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Topic: Femara or tamoxifen

Forum: ILC (Invasive Lobular Carcinoma) — Just diagnosed, in treatment, or finished treatment for ILC.

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Posted on: Mar 19, 2008 10:16PM

trigeek wrote:

Hey Lobular friends !

I finished my Dose Dense 4 X ac and 4 X taxol .. and am going through rads. I have a meeting with my oncologist tomorrow and he I believe is planning to put me on tamoxifen.

I am 45 and was premenaupausal ( well I am now in the deep trenches of chemaupause with insomnia and night flashes galore !!)

I have been hearing that some gals have been put on Femara instead of tamox.. what is the scoop ?

Thanks !

Bilateral MX with Recon, DD AC/Taxol Rads,Tamoxifen, oopherectomy, femara, zometa "Live Deliberately !"www.aylin-yeahright.blogspot.com/ Surgery 9/1/2007 Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 10/7/2007 AC + T (Taxol) Hormonal Therapy 1/4/2008 Femara (letrozole) Radiation Therapy 6/11/2008 Whole-breast: Breast
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Mar 20, 2008 09:49AM matic22 wrote:

Dear trigeek!

For aromatase inhibitors you need to be postmenopausal, which means you do not have a period for at least 12 months.So, I suggest you to go firstly with tamoxifen, for nearly 2 years, then if you are postmenopausal still after 2 years of tamoxifen(what I suppose you will be), switch to Femara or maybe better Aromasin for 3 years and then for 5 years of Femara. I believe this is going to be the best treatment choice of hormone sensitive breast cancer in the future.So, hormonal therapy for 10 years.

Femara is better to start with after 5 years of some other hormonal therapy.

Kind regards!

MATIC

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Mar 20, 2008 11:05AM LizM wrote:

Trigeek,

I agree that you need to ensure you are postmenopausal before starting on an aromatase inhibitor (Femara/Arimidex/Aromasin); however I do not agree that Femara is better to start with after 5 years of some other hormonal threapy as stated above.  Femara has been shown to be slightly more effective at preventing recurrence than Tamoxifen in ALL studies, including those in which Femara is given as first hormone therapy right after surgery.

I was 49 at diagnosis and premenopausal and chemo put me in chemopause.  My oncologist wanted me to go on Tamoxifen for 2 to 3 years and then switch to Arimidex or Femara.  I chose to remove my ovaries and create a menopausal state in order to take an aromatase inhibitor.  I figured why not since I was close to menopause anyway and was already suffering from menopausal symptoms due to chemo.  It was the right decision for me and gave me peace of mind.  You can also create a menopausal state by takign monthly shots of Zolodex to shut down your ovaries.  There are women here on these boards who chosen that course of treatment also.  Studies also show that taking Tamoxifen for 2 to 3 years until you are sure you are menopausal and then switching is another effective way to go.  However, my oncologist told me he has seen women my age get their periods back two years after chemo.  It can be risky to start on an aromatase inhibitor unless ovarian suppression is part of the treatment for a women of your age.  Good luck with your decision I know they are not easy to make.     

Dx 9/19/2005, IDC, 2cm, Stage II, Grade 1, 1/8 nodes, ER+/PR+, HER2-
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Mar 20, 2008 11:16AM LizM wrote:

I believe it is the BIG 98 study that shows Femara to be slightly more effective  than Tamoxifen as first hormone therapy after surgery .  The MI17 trial also shows Femara to be more effective but that is after 5 years of Tamoxifen. [
Dx 9/19/2005, IDC, 2cm, Stage II, Grade 1, 1/8 nodes, ER+/PR+, HER2-
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Mar 20, 2008 11:44AM trigeek wrote:

Thanks for all the input, the study was done on post menaupausal gals tho right ?

Would a premep gal with ovarian suppression( if I decide to take that route ) fit into that category ?

Bilateral MX with Recon, DD AC/Taxol Rads,Tamoxifen, oopherectomy, femara, zometa "Live Deliberately !"www.aylin-yeahright.blogspot.com/ Surgery 9/1/2007 Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 10/7/2007 AC + T (Taxol) Hormonal Therapy 1/4/2008 Femara (letrozole) Radiation Therapy 6/11/2008 Whole-breast: Breast
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Mar 20, 2008 02:40PM - edited Mar 20, 2008 02:40PM by matic22

Dear LizM!

Well , I have one comment on your report.It is all true what you have written down but an oncologist Tanja Čufer,who is a worldwide known oncologist, told me that Femara was slightly better than tamoxifen when given after surgery ONLY in patients with aggressive tumours(those with ER+ PR- or HER-2 +), but not in patients with non-aggressive tumors.Tumors that express both ER and PR receptors need to be treated with tamoxifen if you are premenopausal at the beginning of the treatment and not with an AI!!!

Kind regards!

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Mar 20, 2008 04:06PM LizM wrote:

It is my understanding that once you have your ovaries removed you are no longer premenopausal and are now considered postmenopausal and thus are a candidate for aromatase inhibitors.  My estradiol level was very low after chemo before I had my ooph so I felt very comfortable switching from Tamoxifen (I took Tamoxifen after chemo and during rads for 3 months) to an AI after my surgery.  My oncologist who specializes in breast cancer only at the #3 cancer hospital in the US and who is on the board of ASCO was very comfortable with me taking an AI instead of Tamoxifen after my oophorectomy.  In fact he seemed pleased I had made the decision as it is not something that oncologists will normally recommend since removing an organ seems extreme to them these days.  However, I wanted to be as aggressive as possible with my treatment and the surgery was a peace of cake.   

Dx 9/19/2005, IDC, 2cm, Stage II, Grade 1, 1/8 nodes, ER+/PR+, HER2-
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Mar 24, 2008 11:26AM - edited Mar 24, 2008 11:28AM by susaloh

There seems to be more to it than just having low levels of estradiol. My gyn said some time ago, she had just been to a workshop about the topic - AI versus Tamoxifen for women who had been put into menopause through chemo. She said discussion about this was controversial but that as a matter of fact, researchers and doctors felt very uneasy of giving AIs in that stage. I asked why  and she said that for example even though I am in chemopause, it is obvious that my body and its functions couldn´t really be compared to those of a woman who had undergone menopause naturally (I am 46)  and that therefore they couldn´t be sure how the AIs would work and which side effects to expect because the AI-research had been done on truly postmenopausal women. I would have liked a slightly more scientific explanation, but I guess I trust her because I am not keen to be a guinea pig (especially since I am not part of the risk group with aggressive tumors mentioned by matic further up). 

There is another reason for me to be in favor of taking tamoxifen for the first two or three years and then switch to an AI rather than start off with an AI: It looks like they will recommend hormonal therapy to go on longer than the usual 5 years, as matic says further up, too. So far nobody seems to know how  long AIs actually work or whether they will stop to work eventually like they found out about tamoxifen. So the right sequence seems to be important in order to "survive" those ten years. 

On my German board there was just this case of a lady who had had ILC in 1993 (large tumor and many nodes affected)  and who had been fine until 2005 but deteriorated since. For the past three years they couldn´t find anything  but now finally they diagnosed  metas - apparently all of her organs show what they called a "thin metastatic coating" (Sounds very much like ILC to me) and her bone marrow had basically been completely destroyed . . They can´t do chemo or anything because of her blood situation but they start her off on an AI now. Imagine, this took 12 years to develop 5 of which she´d been on tamoxifen. 10 years of Anti-Hormone-Therapy might have bought her another five years!!

Then again, imagine taking these pills for such a long time without recurrence - what kind of effect will the long-term deprival of estrogen have on our health, on our life expectancy, on our quality of life? I guess we are all guinea pigs after all.....

dx 01/19/2006, 10x9 cm ILC, chemo, bilat., rads, Tamoxifen 3y, Arimidex 8w, large met to ovary, spots elsewhere, ooph, Zometa plus Faslodex/Arimidex 19 months, Ascites, 6x Carboplatin/Taxol + Femara
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Mar 25, 2008 08:06PM trigeek wrote:

Thanks everyone will go with Tamox after rads are over.

Bilateral MX with Recon, DD AC/Taxol Rads,Tamoxifen, oopherectomy, femara, zometa "Live Deliberately !"www.aylin-yeahright.blogspot.com/ Surgery 9/1/2007 Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 10/7/2007 AC + T (Taxol) Hormonal Therapy 1/4/2008 Femara (letrozole) Radiation Therapy 6/11/2008 Whole-breast: Breast

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