Monitoring estrogen level

[Nguyen]

Just something to think about for ER+ patient:

Does anyone happen to monitor estradiol (precursor to estrogen) level while under endocrine (letrozole, anastrozole, etc) treatment? My wife cancer returns while being treated with Femara (letrozole). I happened to notice the estradiol level has been going up in conjunction with tumour marker CA27.29. While this may be a coincident, this MIGHT indicate that one of the reason for recurrence is NOT because the cancer cells have found a way to grow without (or minimal need) of estrogen, but because the body has found (after a while) away to produce more estrogen despite a particular form of endocrine treatment.

The implication of this ONE data point is that for ER+ tumour, while under endocrine treatment, monitor estrogen (estradiol, estrone, and estrone sulfate) level along side with tumour marker or CT scan. If the tumour returns or progresses, look at the resulting data before giving up on endocrine treatment.

Some years ago we were indecisive about removing the ovaries (not needed since she was induced into menopause via chemotherapy), this estradiol elevation data pushes us over the edge of having an oophorectomy. The ovaries (main source), adrenal glands, fat tissues, food intake are sources of estrogen.

Nguyen

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Linda's treatment history:
01/2005 - current: Herceptin (readded) and Femara
07/2004: It returned again via several small nodules in the lung
10/2002: NED (via CT and CA27.29)!
10/2001 - 01/2005: Femara, (Fosamax)
12/2000 - 10/2001: Herceptin and Navelbine
12/2000: lung metastatic was diagnosed (a few small nodules)
02/1998 - 12/2000: Daily Tamoxifen
05/1997 - 04/1998: Modified Radical Mastectomy, many many cycles of chemo regiments (CAF,Taxol, Carpoplatin, Thiotepa, Navelbine, Taxotere), including HDC, and radiation
05/1997: First diagnosed with BC stage 3A, ER+, PR+, HER2 +, poorly differetiated, nuclear grade 3.

[Barbara2]

Do you know the normal range of numbers for estradoil?

[kk1]

Nygen;

Femara is an Aromatase inhibitor and acts to block estrogen production in fat cells. It cannot block estrogen produced by ovaries as that occurs by a totally different biochemical pathway and why AI’s are only given to post menopausal women. It is also not uncommon for women to return to a premenopausal state many months after “chemopause” as the ovaries recover from the trauma of chemotherapy. Yes, my Oncologists measured and continues to periodically measure my estradiol levels to ensure my menopausal state is staying post menopausal. I would definitely discuss Lynda’s rising estrodiol levels with the oncologists ASAP.

For Barbara table of estrodiol levels in women:

Menstruating female (day of cycle relative to LH peak):
Follicular (-12): 19-83 pg/mL
Follicular (-4): 64-183 pg/mL
Midcycle (-1): 150-528 pg/mL
Luteal (+2): 58-157 pg/mL
Luteal (+6): 60-211 pg/mL
Luteal (+12): 55-150 pg/mL
Postmenopausal (untreated): 0-31 pg/mL

[Chelee]

Nguyen, KK1's post is excellent. That is exactly what happened to me. I was only 48 and still peri-meno...but was put into *chemopause*. My onc just *assumed* I would stay in menopause but I didn't! So I was taking Femara for a few months while it was NOT giving me any added benefit. My estradiol levels were VERY peri-meno when I pushed her to check them. So it is important that all women that were peri-meno before chemo get checked regularly after they finish if they are going to be taking any "AI's". Its very common to return back to peri-meno as KK1's post said. That is exactly what happened to me.

Chelee