Thursday, December 6, 2012

Stop changing your mind. You are confusing (and scaring) the patients.

They keep changing their minds. These are the evil 'them' who are out to confuse all the patients they cant kill off. They just released a new study that breast cancer patients should have ten years of tamoxifen, and not five. I thought I was done with it. I was on tamoxifen for 2 years and am just finishing up on Femara for another three. I would be done in January. But will ask my oncologist if there is any reason to go back on Tamoxifen.

Truth be told, I would be perfectly happy to have one fewer daily medication to take and was starting to look forward to the end of Arimidex which is currently scheduled for January.

In an evil little psychotic way, I am glad to read that even the oncologists are confused by this. You can read on below but the gist of it is women who took tamoxifen for 10 years had a 12% rate of dying from breast cancer ove rthe 15 year study compared with at 15% risk for those who took a placebo after the first five years. Howevr about 3% of women who took tamoxifen developed endometrial cancer.
 "“It’s going to be practice-changing, in my view, immediately for pre-menopausal women with breast cancer,” said Dr. Eric Winer, chief of women’s cancers at the Dana-Farber Cancer Institute who was attending the San Antonio cancer conference where the results were presented Wednesday. Those who have “estrogen-receptor positive” breast cancer, the type that responds to tamoxifen, will probably be advised to continue taking tamoxifen for an additional five years, he said.

Younger breast cancer patients who stopped taking tamoxifen years earlier may be counseled to start taking the drugs again.

On an individual level, breast cancer patients will need to weigh their tamoxifen options carefully.
On an individual level, however, breast cancer patients will need to weigh their options carefully. Endometrial cancer is a real concern, but it is usually more common in women over age 60. Patients should also realize that “the benefit isn’t huge, it’s modest,” Winer said.

Some women can’t tolerate tamoxifen and are eager to get off the drug as quickly as possible. They might have hot flashes, moodiness, and vaginal dryness making sex very painful. “About 10 to 15 percent of women don’t like being on it,” Winer added, “and unfortunately, younger women seem to have more of these side effects.”

Those with small, non-aggressive tumors with no spread to nearby lymph nodes might consider taking tamoxifen for only five years if they’re plagued by side effects since their risk of recurrence is very small. Those with larger, more aggressive tumors, however, might feel more compelled to stay on the drug for a decade.

For women whose breast cancer was diagnosed after menopause, the picture gets even more complicated. They’re usually given newer drugs called aromatase inhibitors (Arimidex, Femara, Aromasin) in addition to or instead of tamoxifen for a total of five years of treatment. Post-menopausal patients at Dana-Farber typically get two years of tamoxifen followed by five years of aromatase inhibitors.

“I’ve long believed that these extra years of treatment would help,” said Winer. That’s because with estrogen-receptor positive cancers, half of all recurrences happen beyond five years of diagnosis.

The new study found that 21 percent of those taking tamoxifen for 10 years had a recurrence during the study compared with 25 percent taking tamoxifen for the shorter period. The biggest differences in recurrence rates were seen between 10 and 15 years after the cancer diagnosis.

“That was confusing to some of the oncologists at the meeting,” Winer said, but it could have to do with tamoxifen’s cancer-preventing benefits lasting for up to five years after women stop taking the drug.

Post-menopausal breast cancer patients could be given the option to take estrogen-blocking drugs for longer, but oncologists might be left in a quandary about which drugs to give and for how long.

“Should these patients be given 10 years of treatment with an aromatase inhibitor? Should they have 5 years of an aromatase inhibitor followed by 5 years of tamoxifen? Would more than 10 years of tamoxifen be even better than 10 years? No data exist to support any of these options,” wrote Dr. Trevor Powles, an oncologist at the Cancer Centre 
London in England, in an editorial that accompanied the study."

This article is full of all sorts of 'warm fuzzy' news. Did you notice the statistic about recurrence rates highest between 10-15 years after diagnosis? I'm overjoyed.

This may have been a long awaited study but all it did was confuse and scare the patients and make them all want to call their oncologist right away and ask what impact this has on their treatment.


Anonymous said...

My big question would be what happens to your BONE density if you take those drugs for 10 years. I am taking Femara and in my 4th year and my bones are taking a beating. I am nearly in osteoporosis right now in my hips which is really worrisome. I am at high risk of hip fracture and I am still relatively young. This whole thing is beyond nerve racking!

AnneMarie said...

We MUST talk.... I was in San Antonio.... Yes, I WAS! Damn if THIS isn't why WE need to be driving the research in a different direction.

Some of this stuff was a gigantic waste of money...

Love ya.... was with Jody! And bumped into the DoD researcher who was seated right beside me.... How odd, right???


Cancer Curmudgeon said...

I think I read somewhere that AstraZeneca, maker of Tamoxifen, was a major funder of the study. Should that not give everyone pause in considering the legitimacy of this study?

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