Tamoxafin vs Aromatose Inhibitors w/Lupron

Need any insight that you can offer.....I need to choose between Tamoxafin or Aromatose Inhibitor w/Lupron shots as part of my hormonal therapy.

I have been recieving weekly (24) treatments of Carbo/Taxol/Herceptin since January. I am down to my LAST 2 TREATMENTS!!! Oh my what a feeling!!! I will begin 33 rads soon after. Then Hormonal treatment.

I am 31 yrs., Stage 1, Grade 3, HER2+, PR -, and ER + (70%). No Lymph Nodes involved, did have Vascular invasion, and had a Lumpectomy. Now I don't know which way to go with the Hormonal treatment. I am NOT in menopause yet.

Onc. wanted to do the Tamoxafin b/c initially fertility was an issue for me. Now, 8 months later fertility preservation is not high on my list. Just want to keep this cancer away.

Can anyone shed some light on these 2 different treatments?? Are the Aromatose inhibitors more effective? SIde effects of both??? What about the fact that Tamoxafin has been around for so long and is well documented.

Thank you so,
Victoria :)

[Rozebud]

I have been fighting this battle with my onc. for 6 months. I am on zoladex shots and tamoxifen. I want to switch but she's making me wait until I hit the 2 year mark. There is some antedotal evidence that tamoxifen counteracts herceptin. Al from Canada has some good links on it. I hope that both add incremental benefit, it's just a matter of which adds more.

The bottom line is that there's not a lot of studies on women who are premenopausal and put into chemical menopause comparing the two. I believe eventually it will show AIs are superior for people like us, but there have not been any large studies that have determined that yet. The most important thing is that if you want to do and AI make SURE you are menopausal for several months first. Taking an AI if you are still ovulating is bad news.

Hi Victoria, I'm ER- but I recently listened to Dr. George Sledge (I think that's his name) on a Living Beyond Breast Cancer (LBBC) teleconference on the ASCO update. You can listen to the June 2 teleconference on your computer on streaming video online by going to their website and it's about 60-90 min. in length. He does talk about this based on a caller's question. I think he's in Indiana and you could probably contact him, but this may give you more food for thought to help you in your decision.

Best to you, Vicki Z

My Doctor told me that the Lupron and the Femara was the way to go with me. I had two Lupron shots and decided to get my ovaries out instead. I figure that is one less thing to have to worrie about. (or should I say two. lol) . I was dx March 04. 2.5 cm lump with 8/16 nodes positive and a spot on my liver. I did 6 cycles of Carboplatin/Taxotere/Herceptin. 33 radiation treatments, and now I've been on Herceptin and Femara since December 04. Every one has to make their choices for whatever reasons are best for them. It's hard to give up your fertility but it's worse to not be around to enjoy what you already have. I am 37 with a husband of 16 years and a 7 year old daughter. We were just thinking of having another baby and the big "C" decided for us. I guess it wasn't in the cards. Take Care and don't rush with these tough choices that we are faced with. Sally

Hi Victoria,

Like Sally I've decided to have my ovaries out (on Monday). I am also ER- and PR+ as well as HER2 +.

How long does your doctor say you will need to stay on the Lupron shots? I am 48 and no where near menopause before chemo. I didn't want to think about taking shots for 2,3,4 years. You being only 31 makes that senario very likely and beyond. Then what? Just something to think about.

Good luck with your decision.

Susan

[Rozebud]

SusanAnne - What are your percentages? I'm always intrigued when I meet others who are ER-PR+. We're only about 1-3% of the population! I'm always wondering if you are only one, which one it's better to be, but can't seem to find any research on it. (I am PR+23% only).
Rose

[kathaleen]

hi, im her2 positive premenopausel funished chemo,now just on Herceptin i have 8 treatments left. I was told i needed to be on tamoxifen ..but like yu im not sure if that a good choice? tbe research shows some pretty bad side effects one being ovarian cancer, blood clots and whieght gane. I was wondering if having a hysterectomy would do the same job? if thrs no hormones going out why take the med?

[Laurel]

Kathaleen,

A total hysterectomy where the ovaries are removed along with the uterus will lessen the estrogen produced by your body (ovaries), but believe it or not our bodies will still produce estrogen even in our fat (dang!).

A.I.s are poorly tolerated by many and I can personally attest that they can give one a rough ride. I developed tendon pain secondary to fluid retention within the tendon which eventually got so bad that my knees swelled. Thank God I had reached my 3 years of A.I. therapy and opted with my Onc's full blessing to go back on Tamoxifen. Believe it or not I have no side effects from the Tamoxifen other than vaginal dryness and the standard dryness associated with menopause: dry eyes, skin, hair.....blablabla....This growin' old is NOT for the faint-of-heart, Ladies!

According to my Onc, the standard desire is to see us do 3 years of an A.I. if we can stand it, and then continue on Tamoxifen. How long exactly she was cagey about when I met with her a few weeks ago, but for now they new "standard" is another 5 years of anti-hormonal treatment. The benefit of continuing beyond 5 years is slim, so I told her I'd take it month by month dependent upon how I feel. There are associated risks with both Tamoxifen and A.I.s. The both can increase our risk for blood clots, elevated cholesterol, and osteoporosis. Tamoxifen is also associated with uterine cancer. My Onc. claims the associated uterine cancer is a mild form that is addressed by hysterectomy and rarely any post-surgical chemo.

My advise to you, for what it is worth, is to opt for the Tamoxifen until you reach menopause. Just know that once you achieve menopause you will probably be asked to do another 5 years of anti-hormonal therapy depending upon the research. Reduction in estrogen will cause vaginal atrophy (google it) which will put a damper on your sex life. I was 48 at diagnosis, and became menopausal during chemo, so my side effects are also those commonly experienced with menopause, just heightened by the anti-hormonals. I think your quality of life may be better on Tamoxifen.

[jaykay]

Hi,

Everyone handles the anti-estrogens differently. I was on Tamoxifen for 4.5 years (was already menopausal) prior to the studies that recommended AI's vs tamox for post-menopausal women. HATED every second I was on tamoxifen but there was no alternative. Swelling and achy legs due to fluid retention, hot flashes and just a general feeling of yuck (for 4.5 years!). Ended up taking a baby aspirin every day at my primary care doc's recommendation - it did help with the leg pain a bit.

When my onc brought up the AI study and asked if I wanted to try Femara, I jumped at the chance. Was on Femara for 5 years and did experience the joint achiness. Was already diagnosed with osteopenia prior to starting Femara and it really didn't get visibly worse (I exercise regularly, which helps). Most noticeable side effect was a rise in my cholesteral which lowered almost immediately after I finished my 5 years.

The sad news is that after 10 years on anti-estrogens, I am back on Femara again due my "new" primary diagnosed about 1 year ago. Oh well - at least I know what to expect.

Laurel is right - the body produces estrogen even if there are no ovaries. We are lucky to have the anti-estrogen arsenal of drugs to choose from. And everyone is different in their reactions to the various drugs. I'd give the tamoxifen a shot rather than undergoing a hysterectomy at this time. After all, it is major surgery

Best
Janis

[tricia keegan]

I understood an A1 is better for us her2 er's than Tamoxifen which is usually for pre menopausal people? I have some side effects on Arimidex but was diagnosed eight years ago and have been taking it for seven years and will continue up to ten as my Onc says the studies currently being done are showing this to be promising.