FEMARA
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I'm not so great at reading these studies but it the percentages to progression do not look good to me.
Efficacy of First-Line Letrozole Versus Tamoxifen as a Function of Age in Postmenopausal Women with Advanced Breast Cancer
Exerpt
Figure 2. A) Patients >70 years at enrollment, serum HER-2−.Letrozole: 87 (76%) of 114 patients progressed. Median TTP 9.7 months (95% CI 7.8–14.4 months). Tamoxifen: 131 (87%) of 150 patients progressed. Median TTP 9.0 months (95% CI 6.2–10.7 months).
Patients <70 years at enrollment, serum HER-2+. Letrozole: 56 (90%) of 62 patients progressed. Median TTP 6.0 months (95% CI 3.7–7.4 months). Tamoxifen: 50 (96%) of 52 patients progressed. Median TTP 3.2 months (95% CI 3.0–6.3 months). C) Patients ≥70 years at enrollment, serum HER-2−. Letrozole: 58 (73%) of 80 patients progressed. Median TTP 15.5 months (95% CI 11.7–21.5 months). Tamoxifen: 38 (76%) of 50 patients progressed. Median TTP 5.1 months (95% CI 3.1–9.2 months). D) Patients ≥70 years at enrollment, serum HER-2+. Letrozole: 15 (88%) of 17 patients progressed. Median TTP 8.9 months (95% CI 3.1–17.5 months). Tamoxifen: 20 (87%) of 23 patients progressed. Median TTP 3.3 months (95% CI 2.9–8.5 months).The whole study is at
http://theoncologist.alphamedpress.org/content/9/5...0 -
Marijen, I looked at the study you posted. Several important factors to consider
» Women in this study were Stage IIIB
» 25% were obese
» median age for those less than 70yo was 65 and for those >70yo was 75
I don't meet any of these criteria, but my takeaway was that statistically I am better off on letrosole than tamoxifen.
I hope this helps someone.
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Good to know 6cats, I'm not 3b either. When I find something informative I try to share it even if it doesn't apply to me
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6cats and marijen, the women in that study were not only 3Bs, also women with metastatic disease and local recurrence that could not be operated. They were given an AI as firstline treatment, i.e, not surgery or chemo
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Should I take it down?
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No... I'd leave it up. I think it is important for people to take the time to read studies. This just shows how easy it is to miss vital details.
I told my sister today with all statistics I am a unit of one. The stats may not apply to my situation. Or I may be an outlier.
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Ok, 6cats I'll leave it up. It will apply to some. Seems like the IIIs get left out a lot! Stats, we will be the exceptions right? There are always exceptions
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I agree - leave it up. When a post is just deleted (unless you happen to accidently post the same post immediately) it always makes it seem strange. Leave it so those who read through this Thread can see your post and understand why the posts have been written.
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Marijen, no, no, just wanted to clarify a little. I wasn't criticizing. I happen to be 3B, so it caught my eye. In my case, femara was not the first line treatment. In other words, my doctors treated me with an intent to cure.
Also, 3B is a stage that includes those where the cancer has invaded the chest muscle. This can be difficult to operate. So, I suspect the 3B cases included in this study were cases that were inoperable, and where because of the age/frailty of the patient, chemo was not an option.
In my case, the cancer had "only" invaded the skin, which also qualifies as 3B, but is entirely operable.
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Ok, I'll leave it up. I didn't realize it applied only to Stage IIIwhen I put it up.
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Marijen, it only applies to women with advanced forms of breast cancer where surgery is not an option.
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Marijen- you mean stage III in your last post.
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Hi everyone! I have been on lupron for 8 months, just got my hormone level last week to see if it is in menopause level so I can switch to Femara. Estradiol came back low at 17 which I was happy about but LH/FSH was extremely low (0.4 and 1.7). I read that extremely low LH/FSH indicate ovarian failure? Am I still not considered in menopause?
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Steph, I have no idea. Sorry! They have chemically shut your ovaries down, so it seems logical that blood work would indicate ovarian failure. I didn't want the shots, so I had them yank the ovaries. My onc thought it was extreme, but in spite of the downside to being booted into menopause that way, it has worked for me. My mother had ovarian cancer and my aunt had uterine cancer, so because of the latter I was not inclined to take tamox, and because of the former, I prefer not having to worry about ovarian cancer.
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Thank you for your reply! I just read that lupron can stop pituitary gland from producing LH/FSH, it explains why mine are extremely low now. Will meet with MO tomorrow to see if I can switch to Femara. I am planning to take my ovaries out when I turn 35, because I think it's unrealistic to take the shot for more than 5 years.
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Oh just find out I will be switched to Aromasin instead of Femara. Still want to say thank you again!
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daisy, I wake up every night wit hot pins and needles in my arms and mid section. I have pretty much resigned myself to this sleep interruption. I started taking the femara in the morning, but was having difficulties with fatigue and hot flashes at work. When I retire, I may go back to taking the femara in the morning, in favor of sleeping
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Published in OncologyJournal Scan / Research · July 11, 2017
Endocrine Therapy Does Not Benefit Borderline ER-Positive Primary Breast Cancer Patients
BACKGROUND
Endocrine responsiveness of primary breast cancers with borderline estrogen receptor expression (ER+ (1-9%)) remains unclear. We aimed at investigating differences in endocrine responsiveness, prognosis and clinicopathological characteristics between ER+ (1-9%) cohort and ER-negative cohort or ER+ (≥10%) cohort.
METHODS
Eligible literatures published from inception to November 20, 2016 were retrieved in the PubMed database based on PRISMA guidelines. Data on survival outcomes were extracted and pooled odds ratios (ORs), 95% confident intervals (95% CIs) and two-tailed P were reported. P values of Chi-square test for comparison of clinicopathological characteristics among included patients in ER+ (1-9%) cohort and the other two cohorts were calculated respectively.
RESULTS
The analysis included 6 studies with 16606 patients. Significant differences were detected between ER+ (1-9%) cohort and the other two cohorts based on clinicopathological characteristics respectively. When taking all the patients into analysis without consideration of treatment modality, ER+ (1-9%) cohort presented better prognosis than ER-negative group in terms of 5-year DFS (OR=1.47, P=0.046) and 5-year OS (OR=1.23, P=0.046). However, patients with ER+ (1-9%) breast cancer receiving endocrine therapy seemed to have similar prognosis as those without any endocrine therapy (P=0.684) and those with ER-negative carcinoma receiving endocrine therapy (P=0.145). Patients with ER+ (≥10%) tumors had better endocrine responsiveness compared to ER+ (1-9%) counterparts (OR=0.52, P=0.034, ER+ (1-9%) versus ER+ (≥10%)).
CONCLUSION
Our results indicate that primary breast cancer patients with ER+ (1-9%) expression gained no significant survival benefit from endocrine therapy, but manifested overall better prognosis than those with ER-negative cancer.
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marijen - Thanks for posting that article. I'll have to look it up and read it thoroughly. I'm only 3% ER+ and was really on the fence of whether there was any benefit to taking Letrozole. My MO assured there was. I have stopped as of last Tuesday due to numbness in my right hand. Not sure, I'll go back to it....
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You're welcome bravepoint but check with your Dr? I think hand numbness is the least of my problems. It's all over pain,my eyes and vitreous clouding, premature aging, and cognition I worry about. And problems I don't know about yet. I am 90/40%.
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Misposted- delete
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i have been on zoladex for 7 months and femera for 4 months. Bone pain is terrible. I feel like a 90 yr old women. I am getting conflicting info my gyn md says bone aches are definately from the zoladex but my oncologist says definately from the femera. Maybe it is from being on both, but has anyone been on both. And which do you think is responsible for the terrible pain?
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Claritin helps many with bone pain, the plain otc one. Maybe try that.
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I've been on letrozole for three months. My fingernails break easily and look awful. Will this last the entire time I am on this or will it get better with time? Trying to put moisture back in my hair too but no product seems to work. Ideas?
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I have vertical ridges on my nails that weren't there before letrozole. I believe it's the depletion of estrogen and speeded up aging. I think it will all get worse in time, the longer the estrogen is unnaturally cut off from the receptors. My hair also falls out at a faster rate since dx and tx. And it's thinner and dryer, it used to be way too thick so I have some to spare
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My nails are a mess, too. They break and peel. MO says it isn't letrozole, but I don't agree. I had hard, strong, LONG fingernails before the medication. My PCP has me taking 5000mcg of biotin. I have been on it for 3 months now and my nails look a little better, but not much. They still peel, but don't seem to be growing.
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My nails are also peeling and breaking. There are ridges too - yes it's the estrogen depletion. My nails are still pretty strong and grow quite well. I've been putting a nail hardener (like a nail polish, but clear) on them, and that seems to help with the peeling.
Unfortunately there's not much that can be done about the ridges, but with the shiny nail hardener on them, you don't notice them so much lol!
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Femara/letrozole was poison to me. Just horrible. I took it for just less than a month - have been off of it for about three months - and new SE's (pain in left foot, swelling ankles, trigger fingers, nail issues, etc.) are now occurring despite my weaning from this drug. Prior to letrozole, I took (generic) anastrozole then Arimidex and suffered debilitating SE's. Combined, it was less than a year on AI's. I've read some articles in medical journals that say SE's could go on for years and possibly an entire lifetime, even if a patient has stopped taking the AI's. This is really scary to me given the SE's I've been through and keep having. I'm the one who finally said to the MO - enough is enough - I'm not taking these drugs.
My question - does your MO ever take blood to measure hormone levels or monitor anything else? My MO has never drawn a blood sample or done any tests.
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My MO & my PCP stay in touch. All of my labs go through the PCP. I have not had any hormone levels checked, but I have discussed the possibility with my PCP.
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Hi everyone...most MOs do not test hormone levels. IMO its a huge gap in our treatment plan. Many times you have to rely on your PCP, gynecologist or endocrinologist to get it done. Also some have it done by naturopathic docs. Most MOs know very little about female hormones and yet they are the ones prescribing these powerful anti hormones! Just don't get it. We have to be our own advocates. Good luck to all navigating this complicated disease.
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