On Anastrozole. Should I start Zometa? Had one Bone met that's gone! Tamoxifen instead?

HISTORY
I just started this MBC journey 7 months ago. I had one small bone met in upper sternum and some possible mets to soft tissue in mediastinum and lymph nodes in same area. Only the sternum was biopsied. ER+ (90%), PR+ (30%), HER2+. I started on HP protocal and anastrozole the end of July 2024. No chemo. End of September 2024: NED on PET/CT. I took a 3 month holiday from treatment. End of December 2024: low SUV in soft tissue in mediastinum. Nothing else. Although we don't know for certain that the area in the soft tissue is cancer (never did biopsy), doctors think it best to restart anastrozole and HP protocol. So I did, on January 7th.


CONCERNS
Since I currently have NO bone mets, my MO is not pushing Zometa yet. However, the anastrozole can cause bone loss, so I'm sure in the near future she will want to start the Zometa. I have been doing research on Zometa and found that only one or no bone mets may indicate not starting Zometa, especially right away. But, once again, anastrozole and bone loss may indicate starting is in the future.


QUESTIONS
Has anyone waited to start it, say 9-12 months after starting HP protocol?

And if so, has anyone gotten infusions only every 6 months instead of 3?

Has anyone gone on tamoxifen instead? I know it isn't as effective in post-menopausal women, but is much better for your bones. I was on it for 5 years with my first run-in with this beast.

I am trying SO hard to avoid as many drugs and their side effects as possible. Anyone else out there that delayed Zometa treatment and had good results and fewer side effects?

Any information or thoughts on this topic would be greatly appreciated. Thanks.

Pam

Comments

  • olma61
    olma61 Posts: 1,034

    just wanted to tip you off to a couple of threads that discuss pros and cons of these bone strengthening drugs:

    (And my purely anecdotal population=1 experience is that I stopped Xgeva (another bone strengthening drug) after 2 yrs

    And was on anastrazole for 6 yrs and had all normal dexascans.

    I am over 60 yo. Your mileage may vary however.

  • @olma61 Thanks for your response and the links to other discussions. I still haven't started Zometa, since my MO (at the cancer center where I get my infusions) isn't too concerned yet. I had the single bone met that is gone. Will have another PET scan end of March, so that will be telling. I do have minor osteopenia in left hip. But, to be fair, it's been that way for over ten years, when I had my last Dexa Scan. I did have another one last fall, which showed some progression of osteopenia on the Dexa Scan but, since I've moved cross-country since my last one, that could just be the machine, the reading by the technologist, etc. I know there is a lot of variance in those scans. Additionally, I had my left knee replaced a few years ago, followed by a large extruded herniated disc that affected the nerves in my left leg. Due to these two medical issues, I could not put a lot of pressure on my left leg for a few years! I am finally back to using that leg normally just recently.

    I also have another MO at a teaching hospital (6 hours away) that I consult with after each PET scan (via telehealth). She strongly suggested I start Zometa. Argh! Depending on what the next PET shows, I will make a decision on Zometa. Perhaps every 6 months for 2 years, then stop for a while. I feel so many of these treatments are a roll of the dice. I am trying to mitigate SEs and the need for additional drugs. I'm in my 60s as well.

    A few questions, @olma61 , are you no longer on any hormone blocker? Are you still doing HP? How do you feel overall? Thanks for all of the information!

    Hugs, Pam 💗

  • olma61
    olma61 Posts: 1,034

    About bone density - if needed, maybe you could do Prolia or one of the bone strengthening drugs that non-cancer patients take for osteoporosis. Prolia is the same drug as Xgeva but Xgeva is a higher dose that is given to bone metastasis patients,while Prolia is for other women who need it to build bone density. the purpose of the bone strengthening for bone Mets is to try to prevent fractures- as you say, you only have one met….so, definitely something to discuss with your doctor.

    as for my treatment regimen, I had anastrazole from the time I finished chemo in 2018 until early last year, when my new oncologist agreed to put me on Fareston (similar to Tamoxifen, so it’s not an aromatase inhibitor like anastrozole). Anastrozole side effects seemed to be piling up so I wanted to try something different. Joint pain, muscle spasms, feeling like I had the beginnings of carpal tunnel syndrome.

    And I’ve been on PHESGO (the HP shot) every 3 weeks most recently. But as I posted in the H&P thread, I am stopping H&P as part of the FREE HER study, my last shot was on 1/23. I will remain on Fareston for the foreseeable future.

    The study is only about stopping H&P in patients with negative signatera tests and NEAD scans.

  • @olma61 That's right! You are the FREE HER girl! 😀

    Thanks for the detailed information. I will certainly be giving all treatment options a lot of thought.

    Hugs, Pam 💗

  • lillyishere
    lillyishere Posts: 800

    I had Zometa for 3 years, every 6 months for two reasons:

    1. reduce recurrence risk even slightly
    2. It keeps the bones healthy once you start aromatase inhibitors like anastrozole.

    Most oncologists from teaching hospitals or well-known hospitals recommend Zometa. Did you have recurrence?

  • @lillyishere Yes, I did have a distant recurrence 15 years after my initial IDC. (See my long signature below my post.) Just one bone met that is gone.

    I am wondering… are you going to continue every 6 months or take a break? My Teaching Hospital MO said that I could stop after 2-3 years because the bones can get too strong and snap! (As we've read in other posts.) Anyway, I do have some time to decide. Just gathering as much info as I can to make the best decision.

    Thank you so much for your input. Every bit helps!

    Hugs, Pam 💗