Posted on 10/11/2009 1:15:53 PM PDT by neverdem
Despite the perception of many oncologists that tamoxifen is an inferior drug, and should be substituted by an aromatase inhibitor in post-menopausal women, the current evidence strongly supports the view that AIs should be used 2–3 years after tamoxifen to achieve the maximal overall survival (OS) advantage.
The last year has been an interesting time for oncologists interested in the adjuvant hormonal treatment of post-menopausal women with receptor-positive early breast cancer. Three important new pieces of clinical research were presented at the 2008 San Antonio Breast Cancer Symposium: a meta-analysis of the Aromatase Inhibitor (AI) trials (Ingle et al, 2008b) and two individual AI studies (Jakesz et al, 2008; Mouridsen et al, 2008). These data suggest that it may be premature for oncologists to discard tamoxifen. In this mini review, we analyse whether all patients should be exposed to 2 or 3 years of tamoxifen as part of their adjuvant hormone therapy for receptor-positive early-stage breast...
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In our view, oncologists should always remember the question that comes before all others. How can an individual patient reduce her risk of death? The available evidence for receptor-positive post-menopausal women strongly supports the use of an approach in which all patients are exposed to 2–3 years of tamoxifen and 2–3 years of an aromatase inhibitor. All OS-positive trials use such an approach and this is the only treatment strategy for which a mortality benefit could be seen in the AI meta-analysis. Such an approach also limits the patient's exposure to either class of drug. As these two classes of drug have different safety profiles (tamoxifen is associated with small risks of endometrial cancer and thromboembolic disease whereas the AI's have a moderate effect on bone health) this additional limited exposure to either agent is likely to mitigate the risk of serious complications...
(Excerpt) Read more at nature.com ...
If patients and/or docs are hesitant to use the tamoxifen, try Diindolylmethane (DIM)(from a reputable company ;)
I hated what Tamoxifen did to me. It caused me to have such severe depression and anxiety I almost lost my job, my marriage was almost destroyed and my kids thought I was insane. I thought I was insane! I took myself off of it. I’d rather die of cancer than live like that.
I suffered through it for over two years so I figure I got most of the benefits. If not, well, God has me in his hands. I’ll stay as long as He wills me to but I won’t be afraid when it’s time to go home.
I am not surprised by your horrible reaction to the Tamoxifen as it blocks estrogen receptors. Most women do feel like getting on a watchtower with a rifle! DIM blocks the ‘bad’ estrogen in the Phase 1-2 detoxification pathways in the liver however, allows the ‘good’ to do its job in the body so the mechanisms of action of DIM are selective whereas the Tamoxifen are a ‘blanket approach’. ;)
I agree, I took myself off Tamoxifen also because I had such bone pain I couldn’t walk. That was 15 years ago.
And, then there are people like me, that have triple x negative breast cancer.
Not many studies being done on this type of cancer because only 10% of the breast cancers are triple x negative. But, our odds of surviving to 5 years is “0”.
Thanks for your reply. My friend, recently done with a radiation therapy for breast cancer, was asked to take this drug. She decided against it, mostly for fear of the side effects that you describe.
She had early stage cancer and was told there was a 1 in 3 chance it would go away on its own. Even so, she had a lumpectomy and radiation. Afterward, the docs suggested a double mastectomy, just in case! Unbelievable!
Sorry to hear that.
My wife was on it for the better part of a year after undergoing a mastectomy and chemo in 1967-97. It gave her an unbelievable, uncontrollable cough, so she stopped taking it.
I do want to say that I know quite a few women I met during treatment who took Tamoxifen with few problems, and I would like to note that all of us are alive, five years later.
I would hate for someone to read my post and decide against it based on anecdotal evidence. If I were advised by my Doctor to take it, I would give it a fair try. Even a year or two seems to have benfits.
And in my case the side effects were temporary and completely disappeared within a few weeks of stopping the drug.
Were you working at the time you took it? My friend is a professor and was warned of memory-loss side effects. She can’t teach, she can’t do research if her mind isn’t right. Though most people don’t realize it, professors at research institutions travel for conferences and talks quite a bit. She was afraid to travel for fear of being ill, unable to give her talk, etc. It all seemed a bit much for something that might have gone away anyway.
Yes I was working and that’s why I almost lost my job. I was having a terrible time staying focused an staying on task. It took an enormous act of will just to open a project and begin work and I was so easily distracted.
I got zero accomodation or sympathy - in fact my two (male) coworkers began a covert campaign to undermine me, discredit me, and destroy my credibility. And believe me, it worked all too well.
I would dread going to work with all my heart and spent a lot of time crying in the bathroom.
It never made me feel physically ill but several of my friends reported menopausal symptoms such as hot flashes, which of course is to be expected because the purpose of the drug is to suppress your body’s production of estrogen so as not to “feed” an estrogen postive cancer.
Thank you for sharing. I realize this is your personal experience and not applicable to everyone, but it is worth hearing and considering. If my friend doesn’t make tenure (I’m also a prof, tenure is on our mind all the time), she will be without a job - and maybe sick and without a job. It seems too much to risk, again, especially since she had such a low level of cancer.
I completely understand, but all the same if it were me I would at least give it a shot. She can always stop taking it.
Prayers and best wishes for her.
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