Question about meds after 5 yrs

My onc told me because my cancer was in the slim and none chance catagory he wanted me on femara. He said that it has a proven track record, increased your odds, and was much more agreeable then tamoxifen. Well that might be true for others. I really had it pretty good on tamoxifen. A tendancy to put on twenty pounds but no pains or other problems to really get upset about with tamoxifen. Femara is making me miserable. I know its not supposed to but it is. I am having a lot of the aches and pains I experienced on taxotere. My body never seems to pay attention to the labels that tell you what you are supposed to watch out for. It prefers to blind side me. I have decided I am taking this body back to onc. and talk. Good luck and let us know what you decide. L&H joyce

Hi Gail,

I just read the following in my bc news email and it seemed relevant to your question.....so, I'll post it here.  I didn't do so hot on tamox, but aromasin has been fine.  I was pre-meno with the tamox, had ovaries removed and then could take the aromasin.  I think you and I are similar ages.  It sure depends on your own body of course and what your Doc thinks.  Great question to ask these days.  ~ Joany

[108] Does everyone need letrozole after 5 yearsVIEW IMAGE tamoxifen and breast conservation?

Cameron DA, Kerr G, Jack W, Bowman A, Kunkler I, Dixon M, Chetty U.. Edinburgh, Scotland, United Kingdom; Western General Hospital, Edinburgh, Scotland, United Kingdom

Background
Publication of the results of the pivotal MA17 trial (Goss et al NEJM 2002) show that there is a significant additional benefit for post-menopausal women with hormone receptor positive early breast cancer when they receive additional letrozole after 5 yearsVIEW IMAGE tamoxifen.
There would be a moderate level of toxicity for the patient, and a significant increase in costs if all post-menopausal women were to have an additional 5 yearsVIEW IMAGE letrozole.
The MA17 study did not identify groups of patients who would not benefit from the addition of letrozole, but did confirm that patients alive and disease-free after 5 yearsVIEW IMAGE tamoxifen have an excellent prognosis. The aim of this study was to identify risk factors for relapse after 5 yearsVIEW IMAGE tamoxifen to determine which patients are likely to gain from the addition of letrozole.
Materials VIEW IMAGE Methods

Between 1981 VIEW IMAGE 1998, we identified in the Edinburgh Breast Unit VIEW IMAGE Oncology Department database, 1202 women who were aged 45 or older at time of breast conservation surgery and who started adjuvant tamoxifen therapy. 48% of all patients starting tamoxifen failed to complete 5 yearsVIEW IMAGE therapy, leaving 631 women who wer disease-free and still on tamoxifen, and thus eligible for additional letrozole. To date only 48 of these 631 patients have recurred more than 3 months after stopping tamoxifen.
We considered age, pathological size, tumour grade, ER status and number of involved lymph node as possible predictors of outcome beyond 5 years in the absence of further endocrine therapy.
Results
In a multivariate analysis, only grade (p < 0.01) and number of lymph nodes (p < 0.0001) were predictors of recurrence after 5 years. The effect of grade was paradoxical: it was women with grade 2 tumours that had the highest risk of recurrence, whereas risk of recurrence increased with more involved lymph nodes.

	Grade 1	Grade 2	Grade 3	Node -ve	1 - 3 Nodes +ve	4+ Nodes +ve
No. @ presentation	225	383	240	902	250	49
Candidates for letrozole	126	219	97	483	90	10
5 year RFS post 5 yearsVIEW IMAGE tamoxifen	98%	84%	91%	92%	82%	62%

Discussion
This approach allows clinicians to have more informed discussions with patients as to the likely risk/benefit ratio for prolonged endocrine therapy after 5 yearsVIEW IMAGE tamoxifen, since predictors of recurrence are not the same as they were at time of diagnosis.

Wednesday, December 8, 2004 4:30 PM

Poster Discussion Session: Prognostic and Predictive Factors (4:30 PM-6:30 PM)