Arimidex/Fermara ?

[Jean]

Does anyone have any information regarding which works better.
It seems there is a lot of information related to Arimidex and I do
not hear or read much on Femara. I am curious....


1. Does Fermara work as well or less with herceptin?
2. How many on the site are taking Arimidex and how many are taking Femara?


I was taking Arimidex from 5/05 through 5/06...then chemo from 5/06 to 9/7/2006 and after chemo started Femara.
While on Arimidex I had a lot of joint and bone pain. I am not
having as much joint pain on Femara but I am having muscle
pain and small amount of joint ache in the knees.

Thank you all,
Jean

[panicked911]

I am on arimidex - I was told they are identical in terms of efficacy and for the most part side effects. i would be really interested to know if ther is anyone out there who has had muscle and joint laches and they have lessened on femera.


Susanne

[Jean]

Susanne,

I find Fermara easier on my body than Arimidex, but I am only on Fermara
6 weeks.

Jean

[Lani]

the answer is not in yet

But at San Antonio this upcoming December there will be a lot of poster discussions about it:
Aromatase Inhibitors
101 Factors predicting survival after neoadjuvant therapy with aromatase inhibitors.
Murray E, Renshaw L, Macaskill EJ, Murray J, McCaig F, Young O, Cameron D, Kerr G, Thomas JS, Jack S, Dixon JM. Western General Hospital, Edinburgh, Scotland, United Kingdom.
102 The benefits of letrozole in postmenopausal women with early stage breast cancer who have had five years of tamoxifen are independent of age.
Muss HB, Tu D, Ingle JN, Martino S, Robert NJ, Pater JL, Whelan T, Palmer MJ, Piccart MJ, Shepherd LE, Pritchard KI, He Z, Goss PE. University of Vermont Cancer Center, Burlington, VT; Queens Universtiy, Kingston, ON, Canada; Mayo Clinic Cancer Center, Rochester, MN; University of Southern California, Los Angeles, CA; Fairfax Hospital, Fairfax, VA; McMaster University, Hamilton, ON, Canada; Jules Bordet Cancer Institute, Brussels, Belgium; University of Toronto, Toronto, ON, Canada; Massachusetts General Hospital, Boston, MA.
103 Letrozole suppresses tissue and plasma estradiol, estrone and estrone sulfate more effectively compared to anastrozole.
Geisler J, Ekse D, Helle H, Eystein Lønning P. Haukeland University Hospital, Bergen, Norway.
104 A detailed analysis of the benefits of anastrozole over tamoxifen for venous thromboembolic events (VTEs) after 5 years' treatment.
Cuzick J, Wale C, on Behalf of the ATAC Trialists' Group. Wolfson Institute of Preventative Medicine, London, United Kingdom.
105 Anastrozole and letrozole an investigation and comparison of quality of life, tolerability and morbidity.
Dixon JM, Renshaw L, Young O, Murray J, Macaskill EJ, McHugh M, Dixon OM, Folkerd E, McCaig F, Cameron D, Dowsett M, Langridge C, A'Hern R, Fallowfield LJ. Western General Hospital, Edinburgh, United Kingdom; University of Sussex, United Kingdom; Royal Marsden Hospital, London, United Kingdom.
106 Letrozole-induced arthralgia is not consistent with an autoimmune disease resembling Sjögren's syndrome: preliminary results of a multicentric prospective trial.
Azria D, Lamy P-J, Belkacémi Y, Roux C, Gourgou S, Ozsahin M, Zaman K, Llacer Moscardo C, Lemanski C, Gutowski M, Boneterre J, Romieu G, Gligorov J. CRLC Val D'Aurelle-Paul Lamarque, Montpellier, France; CRLC Oscar Lambret and Lille II University, Lille, France; AP-HP CHU Cochin, Paris, France; Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; AP-HP CHU Tenon, Paris, France.
107 An integrated analysis of zoledronic acid (ZA) for prevention of aromatase inhibitor associated bone loss (AIBL) in postmenopausal women (PMW) with early breast cancer (BCa) receiving adjuvant letrozole (LET).
Brufsky A, Bundred N, Coleman R, Lambert-Falls R, Mena R, Dong M, Schenk N, Lacerna L, Perez E. Novartis Pharmaceuticals Corporation, East Hanover, NJ.
108 Mechanistic studies of aromatase inhibitor (AI) resistance.
Chen S, Wang X, Masri S, Phung S, Wu X, Yuan Y-C. Beckman Research Inst. of the City of Hope, Duarte, CA.
109 Trastuzumab improves the responsiveness of letrozole refractory human breast cancer cells to endocrine therapy.
Sabnis GJ, Brodie AM. University of Maryland, Baltimore; UM Greenebaum Cancer Center, Baltimore, MD.

I have already seen papers trying to compare efficacy and side-effects but
there doesn't seem to be a consensus yet.

[Jean]

Thanks Lani,
I am just making every effort to keep ahead of this.....and as always trying to make the best choice for today...it is not easy since we always seem to have additional questions.

Jean

[Becky]

Jean


There is some preliminary data (done on women with bone mets) that Femara may be slightly better than Arimidex or Aromosin but not statistically better. But this is for progression of metastatic disease and in the bone only. San Antonio may tell more or we might have to wait for the trial to be done. This trial compares the 3 drugs. My cousin (who is only highly ER/PR+) is on this trial and in the Arimidex arm. I am taking Arimidex because last year, this was the only drug whose trial directly compared it to tamoxifen. At that time, Femara's trial was using it after 5 yrs of Tamoxifen and Aromosin was switching to it after 2 yrs of Tamoxifen (Arimidex also had a trial like this as well).

Kind regards

Becky

[Jean]

Becky,

Please forgive me if this is a silly question - but here it goes.
Do you know if the Dr. were switching to Femara after 5 yrs.
because they believe it to be a milder form of AI? Do any Dr.
switch over to Arimidex? It sounds as if Arimidex might have or
is believed to have an edge that Femara does not. I know the jury
is still out - just curious about the difference between them and
of course I am curious as how many women start on the Femara
for treatment? Is Arimidex the major chosen treatment?

I will be eager for San Antonio to deliver some news on this.

Many thanks to you for your response!
All good wishes,
Jean

[Becky]

As most of you know, there are 3 aromatase inhibitors (AI) on the market. They include Arimidex, Femara and Aromosin. All three products prevent a biochemical reaction in the body. This reaction converts androgens to estrogen. In order to do this reaction, the body needs the catalyst, aromatase. These drugs prevent the action of aromatase, therefore, no production of estrogen. The production of estrogen in this manner is done in the adrenal glands and fat cells. Production of estrogen in the ovaries is different and this is why one needs to be postmenopausal to take an AI.



Which is better? Well, the jury is still out on that. There is an ongoing trial comparing the three drugs to each other. Obviously, everyone will be more interested in the long term results which won’t be there for quite some time but at least the study is going.



Arimidex and Femara work the same way in the body and inhibit aromatase in the same non-steroidal way in the exact same place in the biochemical reaction. Aromosin has a steroidal action and inhibits aromatase in a different step of the biochemical reaction. Because of this, there could be different side effects between the Arimidex/Femara versus Aromosin. For example, there is a possibility of developing high cholesterol on Arimidex or Femara but not as likely using Aromosin. So, sometimes when I see that some women are having joint pain on Arimidex, I will recommend trying Aromosin before I would recommend Femara just because Arimidex and Femara work the same way. That said – why are the drugs recommended the way they are. Most of it comes down to what trials (and the results of those trials) have been completed. We all know the oncs love data before prescribing drugs, chemo, targeted therapies…



The trials were as follows (and I may have missed some)

• 5 years of Arimidex versus 5 years of Tamoxifen. This trial showed that Arimidex works significantly better than Tamoxifen in postmenopausal women.
• 2 years of Tamoxifen followed by either 3 more years of Tamoxifen or 3 years of Arimidex. This study showed that switching to an Arimidex after 2 years of Tamoxifen was much better than staying on Tamoxifen.
• Same as #2 but using Aromosin instead – same results as Arimidex. Switching is better.
• 5 years of Tamoxifen then half the women got 5 years of Femara and the other half was observed. The Femara half did better.

This is why Arimidex is prescribed more often than Femara as a first line therapy. It is because Arimidex has been trialed as a first line drug and the others have not been yet (except for the ongoing trial comparing the 3 drugs head to head of which there are no results). Femara is only FDA approved (so far) to be used after completing 5 years of Tamoxifen. Aromosin is only approved to be used after at least 2 years of Tamoxifen. It does NOT mean they don’t work otherwise or work better or if you are experiencing bad side effects on one that you shouldn’t switch to another one. It also does not say which is better as a first line treatment in non metastatic breast cancer. (The trial should shred light on that). However, in metastatic bc, there are some studies with bone mets (2) that have shown that Femara seems to be slightly more effective (but not statistically so and the study # of participating women was small). Theorectically, each should work in the first line setting (meaning that they should work better than having to use Tamoxifen first but Arimidex has been proven to work better than Tamoxifen without having to use Tamoxifen first).

So, that’s my story and I’m stickin” to it.

Kind regards, Becky

[Jean]

Becky Dear,
That helped bunches! And it didn't hurt....

Love Ya,
Jean

[sarah]

I'm curious also. I'm on Femara and have had some slight bone loss and taking Clastoban for it.
I'm wondering what haappens after 5 years!
sarah

[Becky]

http://www.asco.org/portal/site/ASCO...reutersid=5536


Basically, I think you're set.

Becky

[AlaskaAngel]

I wish they would distinguish whether there is a difference depending on whether one is HER2 or not, but although this one doesn't do that, here is a study that came out today for you all to consider, given that the side effects of the AI's can be detrimental to bone and can be difficult to handle.

http://www.fccc.edu/news/2005/Study-...0-17-2005.html

AlaskaAngel

There is a lot of talk about how arimedex is better than tamoxifen etc, but where are the studies showing that arimidex works? Is it worth going throught all that pain and discomfort, or does it keep the cancer at bay?? I am taking arimidex and have one year left. I took femara another one I cannot rember the name, but the three are very similar. I have had joint pain, hot flashes and many other side effects on all of them. So I ask again where is the proof that it works??????

[Jean]

Hi Guest,
This is a rather older thread which was started in 06.


see below link
http://jco.ascopubs.org/content/23/22/5138.abstract
http://www.springerlink.com/content/x52v228t5123343m/

[Laurel]

I am on Femara and cannot say I am enjoying the experience. I have begun running on my treadmill in recent weeks which really seems to be helping my stiffness. I do take Glucosamine/Condroitin, & Fish Oil which really seem to help with the sore joints.

I am looking forward to the close of treatment in 3 more long years. Wonder if we go back to "normal" then? Anyone know?

[Jean]

Hi Laurel,
I am past my five yrs. now...and the verdit from the onc.
was to continue on AI since the studies that came back
were so strong. The Famara had showed very positive
feedback so much that the Dr. are not thinking of the five year limit. Maybe your dr. will be of a different mind set. Dr. Slamon and my onc. here in the East both advised to remain on.

As far as I am concerned we are the test study.
These are new drugs and we are learning as we move forward. Now of course this may upset some who
would rather have results first then take the drugs.
For me who was highly er positive I have made the choice to remain on Femara. I found that the product CosaminDS made by nutramax to be the best for my joints. I purchase this in CVS or Walgreens. My orthopedic dr. swears by this brand and I have to agree. I take one capsule in the morning and one at night. I also find keeping the weight under control (ugh) helps everything! Exercise and movement is a must - but then we should be doing that anyway even if we did not have breast cancer.

The early studies with Femara are impressive. So with that I move ahead. I was hoping that in the near future we her2 gals who are er positive would be able to have treatment with just hercpetin and AI. I believe there is a study on that at present. That data will be interesting
but that study may not be for early stage gals. (not sure).

Hang in there Laurel...
hugs,Jean

[Becky]

I too am past the 5 year mark. I was on Tamoxifen for several months but then got my ovaries removed. I have been on Arimidex over 5 years and my onc is keeping me on. My onc said that the jury isn't out on whether or not more time on is better (and how much more time on) but I will stay on for now.

My mother's onc (who is in the same practice as mine), was not going to keep her on (mom is highly ER/PR+ but not Her2). She demanded at least one more additional year and will play it that way. Her onc did give her a script for another year. He may have been playing it differently with her since she is almost 79. My onc's rationale with me was "that I was young" and that may be the difference since no drug is child's play.

Neither my mother nor I have had joint issues on Arimidex.

[sassy]

Yesterday, I returned to my "fantastic" onc who develped my course of treatment. He moved away three years ago, but has returned closer to me, so I'm back!

I've been on Arimidex for 5 years, but he plans to have me continue on an AI and probably will for life. He says all research is pointing to more is better in this case. I did ask to switch to Femara as a trial to see if there might be a decrease in joint stiffness. Although mine is much better since being on Lasix and stopping Lupron, I still have some stiffness. We will try three months and see what happens.

[Jean]

Hi Sassy,
Love the photo!!!!

Please keep us updated on how you feel after switching to Femara. I switched from Arimidex and for me it was
a great improvement.

Best wishes.
Jean