What factor should be considered for hormone suppression and moving to AI or staying with Tamoxifen? What should we ask our Oncologist?
--------------- case history -------
Premenopausal Breast Cancer women patient (Diagnosed at 36, current age 38, pT2N1aM0 triple+, Ki-67 - 60%) , Received complete TCH, Radiation and now on Tamoxifen from last 17 month.
Came out of chemo induced menopause 8 month back, but cycle duration is now double ~56 days, days and flow half of her normal.
Current FSH (64.6mlU/ml), LH(27.6mlU/ml), Estradiol (25.59 pg/ml). (mostly likely in follicular phase)
(Reference range posted as attachment)
Written by
Payal108
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We met our Oncologist this Friday, first he said Oncologist community is divided on usefulness of Ovarian Suppression, difference is small. But after again asking for his recommendation, he said to go for Ovarian Suppression (though Ovaries has stated functioning from last 8-9 month already). He also suggested to continue with Tamoxifen after Ovarian Suppression. And that it will be require for only two years, after that we need not worry about Ovarian functions.
"Aromasin Plus Ovarian Suppression Reduces Recurrence Risk Better Than Tamoxifen Plus Ovarian Suppression in Premenopausal Women Who’ve Received Chemotherapy" Link breastcancer.org/research-n...
Now few apprehencions
1) What risk difference will Ovarian Suppression make ?
2) Worried about side effects of it, as we see another young lady struggling with calcium deficiency.
3) Which way of Ovarian Suppression is good? ovarian ablation or Drugs called gonadotropin releasing hormone?
4) Is Ovarian Suppression for two year is widely recommended practice ?
We understand your apprehension. To be honest, and to guide you, none of your questions can be solved here. These need face to face discussion. If I answer one, it will lead to five more questions. So my suggestion is, please consult your Oncologist in detail. He would guide you. Also, to make you understand why answers to these are beyond the scope of this forum is - each and every individual patient is different. Two women of same age, same stage of cancer could have difference in treatment based on other factors. Also, I appreciate you are well read. I take about 30 to 45 minutes of intense discussion with my patients on similar subject! So you can imagine if I have to write all that here, neither do I have the time, nor will it be two way discussion with you and it will take me several full sized Microsoft Word pages to give answer to even one.
My suggestion - please login to Tata Memorial Centre’s new online opinion system called ‘Navya’ and take an opinion from there. It will be helpful and guide you better.
It can result in an impaired overall quality of life, which may persists over the 5-year course of therapy.5 Hot flushes (93.4% vs 79.8%), depression (51.9% vs 46.6%), insomnia (57.2% vs 46.3%), musculoskeletal symptoms (75.1% vs 69.0%), and osteoporosis (20.0% vs 12.3%) were more common in the ovarian suppression arm.
Given a loosely defined target population and a lack of overall survival benefit, the ASCO guideline supporting ovarian suppression in premenopausal women with stage II and III breast cancer should not serve as a mandate, but rather as a guide for discussing its relative risks and benefits with patients.
SOFT patients who remained premenopausal after chemotherapy experienced absolute improvement of 5% or more in 5-year BCFI with exemestane plus OFS versus tamoxifen plus OFS or tamoxifen alone, reaching 10% to 15% at intermediate to high composite risk; the benefit of tamoxifen plus OFS versus tamoxifen alone was apparent at the highest composite risk. ( I do not understand "reaching 10% to 15% at intermediate to high composite risk", what it mean and significance?)
For TEXT patients, the benefit of exemestane plus OFS versus tamoxifen plus OFS in 5-year BCFI ranged from 5% to 15%;
Treatment Efficacy, Adherence, and Quality of Life Among Women Younger Than 35 Years in the International Breast Cancer Study Group TEXT and SOFT Adjuvant Endocrine Therapy Trials.
Saha P, Regan MM, ...
Results For 240 human epidermal growth factor receptor 2-negative patients younger than 35 years enrolled in SOFT after receiving chemotherapy, the 5-year breast cancer-free interval (BCFI) was 67.1% (95% CI, 54.6% to 76.9%) with tamoxifen alone, 75.9% with tamoxifen plus OFS (95% CI, 64.0% to 84.4%), and 83.2% with exemestane plus OFS (95% CI, 72.7% to 90.0%). For 145 human epidermal growth factor receptor 2-negative patients younger than 35 years in TEXT, 5-year BCFI was 79.2% (95% CI, 66.2% to 87.7%) with tamoxifen plus OFS and 81.6% (95% CI, 69.8% to 89.2%) with exemestane plus OFS.
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