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Topic: LCIS and Evista

Forum: LCIS (Lobular Carcinoma In Situ) — Just diagnosed, in treatment, or finished treatment for LCIS.

Posted on: Jan 23, 2008 08:07AM - edited Jan 23, 2008 08:09AM by Bren-2007

Bren-2007 wrote:

I was recently told that Evista was not proven to work with LCIS, but was with DCIS.  I was hoping to be able to take Evista, as I had horrible gastro SE's with Tamox and Arimidex.  My LCIS was discovered along with an IDC tumor.  I had a lumpectomy and rads, as well as a total hysterectomy many years ago.  I need to go back and find the studies that were quoted.

Any other info would be great on the effects of Evista on LCIS.

Thanks,

Bren

This is the info I was referring to:

LCIS
First the facts, briefly: for stage I-II breast cancer such as yours, local recurrence occurs in approximately 10%-20% of patients treated with BCS (breast-conserving surgery, aka lumpectomy), which is significantly reduced by postoperative radiotherapy, but the reduction is primarily a reduction of ipsilateral - not contralateral - breast tumor recurrence.

As to LCIS, its biological significance as a "risk indicator" versus a "breast cancer precursor" has been a matter of considerable debate. Note that the risk indicator nature of LCIS is not in dispute - in fact, it is widely accepted that LCIS confers a modest increased risk of development of invasive carcinoma of about 1 to 2% per year, with an 8-year risk of about 4.4 - 4.7%, 10-year risk of between 7% and 8%, a lifetime risk of 30 to 40%, and a relative risk of breast cancer of 8 to 10-fold.

Now, as to the balance of the latest evidence, it suggests:

  1. That LCIS is both a risk indicator and a non-obligate precursor of invasive breast cancer; what this means is that LCIS should be considered a predisposing determinant of risk for subsequent invasive disease in either breast, but as a non-obligate / non-inevitable precursor the development of subsequent invasive carcinoma is not assured, although its risk is elevated, and the invasive carcinoma, should it develop, is not necessarily assured to be of lobular histology.
  2. Nonetheless, as a preneoplastic state from which progression may not be inevitable, LCIS is in general a reversible condition of low biologic potential and typically slow progression to invasive cancer if any.
  3. Local recurrence risk (LRR) varies somewhat with tumor size, with tumors > 3cm sustaining higher risk, and with young age (< 50) being an independent significant factor.
  4. Risk reduction with unilateral mastectomy is only modest, and it is for this reason that PBM (prophylactic bilateral mastectomy) needs to be considered an option for selected patients, based on the cumulative weight of all risk factors.
  5. The landmark NSABP P-1 Study established that progression to invasive disease seems to be significantly inhibited by the use of tamoxifen.

A Warning
Now. although the standard of care with LCIS is currently close follow-up together with chemoprevention via tamoxifen, the recommendation of your PCP to deploy the other SERM, raloxifene (Evista) instead of tamoxifen is in error and wholly against the evidence, and would lead to a false and dangerous illusion of preventive value: as decisively shown in the recent STAR trial, one of the largest breast cancer prevention clinical trials ever conducted, raloxifene (Evista) is of no significant benefit of risk reduction in LCIS; while tamoxifen was been shown to reduce by half the incidence of both LCIS and DCIS, raloxifene (Evista) did not have any appreciable effect on these diagnoses. And this result confirms data reported earlier in 2004 from the large CORE study of raloxifene (Evista). And, unlike tamoxifen which is chemopreventive in both premenopausal and postmenopausal women, raloxifene (Evista) is sanctioned, and of value, only in the postmenopausal setting.

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Jan 23, 2008 08:06PM Peaches70 wrote:

My take on this is that, since LCIS is not what I am trying to prevent, whether LCIS is reduced by Evista does not matter. What matters is whether an invasive breast cancer is avoided. This information was available to me before I made the decision. I AM menopausal, Evista has lesser SEs, and it has been shown to have approximately the same rate of risk reduction for the "bad" cancers. So, I stand on my choice.

Anne

Dx 1/25/2007, LCIS, Stage 0
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Jan 23, 2008 09:57PM Bren-2007 wrote:

Anne,

Thanks for your post.  I get it, kind've like an "aha" moment.  You're right, I can't prevent what I've already got!  Never looked at it that way before.  I did have LCIS, DCIS and IDC and sure don't want the latter two back. 

I was really dreading having to try Tamoxifen or Arimidex again.  My doc had suggested Evista.  How long have you been on it and how are you doing with it?  Any gastro SE's?

Thanks again for your point of view. Appreciate the "aha" moment.

Bren

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Jan 24, 2008 04:39PM Peaches70 wrote:

I've been on Evista since April. I was on Effexor too, but I weaned off of it. I had a pretty hot summer, but I was already having hot flashes off and on for the last three years. And I was gassy and constipated until about October. However, I attributed both at least partially to the Effexor, not the Evista. Whatever the cause, the SEs have abated sufficiently to be very doable. GI seems to be doing better and flashes actually went away for a couple of weeks, now are infrequent and mild. (I hope it's not just the weather ;)

Anne

Dx 1/25/2007, LCIS, Stage 0
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Jan 24, 2008 08:23PM liveit56 wrote:

I have only been on Evista since Dec. and so far no SE. I hope that I continue to not have any. 

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Feb 11, 2008 07:32PM liveit56 wrote:

I lied, now my legs are cramping and my hot flashes are more intense.

Also did any of you on here read where you shouldn't take Valium while on Evista?  My sister a nurse said I shouldn't but my Dr. knows I take it for Meneire's disease...not on a regular basis but when I have a vertigo attack. 

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Feb 11, 2008 08:12PM SISKimberly wrote:

I was just talking to my case nurse about the pros and cons of Tamoxifin vs Evista. I have IDC and had a bilat mast in Dec. 08. I'm researching now knowing that after chemo and rads, I will have to make a choice. I read a study regarding Tamox vs Evista and it seemed like the se's weren't as bad as with Tamox. Also, did any of you have your ovaries removed or a total hysterectomy to deal with the estrogen? I'm thinkng if I do that route then I can either avoid or take a smaller dose of the Tamox or Evista...leaning towards Evista if I have to take a hormone suppressing drug.

SIS Kimberly

Life is a journey that sometimes takes unexpected detours...but detours that often turn out to be the best parts of the trip. SIS Kimberly Dx 10/10/2007, IDC, 2cm, Stage IIIA, Grade 2, 4/10 nodes, ER+/PR+, HER2-
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Feb 11, 2008 09:48PM awb wrote:

I had  a total hysterectomy (not by choice--ruptured ovarian cysts) and I still take tamoxifen as there is estrogen still being produced by my adrenal glands.

"I don't know what the future holds, but I know who holds the future" Dx 9/5/2003, LCIS, Stage 0, 0/0 nodes Surgery 9/15/2003 Lumpectomy: Right Hormonal Therapy 10/29/2003 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 4/4/2005 Prophylactic ovary removal Hormonal Therapy 2/27/2009 Evista (raloxifene)
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Feb 12, 2008 08:42AM SISKimberly wrote:

awb- Ruptured ovarian cysts don't sound fun. I had one in my life and one was awful...can't imagine multiple. So is the Tamox at a lower dose than someone with ovaries?

Life is a journey that sometimes takes unexpected detours...but detours that often turn out to be the best parts of the trip. SIS Kimberly Dx 10/10/2007, IDC, 2cm, Stage IIIA, Grade 2, 4/10 nodes, ER+/PR+, HER2-
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Feb 12, 2008 09:34AM awb wrote:

wolf--no, I still take the normal dose of tamox (20 mg a day).  Not only is the estrogen produced by the adrenals, but it is also in our skin and fat and I have plenty of that!!!  (there's probably a fair amount of estrogen hidden in the foods we eat as well).

"I don't know what the future holds, but I know who holds the future" Dx 9/5/2003, LCIS, Stage 0, 0/0 nodes Surgery 9/15/2003 Lumpectomy: Right Hormonal Therapy 10/29/2003 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 4/4/2005 Prophylactic ovary removal Hormonal Therapy 2/27/2009 Evista (raloxifene)
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Feb 12, 2008 03:09PM SISKimberly wrote:

How are your SE' on Tamox awb?

Peaches-Did your onc baulk at all with Evista? That would be my first choice if I absolutely have to take an HT.

SIS (Sister In Survival)
KImberly

Life is a journey that sometimes takes unexpected detours...but detours that often turn out to be the best parts of the trip. SIS Kimberly Dx 10/10/2007, IDC, 2cm, Stage IIIA, Grade 2, 4/10 nodes, ER+/PR+, HER2-
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Feb 12, 2008 03:27PM awb wrote:

To be honest, before my hysterectomy, my SEs from tamox were very minimal--mild hot flashes and a little trouble sleeping. They all increased after surgery (with the addition of a lot of achiness), but  docs feel that it is now more attributed to the loss of my ovaries.  My oncologist said no to Evista when I asked about it, he felt that tamox has been studied longer, but I may ask him about it again when I'm done with tamox in 8 months.  My pcp feels it would be beneficial for me to take it.  It would definintely help with my newly diagnosed osteopenia.

"I don't know what the future holds, but I know who holds the future" Dx 9/5/2003, LCIS, Stage 0, 0/0 nodes Surgery 9/15/2003 Lumpectomy: Right Hormonal Therapy 10/29/2003 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 4/4/2005 Prophylactic ovary removal Hormonal Therapy 2/27/2009 Evista (raloxifene)
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Feb 12, 2008 03:58PM SISKimberly wrote:

awb, you're done in 8months with Tamox? I thought you had to take it for 5 years? Your posts just started in '05, so wouldn't that be at least 2010? Yes, I've read Evista is good for osteopenia...and a study done with Evista vs Tamox shows it is just as effective as Tamox in preventing future IDC cancers, which is what interested me, without the same SE's.

Life is a journey that sometimes takes unexpected detours...but detours that often turn out to be the best parts of the trip. SIS Kimberly Dx 10/10/2007, IDC, 2cm, Stage IIIA, Grade 2, 4/10 nodes, ER+/PR+, HER2-
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Feb 12, 2008 05:04PM awb wrote:

wolf--I was diagnosed in 2003--didn't find this chat room until 2005.  Even though they say tamox continues to give you some protection for another 5 to 10 years or more, I may still think about going on Evista. But I would probably take a little break in between ( a few months perhaps), so I could differentiate  which SE was coming from which medication.

"I don't know what the future holds, but I know who holds the future" Dx 9/5/2003, LCIS, Stage 0, 0/0 nodes Surgery 9/15/2003 Lumpectomy: Right Hormonal Therapy 10/29/2003 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 4/4/2005 Prophylactic ovary removal Hormonal Therapy 2/27/2009 Evista (raloxifene)
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Feb 12, 2008 05:57PM Lorax wrote:

while tamoxifen was been shown to reduce by half the incidence of both LCIS and DCIS, raloxifene (Evista) did not have any appreciable effect on these diagnoses.

this statement does not make sense to me.  I think the writer must have meant reducing the incidence of invasive lobular cancer or invasive ductal cancer - as far as I have been told there is no "incidence" data of LCIS or data about reducing risk of LCIS as it is usually found by accident and my guess is that there are many people who have it without ever knowing.  I have never heard of any therapy to reduce the risk of LCIS.   In addition, I was startled to read that raloxifene has no appreciable effect (again - on the development of ILC or IDC ? ).  I was under the impression that the star study showed it to be nearly as effective as tamoxifen.  Does anyone have a link for the final results of the Star study?  I also have osteopenia, and thought it might be a good choice at some point.

Lorax 

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Feb 12, 2008 05:58PM - edited Feb 12, 2008 05:59PM by Lorax

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Feb 12, 2008 06:11PM awb wrote:

Lorax---the way I interpreted the STAR study was that while tamox and evista are equal at preventing the invasive bc's, tamox is better than evista at also preventing the non-invasive bc's (DCIS and LCIS).

"I don't know what the future holds, but I know who holds the future" Dx 9/5/2003, LCIS, Stage 0, 0/0 nodes Surgery 9/15/2003 Lumpectomy: Right Hormonal Therapy 10/29/2003 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 4/4/2005 Prophylactic ovary removal Hormonal Therapy 2/27/2009 Evista (raloxifene)
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Feb 12, 2008 06:19PM OneBadBoob wrote:

Try this link maybe

http://jama.ama-assn.org/cgi/content/full/295/23/2727?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=Raloxifene+vs+Tamoxifen+&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

Jane - Dance as if no one is watching!! Dx 7/7/2007, IDC, <1cm, Stage I, Grade 1, 0/2 nodes, ER+/PR+, HER2-
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Feb 12, 2008 07:29PM Peaches70 wrote:

My oncologist was the one who wanted Evista for me. He sent me to get a blood test (I was born without a uterus, so menopause was hard to determine) and said to hope it came back that I was in menopause so I could take it. He is very much in favor of Evista for those who are post - says it has less SEs and risks.

My understanding is that Evista is about as effective as Tamoxifen for the invasive cancers. And, its initial use was for osteoporosis, so I would think it would be useful for that as well.

Anne

Dx 1/25/2007, LCIS, Stage 0
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Feb 13, 2008 12:57PM Lorax wrote:

Thanks for the link and your input - I am going to print out the study and try to wade through it.  Just when I start to think I know all I need to know about this damn condition (LCIS), I realize that either I have made assumptions that aren't true, or that I have just been oblivious to aspects.  You guys are great for keeping me on my toes. 

Lorax 

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