2D6 Article in the New York Times

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phoenixrising
phoenixrising Member Posts: 1,508
edited March 2014 in Breast Cancer #1
Thought I would share this with you as I was one of the women interviewed but not quoted. (boo hoo) The topic is interesting and we'll probably be hearing more of it in the future.

Called: The Evidence Gap

http://www.nytimes.com/2008/12/30/business/30gene.html?_r=1&adxnnl=1&pagewanted=all&adxnnlx=1230620505-qRUDZxD1Oss+lOxUBb1vkA

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  • Jadie
    Jadie Member Posts: 723
    #2
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    2D6
    Thank you, the article was interesting. I think we might be hearing a lot more about it.

    Hugs
    Jadie
  • Jadie
    Jadie Member Posts: 723
    #3
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    2D6
    Thank you. The article was interesting. I think we might be hearing a lot more about it.

    Hugs
    Jadie
  • mimivac
    mimivac Member Posts: 2,143 Member
    #4
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    Jadie said:

    2D6
    Thank you. The article was interesting. I think we might be hearing a lot more about it.

    Hugs
    Jadie

    Interesting article
    I had read about this before regarding Tamoxifen, and it is interesting. What surprised me is that 8% of women taking Herceptin were HER negative and some had not been tested?! I know that's not a high percentage, but why would a doctor assign someone Herceptin who didn't need it? Are there benefits of Herceptin for HER negative persons? Just wondering. I am ER/PR (and HER) negative, so I won't be taking cancer drugs after my chemotherapy and radiation treatments. Anyone else out there like me? Did you do anything after treatment, such as a clinical trial? My doctor mentioned one in which women who were ER negative were given bone strenthening drugs to prevent bone mets. Being ER negative makes me very upset, so just wondering if there are others on these boards...

    Mimi
  • cabbott
    cabbott Member Posts: 1,039 Member
    #5
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    mimivac said:

    Interesting article
    I had read about this before regarding Tamoxifen, and it is interesting. What surprised me is that 8% of women taking Herceptin were HER negative and some had not been tested?! I know that's not a high percentage, but why would a doctor assign someone Herceptin who didn't need it? Are there benefits of Herceptin for HER negative persons? Just wondering. I am ER/PR (and HER) negative, so I won't be taking cancer drugs after my chemotherapy and radiation treatments. Anyone else out there like me? Did you do anything after treatment, such as a clinical trial? My doctor mentioned one in which women who were ER negative were given bone strenthening drugs to prevent bone mets. Being ER negative makes me very upset, so just wondering if there are others on these boards...

    Mimi

    Some ideas
    I have read that chemo gets best results with ER negative cancers. I have also read that anything that strengthens your bones prevents reoccurance and lengthens survival too. Fosamax, Boniva, or a yearly IV bone builder all work, though your doctor may have a preference based on his experience and your medical history. Exercise is also known to reduce reoccurance. Guess what--it builds bones too. I bet the two are related but I'm no doctor so it is just a guess. You don't have to do pushups or crunches. Walking, sports of any sort, even heavy gardening can count as exercise if you do it 30 minutes to an hour a day and sweat from exertion when you do it ('skcuse me, I mean "glow profusely"). Eating a colorful diet of veggies, whole grains, low in fat may be protective, though perhaps not as much as we'd like to imagine. Folks in India who eat lots of spices including tumeric seem to have a considerably lower incidence of breast cancer. (Doctors are looking at the medical properties of tumeric. I only eat tumeric in my mom's bread and butter pickles- definately not enough to do any good and besides pickled foods were on the cancer causing possibilites...) And finally, anything you can do to prevent heart disease and other nasty diseases also prolongs life. My nurse kept telling me not to worry too much when I was first diagnosed (totally a wasted breath!). She told me stress might be related to cancer. The research I had read on that was not and still is not at all clear. But we agreed that worry makes the trip less enjoyable whether or not it caused cancer problems. So (even though it may be impossible at the moment) try not to worry too much. One of the first breast cancer patients I ever met was diagnosed with ER neg cancer two years before I was. I'm at the 6 year mark and she is still doing fine. Good luck!

    C. Abbott
  • Chellebug
    Chellebug Member Posts: 133
    #6
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    Good article
    Thanks for sharing that article. I have a friend who requested her onc do that test. He didn't want to but did it order it. It showed that she didn't metabolize tamoxifen. Yet, her onc did not switch her to another medicine!! He apparently doesn't think that test has enough research behind it. But she's convinced that it's not working. She's opting for an oophorectomy (ovaries removed) and will switch to an aromitase inhibitor.
  • Eil4186
    Eil4186 Member Posts: 949
    #7
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    cabbott said:

    Some ideas
    I have read that chemo gets best results with ER negative cancers. I have also read that anything that strengthens your bones prevents reoccurance and lengthens survival too. Fosamax, Boniva, or a yearly IV bone builder all work, though your doctor may have a preference based on his experience and your medical history. Exercise is also known to reduce reoccurance. Guess what--it builds bones too. I bet the two are related but I'm no doctor so it is just a guess. You don't have to do pushups or crunches. Walking, sports of any sort, even heavy gardening can count as exercise if you do it 30 minutes to an hour a day and sweat from exertion when you do it ('skcuse me, I mean "glow profusely"). Eating a colorful diet of veggies, whole grains, low in fat may be protective, though perhaps not as much as we'd like to imagine. Folks in India who eat lots of spices including tumeric seem to have a considerably lower incidence of breast cancer. (Doctors are looking at the medical properties of tumeric. I only eat tumeric in my mom's bread and butter pickles- definately not enough to do any good and besides pickled foods were on the cancer causing possibilites...) And finally, anything you can do to prevent heart disease and other nasty diseases also prolongs life. My nurse kept telling me not to worry too much when I was first diagnosed (totally a wasted breath!). She told me stress might be related to cancer. The research I had read on that was not and still is not at all clear. But we agreed that worry makes the trip less enjoyable whether or not it caused cancer problems. So (even though it may be impossible at the moment) try not to worry too much. One of the first breast cancer patients I ever met was diagnosed with ER neg cancer two years before I was. I'm at the 6 year mark and she is still doing fine. Good luck!

    C. Abbott

    Hmmmm
    Weird, I have read that ER positive patients respond better to chemo......
  • Eil4186
    Eil4186 Member Posts: 949
    #8
    Options
    cabbott said:

    Some ideas
    I have read that chemo gets best results with ER negative cancers. I have also read that anything that strengthens your bones prevents reoccurance and lengthens survival too. Fosamax, Boniva, or a yearly IV bone builder all work, though your doctor may have a preference based on his experience and your medical history. Exercise is also known to reduce reoccurance. Guess what--it builds bones too. I bet the two are related but I'm no doctor so it is just a guess. You don't have to do pushups or crunches. Walking, sports of any sort, even heavy gardening can count as exercise if you do it 30 minutes to an hour a day and sweat from exertion when you do it ('skcuse me, I mean "glow profusely"). Eating a colorful diet of veggies, whole grains, low in fat may be protective, though perhaps not as much as we'd like to imagine. Folks in India who eat lots of spices including tumeric seem to have a considerably lower incidence of breast cancer. (Doctors are looking at the medical properties of tumeric. I only eat tumeric in my mom's bread and butter pickles- definately not enough to do any good and besides pickled foods were on the cancer causing possibilites...) And finally, anything you can do to prevent heart disease and other nasty diseases also prolongs life. My nurse kept telling me not to worry too much when I was first diagnosed (totally a wasted breath!). She told me stress might be related to cancer. The research I had read on that was not and still is not at all clear. But we agreed that worry makes the trip less enjoyable whether or not it caused cancer problems. So (even though it may be impossible at the moment) try not to worry too much. One of the first breast cancer patients I ever met was diagnosed with ER neg cancer two years before I was. I'm at the 6 year mark and she is still doing fine. Good luck!

    C. Abbott

    Hmmmm
    Weird, I have read that ER positive patients respond better to chemo......
  • Eil4186
    Eil4186 Member Posts: 949
    #9
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    mimivac said:

    Interesting article
    I had read about this before regarding Tamoxifen, and it is interesting. What surprised me is that 8% of women taking Herceptin were HER negative and some had not been tested?! I know that's not a high percentage, but why would a doctor assign someone Herceptin who didn't need it? Are there benefits of Herceptin for HER negative persons? Just wondering. I am ER/PR (and HER) negative, so I won't be taking cancer drugs after my chemotherapy and radiation treatments. Anyone else out there like me? Did you do anything after treatment, such as a clinical trial? My doctor mentioned one in which women who were ER negative were given bone strenthening drugs to prevent bone mets. Being ER negative makes me very upset, so just wondering if there are others on these boards...

    Mimi

    I am in the bisphosfonate clinical trial
    Mimi, I am currently participating in a national clinical trial that is testing the theory that bisphosfonates may prevent bone mets. when given as part of adjuvent therapy. There are three arms in the study---no placebos, just three different bisphs.

    This July I will finish up my three years on the drug and will be followed closely for at least ten years. My onc. is the director of research at my cancer center and warns not to make any assumptions as they do not know if the theory is correct as of yet, and won't know for several years.

    Interesting though......at least for me, I consider it a bit of extra insurance because they could be right.

    Eil
  • mmontero38
    mmontero38 Member Posts: 1,510
    #10
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    Thanks for the article Jan.
    Thanks for the article Jan. I've also read up on this before. I will ask my oncologist when I go back in March. Hugs, Lili

    PS> Happy, Healthy and Peaceful New Year.
  • mgm42
    mgm42 Member Posts: 491 Member
    #11
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    Each has a different take...
    Each of us seems to have a slightly different take on that article, but we all found it interesting. I was astounded by the fact that so many of us take these five year drugs and have no assurance that they will help us, yet we are subjected to various side effects - maybe needlessly. I find that distressing. I realize that reserach has come a long, long way and that we are all recipients of that progress. I'm extremely grateful for that. But, $18,000 for a five year dosage of an AI which may not do me any good -- distressing to say the least. Marilynn
  • phoenixrising
    phoenixrising Member Posts: 1,508
    #12
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    mgm42 said:

    Each has a different take...
    Each of us seems to have a slightly different take on that article, but we all found it interesting. I was astounded by the fact that so many of us take these five year drugs and have no assurance that they will help us, yet we are subjected to various side effects - maybe needlessly. I find that distressing. I realize that reserach has come a long, long way and that we are all recipients of that progress. I'm extremely grateful for that. But, $18,000 for a five year dosage of an AI which may not do me any good -- distressing to say the least. Marilynn

    Hi Marilyn, I think there
    Hi Marilyn, I think there is only one AI that needs a cyp enzyme and that's femara.
    Here's a quote and the link to something I've found about the metabolism of the AI's.

    http://clincancerres.aacrjournals.org/cgi/content/full/12/3/1037s


    Differences in selectivity and potency between the aromatase inhibitors
    It is reasonable to assume that molecular differences between the aromatase inhibitors may affect their activity. For example, the non steroidal aromatase inhibitors anastrozole and letrozole have inhibitory effects on cytochrome P450 enzymes, including CYP1A2 and CYP2A6, respectively, whereas the steroidal aromatase inhibitor exemestane is metabolized by CYP3A4 (23). Therefore, concomitant use of aromatase inhibitors with other drugs that are metabolized by these CYP classes may lead to specific drug interactions that do not extend to the aromatase inhibitor class in general, and the different aromatase inhibitors cannot be assumed to be interchangeable. Structural differences between aromatase inhibitors may play a role in their specificity; for example, letrozole is similar to 11-ß-hydroxylase, which may cause letrozole to interfere with the adrenal steroidogenesis pathway (24, 25). Anastrozole is specific to aromatase and has no significant interactions with other enzymes. Pharmacokinetics of each drug account for the difference in reaching steady-state and plasma levels: Letrozole has a longer half-life and consequently takes almost eight times as long as anastrozole to reach steady-state at relatively higher plasma levels.

    Also here is the Flockhart chart for what is metabolized by what and the inhibitors and inducers. I notice the AI's are not listed and the chart has been updated, perhaps there is some discrepancy concerning this. One thing this chart doesn't say is what the primary route is and so you may see the same drug in more than one place. Some pathways are minor.

    http://www.medicine.iupui.edu/flockhart/table.htm

    I would indeed be distressed to go 2 1/2 or 5yrs on Tam and find out I wasn't metabolizing it.
    Today you find out it wasn't working by feeling a new lump or being told it has metastasized.
    Tomorrow hopefully anyone going on Tam will be checked. After all it is about life and death!!

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