advise on letrozole

[meeta]

i had breast cancer 7 years ago after treatment i was advised letrozole for 5 years now after 5 years i have been advised to stop letrozole but i was told by another doctor that it should be taken for ten years please advise

[Lamchee]

A medicine is w/drawn when disease starts progressing.This can be known by PET /CT scans or marker test or sonography.Sometimes medicine is w/drawn only after few months.

[kontak TeamBCI]

Hi Meeta - There are different opinions given by different doctors. Lets see what Doctor has to say

[roxboxfox RadiationOncologist]

Current International Guidelines: suggest that

a) for Postmenopausal women who are hormone receptor positive recommend to have Aromatase Inhibitor drugs (like Letrozole) for total period of 5 years only.

b) for Premenopausal women who have completed 5 years of Tamoxifen, based on their risk profile, at times your oncologist may suggest additional 5 years of treatment with hormones based on your menopausal status, with either additional Tamoxifen treatment ( Total upto 10 years), or treatment with Letrozole ( 5 years of tamoxifen + 5 years of letrozole).

The role of letrozole beyond 5 years is currently being studied in 2 very large international clinical trials called the MA-17 R trial which will hopefully complete recruitment by November 2015 and the other trial is called National Surgical Adjuvant Breast and Bowel Project (NSABP) B-42 trial which will complete in October 2018. These trials will perhaps answer your question whether would taking Letrozole beyond 5 years be of any clinical benefit or not.

Please re-discuss your clinical options with a qualified Medical oncologist with a degree to clear your doubts.

May i also suggest, there is no role of any PET/CT scan or marker test or sonography to check whether the cancer has gone or not. (in this setting after 5 years of oncology treatment with letrozole).

All what i would suggest, is to continue follow up annually (if you are still anxious / worried), as in many places patients are routinely discharged after 5 years. Your Oncologist would clinically examine you and may suggest mammography (if breasts are still intact). Additional tests and investigations may be done based on your symptoms, if any. If you are asymptomatic, none of these tests and investigations are really needed. They only increase anxiety and increase your costs.

All the best and congrats

With best wishes

Dr Rohit Malde M.D, DNB, FRCR (UK)

Consultant Clinical & Radiation Oncologist

HCG cancer centre, Nanavati Hospital, Vile parle

Mumbai

[sumeet_shah Administrator]

Roxboxfox has given a detailed reply and I don't have much to add to it. 5 years is the standard time for which Aromatase Inhobitors are given. The recent trials on Tamoxifen raised the time period for the years. Same is not true for Letrozole and Anastrozole. With time, however, it may change and they may also be given for a longer time. I have seen quite a few Medical Oncologists extrapolate tamoxifen 10 years to at least 7 years of Letrozole or Anastrozole, but this is all subjective and needs to be discussed with your medical oncologist.