Aromatase inhibitors/side effects/ scary

Christmas Girl said:

Side Effects
Hello, Ohilly. I understand your frustration. I took Tamoxifen 2 years - now taking Arimidex 3+ years... No side effects, at all, from the Tamoxifen. Now, the Arimidex - totally different story... :-)

My pharmacy provides a sheet of info about the drug, dosage, side effects, etc. for every medication. Automatically generated by their computer system. Do you not get this? It's not as comprehensive as that from the drug companies themselves; nevertheless, it's really helpful and not in fine print! Also, it's important to see your doctor(s) on a regular & frequent basis while taking these types of meds - to discuss side effects & so that the doctor can monitor them.

I'm certainly not sticking up for your doctor, nor any drug manufacturer. Once, I experienced a side effect that blew my mind - totally unprepared for it, not warned... When I pointed this out to my oncologist, his responses went something like this: "If we told EVERYBODY about EVERYTHING that MIGHT happen, people would refuse treatment; therefore, more people would die." Sorry for these harsh words.

Your anger is certainly not irrational. We go through so darned much, sometimes it's hard to take yet another thing... I always suggest, no matter what the circumstances - turn anger into action. You might feel better for it. In your case, maybe have a really open discussion with your oncologist. Best wishes to you.

Kind regards, Susan

phoenixrising said:

Trish, there may be other
Trish, there may be other options for you. Raloxifene is used for osteoporosis but is a SERM like Tamoxifen. Here is what they said about it. There is still a risk of thromboembolic events but it is significantly less than tamoxifen. Another drug that comes to mind is Faslodex but I don't have any handy info on that one.


Raloxifene "Preferable" to Tamoxifen for Breast Cancer Prevention CME
News Author: Zosia Chustecka
CME Author: Désirée Lie, MD, MSEd
Disclosures

Release Date: June 7, 2006; Valid for credit through June 7, 2007
June 7, 2006 — In the largest breast cancer prevention trial ever conducted, raloxifene (Evista) and tamoxifen (Novaldex) were equally effective at preventing invasive breast cancer in women at high risk for the disease, but raloxifene had a more favorable adverse risk profile. Results from the Study of Tamoxifen and Raloxifene (STAR) were presented at the American Society of Clinical Oncology (ASCO) 2006 Annual Meeting and in the June 5 Early Release Article issue of JAMA.

The 5-year study was conducted by the National Surgical Adjuvant Breast and Bowel Project (NSABP), and results were presented at the ASCO meeting by D. Lawrence Wickerman, MD, associate chairman of the NSABP. The trial, conducted on 19,747 postmenopausal women who were at increased risk for breast cancer, compared 20 mg of tamoxifen with 60 mg of raloxifene once daily.

After a median follow-up of 4 years, there were a similar number of invasive breast cancer cases in both groups (167 with raloxifene vs 163 with tamoxifen). Both drugs reduced the relative risk for breast cancer by about 50% in this patient population.

The tamoxifen group had fewer cases of noninvasive breast cancer cases than the raloxifene group (57 vs 81), but more cases of uterine cancer (36 vs 23). Other adverse effects were similar in the 2 groups, except for thromboembolic events, which occurred significantly less often in the raloxifene vs tamoxifen group (100 vs 141 events).

"Raloxifene appears on balance to be preferable to tamoxifen," said James Ingle, MD, from the Mayo Clinic in Madison, Wisc, discussant for this presentation at ASCO. Raloxifene had a more favorable risk profile, and as it is already approved for use in postmenopausal osteoporosis, it also has data showing a reduction in fractures from other studies, Dr. Ingle commented.

"Although media coverage of the early release of data from the STAR trial suggest a clear 'winner' in raloxifene, the data from clinical end points and patient-reported symptoms suggest a less clear conclusion," according to William J. Gradishar, MD, from Northwestern University Feinberg School of Medicine and Robert H. Lurie, MD, from the Comprehensive Care Center of Northwestern University, Chicago, Ill, in an accompanying JAMA editorial.

But while raloxifene may not be superior, it may be more acceptable, as it is already widely used for postmenopausal osteoporosis. Although tamoxifen is approved for use in breast cancer prevention, it is not widely used, because the clinicians who would prescribe it are nononcologists who are not familiar with the drug, the editorial points out. But the new data "still may not be enough to convince primary care physicians to be more aggressive than they have been to date in breast cancer chemoprevention," Gradishar and colleagues add.

"We urgently need new tools to reduce the risks of cancer," said Robert Ozols, MD, PhD, senior vice-president of the medical sciences division at Fox Chase Cancer center in Philadelphia, Pa. At an ASCO press briefing that Dr. Ozols moderated, he said the STAR findings provide important information to help women and clinicians consider the benefits and adverse effects associated with each option.

Some authors of the STAR trial have disclosed serving on the speaker's bureau for, receiving honorarium from, and consulting for AstraZenca, the maker of tamoxifen, and Eli Lilly, the maker of raloxifene. Dr. Cronin disclosed serving on the Adherence Advisory Board for AstraZenca. The editorialists have disclosed no relevant financial relationships.

ASCO 42nd Annual Meeting: Abstract LBA5. Presented June 5, 2006.

JAMA. Posted online June 5, 2006.

Clinical Context
Tamoxifen is a selective estrogen modulator that has been used for treating early and advanced breast cancer for more than 30 years. Raloxifene is a selective estrogen modulator used for the treatment of osteoporosis and, according to Vogel and colleagues in the STAR trial, has demonstrated efficacy in preventing invasive estrogen receptor-positive but not estrogen receptor-negative breast cancer in postmenopausal women. More than 500,000 women are currently taking raloxifene in the United States to prevent osteoporosis, whereas tamoxifen is not broadly used for breast cancer chemoprophylaxis because of concerns about thromboembolism and toxic effects.

The current study by Vogel and colleagues is a prospective, double-blind randomized trial in postmenopausal women at higher risk for breast cancer, conducted at 200 North American centers, to compare the efficacy of tamoxifen vs raloxifene against invasive breast cancer.
Study Highlights

I really am struggling with the anastrozole side effects.  I have had EVERY common side effect except for joint and bone pain...my mother who is just finishing 5 years of anastrozole had zero side effects....so our experiences couldn't be more different.  My breast cancer was 12 mm x 7 mm x 4 mm, lumpectomy followed by 5 days of twice a day brachytherapy radiation.  HR+  Her2- Ki67 was 34% (High Proliferation) and I thought, erroniously I guess, that the surgery and radiation would be the hard part.  I now find myself in AI misery and although I work for a healthcare non profit and write research grants, I also was not told about the side effects of AI's by my MD's, only by the pharmacist packaging and online research which simply proved I'm having almost every side effect (even two serious side effects i.e. chest pain and tightening).  I'm certain this next week my Onco will put me on Femara or Aromasin...which state they have the same side effects as anastrazole and the worst side effect for me was being thrown into depression.

I'm really surprised as I've never been depressed, I am a very upbeat person and my personality changed overnight and not in a good way.  If anyone can relate or has any assistance or feedback it would be greatly appreciated.