Tamoxifen started...(what's the research say)

[mimiflower07]

just started Tamoxifen. My onc wants me to begin on this drug before we make the decision to under go an oooph. Just wondering for those of you pre m are you feeling comfortable with taking this drug as a her2 pt. I start herceptin next week i think. I just got my period so chemo did not knock me into meno. Just not sure if i should think about monthly shots to suppress the ovaries then switch to AI's. My onc says he will switch me at some point, but say not all the research is back showing it is better to start on AI from get go. That infact it may be as effective to have started with tamoxifen then switch over due to how they cross talk. Help...what do you think? My next app is in May(3 mths). So should i
1) take tamox till may 2)then consider ovarie suppression 3) then switch it AI's and later on have ooph when i feel up for another surgery
or should i just stay on tamoxifen till I'm ready for ooph?
I'm triple positive, bilateral mast, have not had genetic testing yet but the onc does not think i am BRACA 1 or 2. In Canada these results take along time to come back. I will be having it done. thanks....
suzanne

[Gerri]

Hi Suzanne,

I know you will get tons of replies in support of switching to an AI so I thought I would chime in on behalf of those of us who are taking Tamoxifen. I am premenopausal (really close though) and have been taking Tamoxifen since May of 06. I had all the same concerns you have and have had this discussion with my onc numerous times - actually each time we meet. She stated the same exact reasons yours did for staying with Tamoxifen - for now anyway. I also attended a BC conference and asked the presenting bc specialist about this. He stated the same thing - all the data is not in, and while there is an indication that AIs may work better in the HER2 population there is not solid proof that one is better than the other. He also stated that depending on your age (younger vs older) forcing menopause can cause other problems on down the line. Also coming into play is your ER/PR status. Are you positive for both? Are you highly positive or just barely?

My onc is at a major cancer center and I trust her. She really does seem to be up on all the current research and is willing to listen to my concerns and discuss them with me. Since I am so close to going into menopause I have decided to wait for it to occur naturally. You will have to decide what is best for you. I wish you luck with your decision.

All my best,

[Melissa]

Hi,

I'm also a triple +. Chemo didn't put me into menopause either. I was put on tamoxifin but then my onc tested me for tamoxifin resistence and found that I am among the 10% of poor metabilizers. Sooo my onc said that I was not a canidate for tamoxifin. I then proceeded with an ooph. But had I been a canidate for tamoxifin I think I would have taken it for 2/3 years and then tried to switched. That way I could of taken something for 7/8 yrs. I know other triple + that go with the shots and tamoxifin and they are 4/5 yrs from dx. Also go to breast cancer.org site and read the studies. I believe there is a study that shows triple + do better starting with tamoxifin and then switching. Maybe some women didn't do well because they were poor metabalizers, (like me). Now you can be tested for tamoxifin resistence. It's hard-- I know too well. Best of Luck!

[mimiflower07]

soooo glad you guys piped in. thank you for sharing.
I do lnow that i'm highly pos for er, re, hers making me highly 3 pos.You
have helped now i just need to take a deep breath and sit on the confusion cough. Sure i'll have enough coverage with tamoxifin.
thanks
I will be 43 in March so i think postm is a few yrs away...once some more research comes back in 08 then i think we will have more answers. My onc did say they are expecting results very soon on this very issue
suzanne

[Hopeful]

Melissa,

What was the test you had to determine you were a poor Tamoxifen metabolizer?

Hopeful

[TSund]

Ruth had that test also tho I can't remember the name. It's a special blood test. She was negative and perimenopausal on dx, so she is on tamoxifen for at least a year.

According to our onc. the research that shows AI's are better than tamoxifen did NOT take into account for the percentage of women that are poor tamoxifin metabolizers. And...the advantage of "improvement" over tamoxifin was less than the % of non-metabolizers. So the research did not necessarily prove conclusively. I cannot imagine why they would not figure those statistics into the equation or the controls.

RUth will not stay on the tamoxifen for 5 years, but we decided to stay with the tamoxifen for the first year for the above reasons. Tamoxifen also builds bone rather than destroys it, so it may help when Ruth is switches over. to the AI. The Herceptin helps prevent tomoxifen resisitance that can occur in some HER2 cancer, but once Ruth is off the Herceptin it seems to me wise to change to the AI.

[Melissa]

Hopeful,

My onc gave me the tamoxifin 2D6 test. You can go to DNAdirect to read about it. Like I said I wanted to take tamoxifin but it turns out that I am among the 10% or so that can't metabilize the drug.
Best of health,
Melissa