Does Arimidex prevent mets at all?

karen1956

fearless....I endured AI's for 3 1/2 years....my onc knows how much of a struggle they were for me....he gave me a two month break and I never went back....yes...he would have preferred that I con't the AI's for at least the full 5 years (or longer) or even now to go back on them, but he understands why I stopped.  He never made me feel like he would stop being my doctor if I didn't take the AI's,but to be honest, if a doctor told me if I did not follow their protocol I couldn't be a patient, then they would not be the doctor for me.

QOL is a very important issue for me.  I don't want cancer to come back, but I know there are no guarantees either way.  I got to the point that I would be more upset if I re-occured on the AI's than if I went off and it happened.  I have given it my all...bilat, chemo, rads, ooph and the AI's for 3 1/2 years.....for me the ooph was to help reduce the risk of ovarian cancer as well as ensure that I was in menopause...chemo stopped my periods and onc did not think they would come back as I was already peri-menopause at Dx and was 50.

It is a personal decision, but only you can make it.  For me, I am at peace with my choices.  No matter what decision you make, you need to feel good about it.  I hope you get the answers you are looking for. 

lbrewer

Two new very interesting studies have just come out regading women with oophs and breast cancer.  ONe ( WHI Study) showed women who take estrogen after OOPH have signifcantly less BC than women who don't. That was highlighted on this site last week.  The latest showed that even with BRAC mutations women who take HRT have no signifcant increase in BC as opposed to those that don't. 

 The field of BC research unfortunately does not usually address the difference in treatment of women with and without oophs.  There are trials in Europe and Asia  using OOPH as a treamtent but no site in the US is participating.

I am SOO tired of being a guinea pig!

http://www.breastcancer.org/risk/new_research/20110405.jsp

http://community.breastcancer.org/forum/73/topic/769778?page=1#idx_1

lago

That second link is :

http://community.breastcancer.org/forum/73/topic/769778?page=1 
 

Fearless_One

We would at least need to know how much estrogen is converted from androgen by the adrenal gland to know how effective AI's are after oopherectomy vs oopherectomy alone, since AI's stop this conversion.   I don't know those numbers, but I sure would like to.   It sure would help me in this difficult choice.  

revkat

Fearless, I am right there with you.

I think there is a difference between women who have premenopausal breast cancer and later become menopausal and women who are menopausal when they develop breast cancer. In the first case, the bc developed in a high estrogen environment, so ovarian ablation reduces the estrogen a whole lot. In the second case, the bc developed in an already low estrogen environment and the aromatase inhibitors reduce it even further. The question is, does bc that developed in a high estrogen environment benefit from the little bit more reduction that an aromatase inhibitor gives you over ovarian ablation. And no one knows. At least that's what my oncologist said when I asked. The studies are still in process.

So I sit here and look at my anastrozole bottle and wonder. My estrodiol level was 13. That's pretty low. I think it's on a scale where 30 is menopausal. It's a whole lot lower than the 100 to 1000 that it cycles in in menstruating women. Is whatever little bit this med is going to lower it worth the possible side effects? I know lots of people don't have side effects, but you know what? I would have said I wasn't having side effects on tamoxifen until I went off of it. The last month has been so much better in terms of  reduced muscle aches, clear thinking, lifiting of depression. . .

So, being treated at this time in the history of medical treatment I am left wondering -- was the axillary dissection overtreatment? was the chemo? is an aromatase inhibitor given that the chemo shut down my ovaries? What are you going to do? 

Fearless_One

Ok ladies, I finally accessed Adjuvantonline and unlike Cancermath, it gives stats for OA + AI's AND OA alone.  

My numbers were EXACTLY the same for Chemo + OA and Chemo + OA + hormonal therapy (either Tamox or Arimidex).

I find this interesting and will discuss with my onc.

DesignerMom

Fearless-  I will look forward to hearing what your Onc has to say.  We have similar stats (even the mammo occult part) and I have been wrestling big time with the decision to take AIs or not. 

claire_in_seattle

I actually did find statistics on ovarian ablation and tamoxifen.  This is from a summary of breast cancer research published in 2005.  So would include a host of studies up to that date.

Remember that ovarian oblation was one of the few methods available prior to Tamoxifen.  Now, we also have AIs available.  You can't compare these studies directly, but this certainly suggests that Tamoxifen is more effective than ovarian ablation.  I suspect the ovarian ablation studies were conducted earlier, so hence the lower overall survival statistics.

For Tamoxifen 25.6% died within 15 years, vs 34.8% of the control group. So a survival benefit of 26.4% with Tamoxifen vs w/o.

For Ovarian Ablation, these numbers were 40.3% vs  43.5% for the control, or a 7.4% survival benefit.

I realize these were different groups, so the comparisons may not work directly.  However, for ovarian ablation to have been as effective as Tamoxifen, 15 year mortality would have been 32.8% vs 40.3%.  Quite a difference.

AIs are even slightly more effective than Tamoxifen.  They weren't included in this summary as 2005 was too soon to have even 5 year survival data.

The entire article can be found here:

http://www.ctc.usyd.edu.au/cochrane/publications/EBCTCGpaper.pdf

Hope this helps.  It's a long article, but an interesting read.  Stats are from the charts on 1704 and 1711. - Claire

omaz

Does anyone know how low estradiol levels are on an AI?  Is it 0, 5, 10??

nikola

I questioned my onc a month ago and was told after OA taking AI would give me no more than 10% benefit as opposed to exercise and diet which would give me 40-50% benefit. All these are to be calculated from my 8% risk.

TEH

Fearless, the question I would ask your onocologist is does she recommend an oophorectomy  and  AI to all her patients if even a small amount of estrogen is such a big concern? Ovaries never quit producing hormones which can be processed into estrogen by the body and this estrogen is not blocked by the AI drug. I saw literature where estrogen levels with an oophorectomy alone is as low as the levels attained by some women with ovaries intact and AI drugs so I'm wondering how any onocologist can state any true benefit.

annettek

TEH- therein lies the dilemma with all treatments. It is a science based on assumptions and averages. Some all helped greatly by a particular treatment, while others are not.

I just got back from the world's largest Biotech conference in DC last week. Nobody, none of the scientists and none of the company execs disagreed with that statement above. I was asking all regarding my choice to forgo arimdex in favor of supplements and lifestyle changes. It should help, it may help, it could help. I appreciated the candor and was saddened by the truth I already knew. The best indicator is my body at this point. I will continue vigilant monitoring and pay attention to the numbers and anything else that can be measured. If estrogen levels rise and stay there, I may reconsider arimidex or another AI, or not. One day at a time. All of the drugs and treatments have helped somebody somewhere at sometime. I don't think there is an evil cabal keeping a cure from us. It is just near impossible to deal with a sneaky b*stard like bc and know how it all reacts within a specfic body with a specific genetic profile. That is the common theme I heard for virtually all serious ailments....a person's dna- personalized medicine. In the meantime, well, we all do the best we can.

Member_of_the_Club

Coming in late (unless I posted earlier in this thread, can't remember) just to say there's no reason why a woman who is post-menopausal can't take tamoxifen.  Sometimes women who can't tolerate AIs do just fine on tamoxifen.

After I completed five years on tamoxifen I was still pre-menopausal.  My onc said the benefit of putting myself into menopause in order to switch to an AI was not large, so it was totally my call.  I decided to do it because my children are still young and i want to maximize my survival chances.  I can completely understand someone making a different call on that.  For me the most difficult decision was an ooph versus zoladex (like lupron) and I finally decided to keep my ovaries and shut them down with zoladex.  Again, I can completely understand someone making a different call.

Surprisingly, I feel better on zoladex plus arimidex than i did on tamoxifen. 

lago

We do need to understand that the benefit for stage II or III would be a higher than stage I because our risk of recurrence is higher. We all need to look at our individual benefit since it is very different depending on our diagnosis.

I'm still doing OK on Anastrozole (4+ months). Some stiffness in the fingers and legs in the morning. I think my eyebrows have thinned from it (or it could be chemo and the hairs aren't growing out of sync yet). Nothing a little powder can't fill in. My hot flashes are gone I think. I might get some slight ones when I eat my spicy chili

annettek

I am totally in agreement with what both MOTC and Lago stated in regards to diagnosis being very crucial in determining treatment- when one is at a further stage or grade- that is a game changer for me in being "adventurous" . As it is, I was right on the cutoff point where the NCCN guidelines said it was an option rather than a requirement...even so, after much dickering around with my onc, she is relunctantly supportive and monitoring me closely (every 90 days) and i have had every PT CT MRI BONE Scan there is and will again next year.

Merilee

I still don't understand the difference between Ferma, Amrimidex an Aromisin.

And I have not been able to find out exactly what are in these medicines. Someone suggested that one of them has steroids. From my Internet searches I often end up on body building sites which indicate that they all  might have steroids. Does anyone know? Also which one has statistically less  or milder side effects?

And what is up with the dosages being so different between them?

lago

Merilee these drugs are aromatase inhibitors. I don't know much about Aromisin other than it seems to be given to women after they have been on Tamoxifen and is quite effective, I think a little more so than the other AIs.

Femara and Arimidex seem to be given interchangeably. Right now there is the generic form or Arimidex called Anastrozole so it can be less expensive. My onc seems to feel that Arimidex/Anastrozole have shown the fewest SE but it really depends on the person. That's why if one is give you bad SE they might change you to another. I'm on Anastrozole.

I haven't read anywhere that these drugs contain steroids. I have read that body builders who take anabolic steroids may take it to prevent the steroids from converting to estrogen.

omaz

Merilee - Arimidex (anastrozole) and femara (letrozole) are in one group and they bind to the aromatase enzyme reversibly (goes on and off) to inhibit it's conversion of pre-estrogen to estrogen.  The aromasin has a steroidal type structure and is a different type of AI.  It binds to the aromatase enzyme irreversibly (goes on and stays on) to inhibit it's function.  They basically achieve the same goal but in different ways and with possibly different SEs.  It's good to have choices since one may work better for someone than another.  Please correct me if I got this incorrect!