Your thoughts on tamoxifen 7 vs 10 yrs (SALSA study)

sg751

I just started year 7 on tamoxifen and while I thought I was on the 10 year plan. My oncologist just told me that she now recommends I stop after 7 years, based on the SALSA study https://ascopost.com/issues/november-25-2021/durat...

This confuses me bc 1) the study refers to post-menopausal women, while I am still (at least based on my estradiol levels) pre-menopausal and 2) the study refers to people taking an AI, whereas I have only taken Tamoxifen.

Anyway, I'm feeling very anxious about the thought of stopping Tamoxifen after 7 years... I tolerate it well and even though I was stage 1A BC, I was also 19 oncotype, premenopausal, and didn't do chemo, so I find myself wanting to max out on whatever else I can do to prevent a recurrence.

Anyone have any wise thoughts and/or spoken to your doctor about the SALSA study?

elainetherese

sg751,

I'm coming up on seven years of Zoladex + Aromasin. I also have to make a decision about whether I want to stop soon, and I'm also premenopausal. Have you asked your oncologist about the Breast Cancer Index test? It's supposed to show whether or not more hormonal therapy is beneficial, given your tumor's characteristics. My oncologist is supposed to be sending my tumor off for that test.

If the BCI shows that stopping hormonal therapy is OK, I'd do it. I don't want to be on hormonal therapy forever if it's not really necessary. I might actually enjoy having a little estrogen in my life after depriving myself for seven years.

sg751

Thanks, Elaine. I did mention the BCI test in a message to my onc team, but it doesn't look like they want to do it. Has your onc mentioned the SALSA study to you at all?

elainetherese

Yes, she has. I was originally supposed to go 10 years as well, but she's been pushing 7 years lately because of SALSA. I will see her in a few weeks, and am interested in her reccomendations.

pt1234

What exactly have you followed other than zoladex + aromasin. I started hormonal therapy since June 2021 zoladex + anastrazole but from last month moved to Lupron instead of zoladex.

Were you used to take any bone injections and how frequent were they , any other medicines.

salamandra

Hi ElaineTherese,

I'm only on year 3 of toremifene but in your shoes I would absolutely get a second opinion. It does not seem at all valid to me to apply a study on postmenopausal women on a different drug to a situation like ours. That is not evidence-based medicine.

pupmom

I finished my 10 years 3 months ago. If the study is valid, and I'm assuming it is, go for the 7, IMO.

elainetherese

pt1234,

I did have bone loss on Zoladex + Aromasin, so I have been getting Prolia injections every six months. I'm also on Celexa because Z+A made me moody.

Salamandra,

The SALSA study isn't the only one to show that 7 years is often as good as 10 years. There was also the GIM4 study. See:

https://ascopost.com/issues/november-25-2021/duration-of-endocrine-therapy-in-breast-cancer-how-much-of-a-good-thing-is-too-much/#:~:text=The%20benefit%20of%207%20to,switched%20to%20an%20aromatase%20inhibitor.

sg751

The study is valid but applies to premenopausal... It's confusing bc for the sake of choosing which med I can take (tamoxifen vs AI) they say I'm premenopausal bc of my estradiol levels. But today she said bc I'm not getting periods, then I'm considered menopausal. She's going to look into the BCI test, so maybe I'll have more info soon. Thanks for your thoughts!

sg751

@pupmom congrats on finishing your 10 years disease free!!

voraciousreader

i started my journey premenapausal with an OncotypeDX score of 15. i did lupron and tamoxifen for 3 years, then became post menapausal and continued on letrozole for 5 more years. Based on the BCI test done at my 8th year and earlier studies suggesting 7 years was sufficient, I stopped treatment. This month I celebrated my 12th year of NED.

I wiOuld strongly support doing the BCI test and gettinga second opinion. That said, I think you have excellent prognostics and should do well.

pupmom

Thanks sg751! I was so frightened in the beginning, but now I rarely think about bc!

salamandra

As far as I can see the GIM4 study also was post menopausal women. I also see in this 2021 summary, it states, "They also point out that the survival curves only began to separate, in favor of letrozole, after around 9.5 years of follow-up, which "underscores the importance of adequate follow-up length in hormone receptor-positive early breast cancer to assess the effect of treatments and is consistent with the previously reported carryover effect of aromatase inhibitors."

I was diagnosed before I hit 40. Studies on post menopausal women based on the 15-20 year survival point are just not reassuring to me. I won't even be retirement age by then, but we know that hormonal cancer can come back after *thirty* years.

We all rely on oncologists to be able to interpret data and help us understand how it applies or doesn't apply to us. But I would need an awful lot of explaining from my oncologist to justify applying these studies to my situation.

sg751

@salamandra -- that's where I am now. I keep asking how this applies to me when I have only ever taken tamoxifen and am premenopausal (I was diagnosed at 45). I keep hearing "this is the direction we think the data is going for all but the highest risk"

elainetherese

Salamandra and sg751,

I wonder if I would feel differently about stopping hormonal treatment after 7 years if my cancer had been purely driven by the hormonal element (ER+). My oncologist claims that my cancer growth was driven more by the overexpression of the HER2 protein than by estrogen. In fact, the rates of recurrence for HER2+ cancer nosedive after the first 2-5 years. Still, my cancer had a high percentage of estrogen receptors (95% ER+).

So, I'm really interested in having the BCI test done. We'll see!