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Debbie L. · 10-17-2012, 08:06 AM

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/canc...ters-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

10-17-2012, 08:06 AM	#7
Debbie L. Senior Member Join Date: Jul 2006 Posts: 463	Re: Thoughts on Aromatase Inhibitors? 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/canc...ters-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 __________________ 3/01 ~ Age 49. Occult primary announced by large (6cm) axillary node, found by my husband. 4/01 ~ Bilateral mastectomies (LMRM, R elective simple) - 1.2cm IDC was found at pathology. 5 of 11 axillary nodes positive, largest = 6cm. Stage IIIA ERPR 5%/1% (re-done later at Baylor, both negative at zero). HER2neu positive by IHC and FISH (8.89). Lymphovascular invasion, grade 3, 8/9 modified SBR. TX: Control of arm of NSABP's B-31 adjuvant Herceptin trial (no Herceptin, inducing a severe case of Herceptin-envy): A/C x 4 and Taxol x 4 q3weeks, then rads. Raging infection of entire chest after small revision of mastectomy scar after completing tx (significance unknown). Arimidex for two years, stopped after second pathology opinion. 2017: Mild and manageable lymphedema and some cognitive issues. Last edited by Debbie L.; 10-17-2012 at 08:13 AM.. Reason: hit reply before I was finished.