Poll - Hormonal Therapy

Hello,

My wife will be finishing radiation and moving onto Hormonal therapy after first having an oophrectomy. She will continue to receive Herceptin for a year. We have decided to use an Aromatase Inhibitor since tamoxifen may not be the best course for her2+ tumors in post menopausal women as per ASCO guidelines.

I would like to find out if anybody is using Arimidex/Herceptin combo or Femara/Herceptin combo. Studies are just now getting underway to see which AI is better and also which AI is better with Herceptin. So I think it is pretty much a call of the patient and oncologist since there is not enough data out there. If you have had a particular reason why you chose either combo, please elaborate and also are there any special side effects to worry about

Thanks for the feedback.

Vinnie

My sister had a year and a half run on femara with great success, once her markers started to increase a little they switched her to arimidex which she has been on since last August with even better success. I think they are both very effective and can be used with great success in either order. Good luck! Jennifer

Hi Vinnie,

From what I understand by my onc's explanations, Femara is supposed to be considered as first-line hormonal therapy. She also highlighted the success of Femara head-to-head to Tamoxifen. However, many onc's are reluctant to prescribe AI's now, because:

1) AI's are fairly new;

2) this study that my onc was involved was a comparision between Femara & Tamoxifen, the study was actually stopped early (about 2 or 3 years early), due to such surprising results (more Femara patients responded better than Tamoxifen, sorry I forgot its percentage);

and finally 3) Tamoxifen has a success rate, as it has been around for many years, I think 10 or 20 years.

I have been on 3 different hormonals for the past year (not Arimidex yet), and my onc did not even once mention of Tamoxifen. I do not know if she is totally against it, but I think that personally this will be my last call, should Aromasin not work in my case.

I do not know the difference between Arimidex & Femara; I just know that they think Femara is more successful than Tamoxifen.

Good luck, keep us posted. Take good care ~ JO.

I am on Femara with Lupron shots to shut down my hormones (I am pre-menopausal). I get Herceptin once every three months. My Dr. said that the most studies for the Aromatose inhibitors are with Femara. SOme are better for the bone than others (the one made by Pfizer) showed it was better for the bone than Femara. So my Dr. basically told me that there are not huge differeces between the two. I went to 2 oncologists for an opinion. Since Femara has most of the data I went with that. Probably like Coke v. Pepsi.

Annmarie,

Do you think the Lupron/Femara has kept you NED in body? What percentage of ER/PR are you?

Thanks,

Beth

I have just begun the Lupron/Femara and the Herceptin routine. I had gone through so much that I needed a break from this cancer business. I never had cancer other than in my left breast and brain mets. I am 40% er poitive and I forget what pr %. Tamoxifen does not work very well on her2 positive pts. Personally, I think as time goes by there are better medicines. Out with the old and in with the new. I am looking towards the future to save all of our lives!

Vinnie:

My wife's situation is very similar to your's (Her2/neu and er+/pr+, oophorectomy). We can't get much info from the doctors if they feel one is superior to the other, but from what I've seen on the internet Femara(Letrozole) is more potent than Arimidex(Aromasin). Whether that translates into any additional
benefit remains to be seen as Arimidex shuts down estrogen production from androgen conversion by 97%. Letrozole is 99% effective. The estrogen suppression may reach a point where more is not necessarily better and may have more long term side effects we don't know about yet.
If my wife wasn't Her2/neu I may go with Arimidex as there is more safety data available and they have similar overall efficacy, but all the trials seem to combine Letrozole with Herceptin or Lapatinib. So I'm going to gamble that Letrozole may have a slight advantage over Arimidex in our situation. I'm also keeping my eye on GSK's Lapatinib application for FDA approval later this year as Herceptin can't be taken long term and requires an infusion, while Lapatinib is more effective and is a daily pill.

Please post back if you find any more info.

Thanks and good luck,

Scott

Thank you all for your replies.

Some more data will presented on Jan 27 from St. Gallen Breast Cancer conference in Switzerland on the Adjuvant use of letrozole. I am hoping that will help us decide which course to go with.

Are these HT/herceptin combos being given for pre-met stages? Off label?