Questions about Hormone Blockers: Side Effects?

Hi Colleen,
Thank-you so much for the links, especially for the Hormonal Therapy Side Effects Comparison Chart. I’m about to start taking an Aromatase Inhibitor. My oncologist said I could choose any of the three. But with all the serious side effects, and to make that decision, I’m looking for randomized controlled trials (RCT) that answer these questions:
1. Are there links to RCT trials that demonstrate the efficacy of these drugs > Arimidex (anastrozole) vs. Aromasin (exemestane) vs. Femara (letrozole) vs. a control group of women who do not take an AI? It would be ideal to see any more recent reports that reevaluated the efficacy and where more years of data were included.
2. My oncologist indicated the standard AI dosage is exactly the same for every woman regardless of stage/grade/type of estrogen positive breast cancer. Are there any RCT studies available where the dosage was evaluated based on the severity of the cancer? Did the trials dosage determination include that criteria too?
3. The oncologist also noted the standard dosage is the same if the woman weighs 90 or 395+ pounds. Are there any RCT studies available where the dosage was evaluated based on the patients weight or BMI?

I’ve looked for this info on many websites including the FDA, NIH, Mayo clinic and more without luck and truly appreciate any info you may provide.

Welcome to Connect, @lindalm. I can only imagine the many questions you must have before making a decision! Here’s some information I found – although this may not pertain specifically to RCTs, they are all recently published studies based on clinical trials – are you ready for a lot of reading? 🙂

Q1.
– First Trial of Three Aromatase Inhibitors: Similar Efficacy, Safety https://www.medscape.com/viewarticle/894890
"This is also the first trial to compare an up-front treatment schedule with a switch schedule using anastrozole, the study authors note. The up-front schedule consisted of 5 years of treatment with aromatase inhibitors; the switch schedule consisted of 2 years of treatment with tamoxifen followed by 3 years of treatment with aromatase inhibitors.”
– Risk–benefit ratio requires ‘highly individualized’ plan for extended aromatase inhibitor therapy http://bit.ly/303EY7x

Q2.
– Optimizing the Use of Aromatase Inhibitors https://www.cancernetwork.com/supplements-2009-breast-cancer/optimizing-use-aromatase-inhibitors
– Aromatase Inhibitors in Gynecologic Practice http://bit.ly/2N5DSEC
"What is the best sequence, timing, and duration of AI use? Conclusions and recommendations of The American College of Obstetricians and Gynecologists”

Q3.
– Efficacy of letrozole, anastrozole linked to BMI http://bit.ly/33BdmsE
– The predictive impact of body mass index on the efficacy of extended adjuvant endocrine treatment with anastrozole in postmenopausal patients with breast cancer: an analysis of the randomised ABCSG-6a trial https://www.nature.com/articles/bjc2013367

I hope this helps, @lindalm. We look forward to getting to know you – could you share a few more details about your health?

Hi- I have been taking anastrozole as my estrogen blocker which can soften my bones. I just had my first infusion of Zolendraic/Zometa that is supposed to strengthen my bones. My dr husband did some research and told me that this infusion is supposed to result in 70% fewer vertebral fractures and 40% fewer bone fractures. These seem like good odds to me. Have you started your Zometa? Of course when I read about all of the side effects it is frightening, but I just felt a little out of it after my first treatment-thank goodness. I just took it easy for a couple of days. Good luck!

dmgweiss @dmgweiss
I've had 3 "bone glue" Zometa infusions. They must be doing something right as I do have osteoporosis and have had two "whoppers" of falls that were quite bad but no broken bones. The nurses do slow down my infusions from 30 minutes to 45 minutes as I had trouble with my second infusion and started to faint. With the longer infusions, I don't seem to have a problem.

Thank you! That is a valuable tip about slowing down the infusion if there are side effects. So glad to hear that your falls didn't result in break-yay! Denise

Hi @trixie1313, Were the Zometa infusions done because of broken bones in the past? I'm also wondering what other bone-building meds you may have taken?

@hopeful33250
No broken bones in past. I had taken Fosamax years ago. I walk every day 2.5 to 3 miles trying to help with bones. Except for a couple of falls, I do well but walk with hiking sticks as I have a balance issue since having strokes.