HER2/neu+ and ER+ post treatment question

[Tricia L.]

I have just finished my radiation treatments and was ready to begin Tamoxifen until I read an article about a study being done on HER2+ and ER+ patients that says Tamoxifen may act like estrogen in these patients, acting like a growth factor. I have talked with my oncologist about treatment route and one way would be to remove my ovaries which would put me into a post-menopausal state and then I could take one of the aromatase inhibitors. Anyone familiar with this study? I know it is being done at Baylor University and is now just in clinical trials. Any thoughts pros and cons on ovary removal, etc... I am 45 years old. I had a lumpectomy and node negative.

[sassy]

Tricia,

I am triple positive and was recommended not to go on tamoxifen because it does not work as well with herceptin as AI's. I was 45 at dx and chemo put me into menopause. I asked about having ovaries removed. Surgeon and Onc wanted to wait to see where I was in menopause after chemo was complete. Testing indicated I was far enough into menopause that Lupron shots should keep me there . I have had two shots (three months apart) and will probably have two more and be done with shots and menopause!

Lupron may not be an option for you if you did not have chemo--but all that I have read indicates that AI's are better for triple positives and there are several women on this board who have had ovaries removed.

Sassy
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[Tricia L.]

Thanks Sassy! I had 8 rounds of chemo every 2 weeks. First 4 were cytoxan and epirubicin and last 4 were taxotere and herceptin. I had 36 treatments of radiation and will have a Herceptin treatment every 3 weeks for a year. The chemo did put me into menopause but was told that I had to be sure I was post menopausal before I could take an AI. I have not heard about Lupron but will definitely ask.

Tricia

[sassy]

Tricia,

They did blood work to see if I was far enough along in menopause that Lupron would "push" me on thru. My surgeon was really against another surgery to remove ovaries. My last blood work shows that I am almost completely thru menopause and soon will be POST Meno. Hot flashes and all that good stuff has really slowed down. Evidently you don't have to be completely thru to start AI. I started Arimidex in November after completing rads.

Worth looking into. I'll try to find some articles on herceptin and AI's and post them for you.

Sassy
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[Becky]

However...


I was also 45 and my bloodwork showed I was "certainly" postmenopausal after chemo (4 AC and then 4 taxol dense dose). Started Herceptin after rads and refused tamoxifen (I am only 50% ER and PR neg so there are even more tamoxifen studies that say tamoxifen isn't for me). I was 46 at this point and so I was put on Arimidex. Well... 7 months after my last chemo and only 7 weeks into Arimidex, I got my period back (and blood work confirmed this (that I was no longer postmenopausal) - and I had 3 sets of bloodwork 2 from my onc and 1 from my gyno to confirm menopause with LH, FSH and estradiol levels). So... I was off Arimidex for 3 weeks (but still getting Herceptin) and had my ovaries removed. My onco wanted me to stay off Arimidex for 2 weeks post oophorectomy for my hormones to settle down before lowering them to the max. I am 47 now so we are at an age that anything can happen. When I had the ovaries removed, my gyno said that I was experiencing a double ovulation on the left side (thank goodness my husband had a vasectomy 6 years ago!!! - Can you imagine??)

Just my story and how this can change for you on a dime.

Kind regards

Becky

[dberg]

Tricia,

I am Her2+ ER/PR+ and have been on tamoxifen for 1 year. What study are you referring to? I have been round and round with my onc about this.

Thanks!
Diane

[saleboat]

Hi--

Yep, I've gone round and round with my Onc too. There is some evidence that Tamox is not as effective in Her2+ women as in Her2- women. And I think there's some petri dish studies that show Tamox to be a growth factor-- but my Onc does not have a better solution than Tamox and there is no real evidence (in their minds) that I should do anything other than Tamox. And truthfully, I really really don't want to do an AI-- I'm 35 years old and not ready for menopause. I've been to three Oncs, all at major cancer centers, and they all say Tamox for me. One said to add Celebrex to my regimen, which I've done.

Jen

[Tricia L.]

Here is the website to view the article: www.bcm.edu/fromthelab/vol03/is6/04aug_n4.htm (http://www.bcm.edu/fromthelab/vol03/is6/04aug_n4.htm)

[snoopy]

Had an oophorectomy to allow me to have an AI - wasn't prepared to take tamoxifen when my herceptin finished.

http://jncicancerspectrum.oxfordjournals.org/cgi/reprint/jnci;96/12/895.pdf

Bloods post chemo suggested I was post menopausal following chemo (but I wasn't prepared to "wait and see" if it was permenant.

[tricia keegan]

Hi Tricia I have decided to have my ovaries removed as I'm highly triple pos.I'm 47 and can't be sure I'm fully menopausal since chemo so my onc wants me to start Tamox shortly but only until I have the op in 2 months or so.My onc was'nt in favour of giving me the lupron shots and said they only give them to women with a lot of pos nodes or that have ovarian cancer run in their family.I intend to start Arimidex after the op.
Tricia

[ldcuster]

please post the link to the Baylor study on the use of tamoxifen vs. arimidex.

[Tricia L.]

Here is the website to view the article: www.bcm.edu/fromthelab/vol03/is6/04aug_n4.htm (http://www.bcm.edu/fromthelab/vol03/is6/04aug_n4.htm)

This is the link to the Baylor study but is not comparing tamox to anything.

[Bev]

Hi, I think AI's are more effective for triple positives while on herceptin but should you revert to pre-menopausal status they are ineffective where tamoxifen will remain effective. I'm triple positive and on tamoxifen and will switch to an AI on my 1 year anniversary of chemopause. I imagine they'll do bloodwork to confirm this. Good luck, BB