Thoughts on Aromatase Inhibitors?

[embur102]

Hello everyone!

I will be enjoying my last Taxol infusion this AM--YEA! Reduced dosage due to neuropathy.

My onc wants to add hormone therapy due to 15% ER+ (PR-).

I have many conflicting feelings, complicated by:
(1)Tamoxifen would be the drug-of-choice for my age (48) and premenopausal
status, however, it is contraindicated with the Prozac I take daily.
(2) He wants to push me through menopause with hormone injections so I can take an aromatase inhibitor
(3) AI side effects include cardiovascular/heart issues and significant bone loss/increased risk of fractures
(4) Heart is already taking a beating (no pun intended) with Adria and Herceptin
(5) I already have significant bone loss for a woman of my age
(6) Is 15% ER+ really that significant to warrant treatment--(HER2+++ is more likely to recur than 15% ER+, yes??)

I will be doing more research before I decide, but wanted to hear your thoughts/experiences.

Thank you, Sisters-In-Pink!!
peacelovehugs
xoxoxoxoxoxox

[tricia keegan]

I recently agreed to another two years of Arimidex making a total of seven years, I had an ooph as a preventative measure and so far this is working for me so I feel why fix what isn't broken??
I do get some joint stiffness as a side effect but its preferable to a recurrance so for me, this works and wish you well with your decision.

[Laurel]

What is your prognosis? Occurrence risk? Without your history in your signature it is difficult to say whether the benefit out weighs the associated risks. A.I.s are not easy for many. If you are Stage 1 or 2 I would not consider it with only a 15% E.R. positivity.

[Jackie07]

Hi,

I've been taking Tamoxifen since 2004 even though my ER is only 5%.

Thought I would be given AIs after my prophylactic hysterectomy/oophorectomy, but I was still given Tamoxifen and so far it's been working well.

[embur102]

Thought I had figured out how to make my bio appear on my profile, but I guess not.

Diagnosed April 12, 2012
IDC, 4,2 cm, ER+ (15%) PR-, HER2+++
2 of 14 nodes +, Gr 3, Stage 2b
Mastectomy May 25
AC x4, Taxol x 4
no rads
Herceptin 1 yr

My concern with AIs is exactly what Laurel mentioned....are the side effects worth the risk with only 15% ER+? I am thinking I have a higher chance of recurrence because of the HER2, not the ER+.

Obviously, I will have this discussion with my doc, but also wanted the stories of women who have been there. This journey would be infinitely more difficult without the support of fellow Sisters. Thank you!! :)

[Lien]

Whether or not it's worth all the risks, I cannot say.

I did the ovarian suppression for 4.5 years and an AI. I had very few side effects and although my bone density decreased during the first 2 years, it stabilized after that. I never took bisphosphonates because of other issues and although I officially have osteopenia, I have no noticeable problems. I slipped and fell on a concrete quay but didn't fracture anything. I've also gone skiing each year and stick to the easier slopes.

I try to exercise and walk a lot, so I keep my bones as strong as I can. When I quit the AI and Zoladex, my periods came back, at age 50. Grr. But that may help me re. bones and heart issues, so I'm trying to look on the bright side.

Hope this helps a little.

Jacqueline

[Debbie L.]

Hi Embur,

Tough decisions. A few thoughts:

Who tested your cancer for ER? If it was done at a smaller local facility, it could be worth sending your tissue blocks for a second opinion at a comprehensive cancer center: http://cancercenters.cancer.gov/cancer_centers/cancer-centers-list.html

ER/PR testing is not always accurate, and when you're at the far end of the low spectrum, a small inaccuracy can make a big difference to your decision-making. It wouldn't be a bad time for a regular clinical second opinion also, just so know you've explored all options.

I'm not sure the reasoning about whether the ER or the HER2 is a bigger threat to the chance of recurrence is accurate. ER and HER2 probably are intertwined in stimulating growth so that blocking both works more than double as well as blocking one or the other.

An AI's cardiovascular effects are, at best, a vague issue right now.

The issue of Tamoxifen and other meds that affect CYP2D6 is far from clear also. In theory it should make a difference but many studies have not been able to find that it does. There are other anti-depressants that could be explored, if the idea of Tamoxifen with Prozac makes you too uncomfortable.

Let us know how the onc visit goes, and what your next step(s) will be.

Debbie Laxague
(http://cancercenters.cancer.gov/cancer_centers/cancer-centers-list.html)

[Jackie07]

My new oncologist (the 'old' one who I'd seen for 9 years has moved back to his hometown) has just prescribed me Exemestane today! One of the reasons he mentioned was what's listed on the drug information sheet: "This medicine is an aromatase inhibitor used for treating advanced breast cancer in women past menopause whose disease has progressed after treatment with other medicine." "It is also used in the treatment of early breast cancer in certain women past menopause after treatment with other medicines."