Onc Px's Tamoxifen for 60 yr old friend ????

[mts]

A co-worker was recently dx'd w/ Stage I bc and she went through menopause in her late 30's. She is now 60 yrs old.
She is ER+ PR+ Her2-
Her onc prescribed Tamoxifen.
I figured she needs an AI --- or a new onc !

What do you think ?

[Sheila]

MTS
My Mom was diagnosed at 60, ER+, and PR+, they didnt test for Her2 back then....she was placed on Tamoxifen after undergoing a Radical mastectomy with 9/13 nodes positive. That was 21 years ago, and she is still alive (by the way, she took Tamoxifen for 17 years)....she has other health issues, but certainly not the Breast Cancer.

[Debbie L.]

>I figured she needs an AI --- or a new onc !
>What do you think ?

I think Tamoxifen's fine. The additional benefit of an AI over Tamoxifen is quite small, especially for those already at low risk of recurrence (ERPR+, HER2-, stage I). AI's are much more expensive. Tamoxifen has a long track record and we know its risks. AI's have a relatively short track record and questions remain about their longterm risks (cognitive, cardiovascular health, bones, etc).

It's not a recommendation (yet) as far as I know, but she might want to ask about being tested for CYP2D6 enzyme function as that probably has a role in metabolizing Tamoxifen effectively. Alternatively, she could take the Tamoxifen and see if she has side effects (mainly hot flashes) which may be a sign that it's metabolizing well in her body. So far, just a few studies are talking about these things (CYP2D6 and/or symptoms) so these are pretty loose recommendations.

Debbie Laxague