Breast Cancer Medications

Hi Brandi, I did not take this, but I took Arimidex and had such severe side effects that I had to stop. Reactions to these meds vary; some women do fine on one drug and have reactions to others. I told my doctor right away, she had me stop for a while, tried again, but was always immobilized with pain. It can be dangerous to stop a drug without supervision, as some meds can cause a rebound effect, so check with your doctor. You can look up side effects of fareston here, and search for any other med: www.rxlist.com/fareston-drug.htm
Good luck!

Everyone is different ... my doctors told me not to expect any noticeable side effects from herceptin, however, I do have them.
My exhaustion levels are still so high. At first the doc blamed recovery from other chemo, but at this point believes it's the herceptin causing it.
Also, for about 2-3 days after infusion I have flu-like symptoms (very achey and sore and more tired). And for about a week I get taxol-recall joint pain.
That said, my doctors have said this isn't common BUT I have reacted strongly to everything we've done so far and they theorize that my body is just hyper-sensitive. Chances are you aren't and won't deal with it, but I share on the off chance you do get side effects, you're not crazy or imagining it!

The standard recommendation is for five years of aromatase therapy based on our present knowledge and the results of numerous large clinical trials that compared aromatase inhibitors to tamoxifen. It is also an acceptable strategy to initiate therapy with tamoxifen and switch to an aromatase inhibitor after 2 to 3 years to complete a total of five years of therapy. Based on evidence from a large clinical trial, it is also acceptable to switch to tamoxifen from an aromatase inhibitor; this is an option for individuals who are experiencing difficult side effects with aromatase inhibitors.

This may vary depending on the individual and their risk for bone density loss or fracture. It is important when starting an aromatase inhibitor that you have a baseline bone mineral density study (referred to as a DEXA scan) and a clinical assessment for other potential risk factors for osteoporosis (defined as a T score < 2.5 on a DEXA scan by the World Health Organization). These risks include older age, previous fracture, low body weight, current tobacco use, and excessive alcohol consumption, among others. I encourage all women starting an aromatase inhibitor to adopt lifestyle changes that promote not only bone health but overall health as well. These include increasing physical activity (including weight bearing exercise), stopping smoking, and taking calcium and vitamin D supplements. Some individuals starting an aromatase inhibitor may be advised to take drug therapy with bisphosphonates if they have osteoporosis or a history of a fracture or osteopenia (http://www.medterms.com/script/main/art.asp?articlekey=8048)(T-score between -1 and -2.5 on a DEXA scan) with other risk factors. There is no consensus on the optimal strategy for monitoring but every two years is a common strategy.

Aromatase inhibitors lower estrogen levels in your body and this estrogen deficiency leads to increased bone turnover and bone loss. This side effect, however, does not reflect whether the medication is working for your breast cancer. Estrogen is known to stimulate hormone receptor positive breast tumor cells and aromatase inhibitors are very effective at lowering estrogen levels and thereby removing this growth signal and resulting in tumor cell death. Thus, the lowering of estrogen is a critical reason why these drugs work so well to treat hormone receptor positive breast cancer but may have, at the same time, a negative impact on bone health.

The role of hormonal therapy for risk reduction should be carefully considered and discussed with experts in breast cancer risk assessment and management in a shared decision-making environment. Guidelines from expert groups recommend that the risks and benefits of breast cancer prevention be discussed with premenopausal and postmenopausal women who are at high risk for the disease.

Women at high risk may include some women over the age of 60; women with certain high-risk conditions found on breast biopsy, such as lobular carcinoma in situ (LCIS) or atypical ductal or lobular hyperplasia; women between the ages of 35 and 59 years who have a calculated five-year risk of developing breast cancer of 1.7 percent or higher, according to a system called the Gail model. The Gail model uses a woman's current age, age at first menstrual period, age at first live birth, the number of first-degree relatives with breast cancer, and the number and pathologic findings of any breast biopsies to estimate the probability of breast cancer over time. This model, and others, is used by health professionals to calculate an individual’s risk and the results should be interpreted with an expert in breast cancer risk assessment. It is also important to remember that the presence of breast cancer risk factors does not mean that cancer is inevitable as many women with risk factors never develop breast cancer.

Another very important issue is that the Gail model does not consider the risk of cancer associated with inherited breast cancer-predisposing genes such as BRCA1 and BRCA2. If an individual has a strong family history that suggests the possibility of an inherited predisposition to breast cancer, then that individual should be referred for genetic counseling. Other components of a risk/benefit assessment and counseling include a careful discussion of the side effects of hormonal therapy, options for participation in clinical research and healthy lifestyle changes.

Initiation of hormonal therapy is commonly begun after the completion of chemotherapy (and after completion of radiation therapy if you receive both). In terms of actual timing, hormonal therapy will typically begin approximately four to six weeks following completion of chemotherapy. A preference for sequential timing of chemotherapy and hormonal therapy, i.e., adjuvant chemotherapy followed by hormonal therapy, was suggested by a clinical trial, in which sequential versus concurrent chemo/hormonal therapy were directly compared and sequential treatment had superior outcomes for disease free and overall survival.

I would add that there are limited clinical data and no consensus on the use of concurrent hormonal therapy and radiation therapy, thus some medical oncologists advise overlap of hormonal therapy with radiation and others advise waiting until radiation is complete. I generally advise waiting until radiation is complete.

Assuming you are talking about adjuvant therapy here, the answer is split into pre and post menopausal women. Most premenopausal women are asked to start on Tamoxifen but some may get an AI plus a zoladex shot (to make them postmenopausal). In that case, the advice is 5 years. If you are premenopausal and start on Tamoxifen but then become postmenopausal, you may be switched to an AI for 5 years after 5 years of tamoxifen.

For postmenopausal women, it is typically 5 years of an AI only OR it could be 5 years of an AI AFTER 5 years of tamoxifen.

There were some early reports in the literature that soy foods may reduce the effectiveness of Tamoxifen in animal studies, but at least one study from the Univ of So Cal (wu, JCO, 2007) showed that soy food consumption had no effect on the active metabolites of Tamoxifen in Asian American breast cancer survivors.

This is really a common side effect with Tamoxifen treatment and all too frequently leads to discontinuation of a really helpful drug. Recommendations that are at the top of the list include regular exercise and a Mediterranean diet. Do those first. Next I would consider acupuncture. There was a study in the Journal of Clinical Oncology a couple of years ago that compared acupuncture to an antidepressant drug commonly used for hot flashes called Effexor. Acupuncture was just as effective in decreasing hot flashes and patients reported increased libido, and improvements in energy, clarity of thought, and sense of well-being with acupuncture. Side effects for the Effexor group included dry mouth, nausea, constipation,and decreased appetite. Black cohosh is another option. I won’t go into all the weaknesses of the big studies that have been done on black cohosh and hot flashes but I’ll summarize by saying the preponderance of the evidence shows that black cohosh is effective in treating hot flashes. It is not a phytoestrogen as some have believed in the past. Many of the common herbal preparations used for hot flashes do contain phytoestrogens so I would avoid those and stick with plain black cohosh.

If you have metastatic breast cancer and chemotherapy is part of your treatment plan, your doctor may use different tests to determine how well the chemotherapy is working and how you're handling the chemotherapy. These tests may include CT scans, bone scan, MRI, X-rays, laboratory studies, among others. If these tests show that the cancer is growing or that the cancer is showing up in new areas then that may signal a time when the chemotherapy needs to change. Chemotherapy may also change if it is causing too many side effects and problems for you.

Both you and your physician will be monitoring the potential risks of letrozole.

The risks that may cause the most concern are:
- Decreases in bone mineral density (BMD).
- Increases in cholesterol.

The patient should be aware and notify the physician of any changes in how they feel, particularly paying attention to bone pain and liver pain (upper right quadrant).

The way to monitor these risks are through the following:
- bone density test
- complete blood cell counts (CBC)
- thyroid function tests
- monitoring serum electrolytes
- monitoring cholesterol and liver function tests, kidney function, and blood pressure.

There will also be the physical assessment of the patient. This will include blood pressure readings, pain assessment, gastrointestinal upsets, and hot flashes.

When initiating letrozole treatment, patients may experience dizziness and fatigue. Until your body adjusts be cautious before performing work that requires mental alertness, such as driving.

For more information, see the follwing links:

http://www.rxlist.com/femara-drug.htm
http://www.webmd.com/drugs/drug-4363-Femara+Oral.aspx?drugid=4363&drugname=Femara+Oral

Both you and your physician will be monitoring the potential risks of anastrozole.

The risks that may cause the most concern are:
- Decreases in bone mineral density (BMD). (Potential increase in bone loss.)
- May cause higher cholesterol levels or liver disease.
- Patient's with heart disease may have more of a chance to experience an ischemic cardiovascular event. (An ischemic cardiovascular event is reduced blood supply to the muscles of the heart).

The patient should be aware and notify the physician of any changes in how they feel, particularly paying attention to bone pain, chest pain, or liver pain (upper right quadrant).

The way to monitor these risks are through the following:
- bone density test
- complete blood cell counts (CBC)
- monitoring cholesterol and liver function tests
- thyroid function tests
- monitoring serum electrolytes
- kidney function, and blood pressure.


There will also be the physical assessment of the patient and monitoring for the postmenopausal women taking anastrozole. This will include blood pressure readings, pain assessment, gastrointestinal upsets, and hot flashes.

When initiating anastrozole treatment patients may experience dizziness and fatigue. Until your body adjusts be cautious before performing work that requires mental alertness, such as driving.

For more information, see the following link:
http://www.rxlist.com/arimidex-drug.htm

Anastrozole is indicated for:
- Treatment of hormone receptor-positive early and metastatic breast cancer in post-menopausal women. It may be used alone or after surgery or radiation. (Early breast cancer is cancer that has not spread outside the breast to other parts of the body.)
- Treatment of hormone receptor-positive breast cancer that has progressed after receiving tamoxifen treatment for post-menopausal women.
- Post-menopausal women where the ER-positive or hormone receptor unknown breast cancer has spread in the breast or to other parts of the body.

For more information, see the following link:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000982/

There is no dosage adjustment for patients taking anastrozole with normal liver function. The physician will monitor the patient's liver function and change medications if needed.
- For elderly post-menopausal women, there are no recommendations to change the dose.
- For patients with mild to moderate liver disease, as determined by liver function tests, there are no recommendations to change the dose.
- In patients with severe liver disease there have been no studies to conclude if the dose should be changed. The physician will decide whether to change medications.

For more information, see the following links:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000982/
http://www.drugs.com/pro/arimidex.html
http://www.rxlist.com/arimidex-drug.htm

There is no dosage adjustment of letrozole for patients with normal kidney and liver function. The physician will monitor for kidney and liver function using kidney and liver function tests and change medications if needed.

- With mild to moderate impairment of the liver, the dose of letrozole will not be changed.
- For post menopausal women taking Letrozole with liver problems (cirrhosis and severe hepatic impairment), as determined by liver function tests, the dose recommended for this patient population is 2.5mg every other day.
- There is no change in dosage requirements for patients with a creatinine clearance of the kidneys greater than or equal to 10ml/min.

For more information on this subject, see the following links:
http://www.rxlist.com/femara-drug.htm
http://www.drugs.com/dosage/letrozole.html

Letrozole (Femara) may be employed for breast cancer in these circumstances:
- Early adjuvant treatment for hormone receptor positive (HR+) breast cancer in post-menopausal women. It is unknown how long letrozole should be taken, but the duration of the clinical trial was 5 years. Adjuvant treatment is the administration of letrozole after surgery, radiation, and/or chemotherapy.
- Extended adjuvant treatment for hormone receptor positive (HR+) breast cancer in postmenopausal women who have received 5 years of adjuvant tamoxifen treatment. The ideal length of treatment is not known, as the international study of 5,187 postmenopausal women discovered that when letrozole was taken after completing five years of tamoxifen therapy, there was a decrease in breast cancer recurrences. Treatment may be discontinued if there is a relapse.
- As first or second-line treatment of breast cancer that has advanced in menopausal women after anti-estrogen treatment. Administration may be continued until the breast cancer tumor worsens or metastasizes.
- Locally advanced or metastasized breast cancer with hormone receptor positive or unknown hormone origin.

Here are a couple of other sites to visit for more information.
http://www.ncbi.nlm.nih.gov/pubmed/15161328
http://www.cancer.gov/cancertopics/druginfo/letrozole

Anastrozole treats breast cancer by inhibiting the production of estrogen in tissues of the body of post-menopausal women.
- By inhibiting the production of estrogen, the estrogen receptor [ER]-positive and/or progesterone receptor [PR]-positive cancer cells cannot grow.
- Anastrozole operates by blocking the aromatase enzyme that converts androgen to estrogen in the tissues of women who have gone through menopause.
- Postmenopausal women get estrogen from the conversion of androgen into estrogen in the tissues of the body.
- In women who have not gone through menopause, they receive their estrogen from the ovaries.
- Anastrozole is categorized pharmacologically as an antineoplastic agent and as a nonsteroidal aromatase inhibitor and is indicated for postmenopausal women.

Letrozole (Femara) is an antineoplastic agent. Antineoplastic agents are anticancer medications. Letrozole is also categorized as a nonsteroidal aromatase inhibitor. Aromatase inhibitors do not allow the aromatase enzyme to convert androgen into estrogen in the tissues. By blocking estrogen production in the tissues of the body, the estrogen receptor [ER]-positive and/or progesterone receptor [PR]-positive) breast cancer cells cannot grow.