What options do pre menopausal +++ women have?

[astrid]

I have read a lot about tamoxifen resistance for ER+, PR+ and HER2+. What options do pre menopausal +++ women have after they have completed surgery, chemo and radiation??

[Becky]

Well, according to some researchers at ASCO, if you are on Herceptin, then tamoxifen works fine. However, tamoxifen alone can be a problem. If you do not want to have anymore children, you can consider removing your ovaries. You will need to have a frank discussion with your doctors on this because if you are quite young, you will be dealing with menopausal issues and bone loss much earlier than if you were, say, in your mid to late 40s (since this age group will be going through menopause soon anyway).


You might also be able to take Lupron or Zoladex shots to put you in a "temporary" menopause so you could take an aromotase inhibitor (but some doctors don't like to do this).

If you have a whole year of Herceptin to do, you will have about 9 months of the Herceptin/Tamoxifen blend to sit back and think about and explore next steps. New things are coming out every day as well as new studies and information.

Kind regards

Becky

[panicked911]

unfortunately not many options for us triple positive pre-menapausals. It is either tamoxifen if you don't want to be thrown into pre-mature menapaus - or opting to go thru menapaus early either by injections, radiation or surgery. No matter how you slice it, dice it or spin it - it sucks - BUT - we are so fortunate that this beast was caught early and we have another line of defense against reoccurance when you are er+ -- As one Onc put it to me - making the decision to undergo hormonal treatment therapy should depend how strongly fueld your tumor is by hormones. I consider myself fortunate that I have this "extra" line of defense - Yes the aches, pains, nightly hot flashes, are an "annoyance" that I would rather not be dealing with but it is certainly better than the alternative - I am hoping that most of the litany complaints will go away once I stop Herceptain in November and continue with straight arimidex -but only time will tell and I have two young kids to raise and a whole lot of living to do :)

Susanne

[AlaskaAngel]

Ethically speaking...

Now that science has provided some of us with ways to detect cancer earlier, it seems to me that given the extreme costs of current standard treatment options to both society and to the individual, given that it is estimated that 60% of early stage breast cancer would never need anything more than surgery, why aren't they conducting a clinical trial to see how many early stage HER2+++ patients would never need anything more than Herceptin? Is Herceptin completely dependent on the patient being menopausal? If it is, then why would it have any effect on those whose bc is not estrogen-driven?

AlaskaAngel

[panicked911]

that was my argument exactly to the 4 oncs I saw and hence that is why i am on Herceptain w/o chemo . 1 yr - it was also my choice to put myself into temp. menapaus w/lupron ( I am having my hormone levels checked regularly to make sure it is working and based on th dry skin and cuticles and hot flashes I cna say it is) thus able to take arimidex.
The main onc I am seeing is convinced that herceptain works w/o chemo but I was not willig totake a chance on this coming back despite the lupron hence the arimidex - if given the choice I would have stayed on tamoxifen - I felt great on it with tons of energy - but given the fact I skipped the chemo I needed to make sure I was attacking this aggressively as possible b/c of my kids.

[astrid]

Alaska Angel; Herceptin is NOT dependent on the patient being menopausal at all. Herceptin is ONLY given to patients who are HER2+.

Herceptin is not chemotherapy. It is a monoclonal antibody (sometimes called biologic therapy). Antibodies are part of the body's normal defense against bacteria, viruses, and abnormal cells such as cancer cells. Heceptin targets cells that make too much HER-2. HER-2 is a protein found on the surface of cancer cells. 25% of breast cancers are HER-2+. HER-2 + cancer tumor are more aggressive and tend to grow back faster. My cancer was HER-2+. Herceptin binds to HER2-positive cancer cells and may block them from dividing and growing. It may also signal the body's own immune system to destroy the cell. Herceptin, a monoclonal antibody, zeroes in on cancer cells much more closely than chemotherapy drugs do, thereby sparing surrounding tissue. Because it's a monoclonal antibody and not a chemotherapy drug, Herceptin doesn't bring about the same side effects as chemotherapy drugs do, such as nausea and vomiting, hair loss, and increased risk of infection. And Herceptin is not an anti-estrogen treatment, so it doesn't cause side effects related to the lowering of estrogen levels, such as bone thinning or hot flashes. However, Herceptin does increase your risk of congestive heart failure. Although this risk is low, trials don’t yet provide long-term outcomes, so it's possible this risk could increase over time.



Susan Loves breast book says that tamoxifen is not very effective with HER2+ cancers, so I did some web research and have seen the following: The tumors most resistant to tamoxifen are those that contain not only estrogen receptors but also an overabundance of another growth factor receptor called HER2/neu and a molecule that activates the estrogen receptor called AIB1. Other studies suggest that some estrogen receptors may be located in the membrane, close to HER-2. “Tamoxifen binds to the estrogen receptor in those cells and instead of antagonizing it, it activates it. It acts like estrogen”.



Panicked911; I also considered NOT doing chemo; however after research it was shown that reoccurrence rates and survivability rates for young women are improved by chemo. Not at first, the first 5 years there is less then 10% advantage; however this doubles at 10 years and doubles again at 15 years, so your reoccurrence and survivability are 40% better for women who did surgery + chemo + radiation then surgery + radiation alone. Of course chemo is not required for everyone. Tumor grade, age, status, tumor size etc all indicate the need for chemo. My surgeon stated that if my tumor had been less then 1.5 cm that chemo would not be required. Mine was 1.8 cm, grade 3 and ER+, PR+ and HER2+.

[panicked911]

you are correct as to tumor size - the problem really comes in for those women whose tumors are b/w 1cm and 2 cm. I had two "twin tumors" nexct to each other with a thid focal forming measuring .1mm The twins were 1.2 - all agreed that based on the pathology - this had not traveled anywhere - and thus chemo would add even less to to the reduction of the reoccurance rate - for me long or short haul it was less than 5%- Not worth it considering my biggest risk of reoccurance is in the same area - to further lessen the chnace the surgeon widend my margins to 2 cm all around and down to the chest wall.

As for the side effects of herceptain - they are not just limited to the runny noise etc- fatigue, muscle aches, and even a form of brain fog -losing words - still very doable compared to chemo and couting down my last 7 treatments - hopefully all will go away over time.