data (longer survival 50% more than Tamoxifen. If Femara failed, the next one would be Faslodex, then Aromasin. I first took Femara, but had to switch to other hormonals, when I had recurred on Femara. So, Faslodex & Aromasin respectfully both have put me in stable, just for several months, although not long-term. I guess that is better than sooner getting disease progression!

Have never taken Tamoxifen before -- my onc simply has not brought that up in conversation at all, not even once. So, I wonder if she is at all a fan of Tamoxifen...

Is Arimidex steroidal, too?

Rich & anyone else, if you find out anything more about these AI's, do let me know! Thanks

[*_AlaskaAngel_*]

First tamoxifen came out.
Then Arimidex.
Then Femara.
Then Aromasin.

Although Arimidex, Femara, and Aromasin are all aromatase inhibitors, Aromasin is different from Arimidex and Femara in that Aromasin is a steroidal, and in that it actually works differently and more permanently than Arimidex and Femara. This could be a good or bad, possibly, depending on what effects it has that are not as desirable as the effects it has that are, and none of the 3 AI's have a really long history yet of being studied long-term. None of these are perfect solutions. Joint pain is a very common complaint with the use of aromatase inhibitors. They all are intended to stop the production of estrogen in the body.

AlaskaAngel

[jojo]

Alaska Angel, I would have not noticed that Aromasin was steroidal. I have been on it for a few months already, and I do not feel any side effects.

Decadron definitely yes, but not Aromasin -- at least, in my case. Just wondering about the combo of Decadron & Aromasin, though... would that alleviate extra, or more intense, side effects of being on "steroids"?

Thanks for your informative post! :-)

[*_Scott_*]

Rich,

Some Dr.'s think Aromasin(Exemstane) may have a slight advantage because it irreversibly binds aromatase where the other two do not. Some Dr.'s say there is no difference because they all inhibit estrogen production so well it doesn't matter. Time will tell, but there definitely is some data that suggests Aromasin is more bone friendly than the other two and this is due to its steroidal nature.
The reason why some drugs tend to be more popular than others is marketing. Arimidex had the best sales pitch and it got the most publicity.

[al from canada]

Scott,
It was my understanding that most "steriodals" induce ostiopenia or pourosis. Just wondering if this doesn't apply here?
Regards,
Al

[SusanAnne]

Hi Al,

Just to add my two cents about osteoporosis. I was diagnosed after my chemo ended with osteoporosis of the spine (-3). I just had my 1 yr. followup DEXA scan and my bone density has improved dramatically, now at -1.5 (osteopenia). Yeah for Fosamax, calcium supplements and exercise! FYI, three months of the past year I was on Tamoxifen, the rest on Arimidex.

Susan

[Lolly]

Susan, what's your dose of Fosamax, if you don't mind my asking? I also was dx'd with osteopenia, at -1.7 currently. On calcium supplements etc, but couldn't handle side effects of weekly 70 mg Fosamax. Joint/muscle pain and fever/fatigue; wiped me out for most of the week, then would staart to feel better just in time for another hit! Worse than most chemos I've been on. I know I must do something if my DEXA this year shows more progression, so I've talked with my doctor about cutting the 70 mg dose in half, since 70 mg was approved for actual osteoporosis, and osteopenia being pre-osteoporosis...Just wondering how you're doing on it. I know several others who take it with no problems, my mother-in-law included, don't know why it's so hard on me.

<3,
Lolly

[Rich]

So it's not for adjuvant yet?
http://www.mydna.com/resources/news/200504...08_trbrcan.html (http://www.mydna.com/resources/news/200504/news_20050408_trbrcan.html)

[*_Scott_*]

Al,

I recently talked with a hormonal expert in Boston about Exemestane, and he really thinks this will be the A.I . of choice. It continues to be effective in cell lines that have grown resistant to the other two in culture and also has the added benefit of being more bone friendly.
Due to its steroid nature, Exemestane mimicks a testosterone precursor leading to the masculinization of the skeleton and denser bone as seen in men. Years ago they actually prescribed testosterone for breast cancer and it was effective, just that women grew facial hair and deepened voices, so the side effects were deemed unacceptable.
In this case, the side effects of Exemestane are beneficial to bone health, but you won't see any of the secondary side effects as seen with testosterone. The Dr.'s name is Paul Goss for anyone that is interested, and he is in the literature on the internet.

Thanks,

Scott

[al from canada]

Scott,

Thanks for the reply. Maybe you can help answer this question about AI's and chemo. What is the current thought on concurrent administration of AI's and chemo. I know that one school of thought advocates stopping hormonal therapy when on chemo but with the new drugs out there, it's hard to keep up. Is this a question we should be asking Paul Gross??

Regards,
Al

[Rich]

http://www.pfizer.com/are/investors_report...08_09_10_11.htm (http://www.pfizer.com/are/investors_reports/annual_2003/review/p2003ar08_09_10_11.htm)

"Yet many eyes are on the newest aromatase inhibitor, Pfizer’s Aromasin. Currently approved for advanced metastatic disease, Aromasin differs from its two competitors in how it blocks an enzyme that produces estrogen. It is also unique in acting as a weak male hormone, which may help control breast cancer and protect or even promote bone density. (Anastrazole and letrozole are linked to more clinical fractures.)

"Emerging data suggest that Aromasin possesses both a therapeutic advantage for treating breast cancer and also a general women’s health advantage," says Dr. Paul Goss of Toronto’s Princess Margaret Hospital, architect and leader of the letrozole trial. "That’s why Aromasin is the key drug in all imminent hormonal therapy trials under way in early-stage breast cancer." Goss is leading key Aromasin trials in early breast cancer and breast cancer prevention."

So...seems like some data is leaking out. Maybe someone can press Dr. Goss for details?

[AlaskaAngel]

Scott and Jojo:

Steroids are generally avoided as much as possible in medicine and used as briefly as possible. (That isn't to say that they won't prove to be a good answer for breast cancer; but it is why I personally would be very reluctant to jump on the bandwagon for exemestane since it has such a short history of use. So Jojo, in answer to your question my thought is that using 2 steroids may be even more cumulative in whatever adverse effects steroids have, even if they make one feel better for a time while they are being used.)

Scott, your information about the testosterone-like effects and former use of testosterone itself to treat bc particularly interested me. I am a participant in the clinical trial for low-dose testosterone use by NED bc survivors, and in the scramble of use of all the different choices of drugs to try to treat cancer, I don't find it foolish to give equal serious consideration to "natural" substances such as testosterone. (I am aware that widely-known bc sources such as Dr. Love caution that testosterone may be dangerous for bc patients to use.)

I'd be interested in any particular references you have to the past or current use of testosterone itself.

A.A.

[SusanAnne]

Hi Lolly,

Wow, I haven't heard of anyone having such a reaction to Fosamax. Most of the time it's the stomach upset that folks complain of. I guess I'm lucky to have absolutely no side effects (except to gain bone density!). I am on the 70mg dose once a week. My mom is on Actonel 35 mg once a week. Don't know if it would be any different for you but I know it comes as a 5 mg tab as well. Also, I'm not sure about Zometa infusions. Do they reserve that only for bone mets pts. or do they use it to treat osteoporosis? A once a month treatment sounds convenient! I wish you luck on your next DEXA and hope you don't need any of these options.

Take care,
Susan

[*_Scott_*]

AlaskaAngel,

I don't want to confuse anyone by saying Exemestane mimics a precursor to testosterone or that its steroidal. It's not testosterone or a steroid like decadron. There would be no steroid side effects. It's side effects are similar to the other two AI's. It just has an additional benefit that it irreversibly binds the aromatase enzyme unlike the other two which may detach and need a second molecule to come along and bind aromatase. This is due to its "STEROID-LIKE" structure, which also looks like the precursor to testosterone which is beneficial to bone building. So, its not a steroid as we think of to reduce inflammation or suppresses the immune system or to hit a baseball farther.

Sorry for not being clearer,

Scott