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Aug 10, 2021 07:27PM
Hi, morrigan. So your aunt took tamoxifen for 5 years, then got 2 more years apparently cancer-free. Then a new breast cancer was found, she took anastrazole for 5 years, then got 11 more years apparently cancer-free. Is that right? It sounds like these cancers have not been particularly aggressive, though one of them is persistent. I'm guessing that this slowness would make an oncologist lean toward choosing easier treatment over aggressive treatment. And low-key treatment could keep the cancer at bay long enough for your aunt's natural lifetime, without subjecting her to more side effects. I think the two-pill option would be an anti estrogen such as anastrazole plus a targeted therapy like Ibrance. This targeted therapy could double the progression-free survival time. So this is where your aunt and her oncologist need to talk about how her health is otherwise, what is her own individual life expectancy. Do the ladies in her family live into their 90s and is she in great health otherwise? Or is she rather frail? Is she willing to put up with a lot for a better chance at seeing that next grandchild? Age alone should not determine the course of action. It has to be individualized. I would ask if the recommended treatment would be the same if your aunt was age 53. If not, why? In her position I might seek a consultation with a geriatric oncologist. It could probably be done via telehealth and you could attend.
It makes sense to me that the doctor would not order a biopsy that is too risky. I think monitoring ought to be not only with blood tests (liver enzymes) but also with scans (CT, MRI, or PET), typically every three months. I would ask why use tamoxifen or anastrazole again since eventually one of those failed; how about aromasin? (These are all anti-estrogens but not exactly alike.) Fulvestrant/faslodex is another one, but it is some pretty big injections that I hate to think of giving to an older lady, so I would be inclined to try the others one first. Again, your aunt has to say what she is up for, what her goals and values are. (Choosing quality over quantity is not "giving up".)
It sounds like you are a good ally -- sensitive to your aunt's feelings, looking out for her, without wanting to take over. Help her make sure she has a smart, compassionate doctor who is in her corner, and you have done a lot.
2011 Stage I ITCs sn, premenopausal, Oncotype 16. 2014 Stage IV mets breast,liver. TaxolNEAD. Ibrance+letrozole 2yrs. Fas+afinitor nope. XelodaNEAD 2yrs. Eribulin,Doxil nope. SUMMIT FaslodexHerceptinNeratinib for Her2mut NEAD
2011, ILC, 1cm, Stage IA, Grade 1, 0/1 nodes, ER+/PR+, HER2-
2014, ILC, 2cm, Stage IV, metastasized to liver/other, Grade 2, ER+/PR+, HER2-
Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)