Zometa (Zoledronic acid), should I take if not on AIs?

Posted by Laurie @roch, Aug 8, 2020

Wondering if anyone with Stage 1 or Stage 2 breast cancer is taking Zometa or Reclast even if they are NOT using aromatase inhibitors (Ais)?

I have stopped taking AIs so at next oncology appointment there will be a discussion if I should also stop the Zometa IVs.

My layman's understanding of why to give Zoledronic acid to patients receiving AIs is that AIs reduces estrogen in body (to prevent recurrence of breast cancer) , but the decreased estrogen levels are associated with elevated rates of osteolysis and the resulting bone loss. Zoledronic acid belongs to a group of drugs called bisphosphonates and those drugs slow down or prevent bone damage.

There is also research that suggested that Zometa also might help stop breast cancer from spreading to the bones by making it harder for breast cancer cells to grow in bones. But my oncologist said it only reduced the risk of breast cancer cells in bone by 1-2% .

My treatment background:

After my treatment for breast cancer (lumpectomy, few positive lymph nodes removed, chemo and radiation) , my oncologist placed me on AIs and Zometa IV every 6 months for 3 years. AIs caused multiple side effects (discussed in other threads on Mayo Connect) so after a year I have stopped taking. So now the question is there a reason or benefit to continue with Zometa if not taking AIs. My next is infusion is due in Oct 2020.

Before making the decision, the dr decided to check my bone density. In 2018, after initial diagnosis and before any treatment a bone density was done. This week it was repeated. I was pleasantly surprised that I had slight improvement in bone density. For a 64 year old post-menopausal women who has undergone breast cancer treatment, anything that showed my bone density is not deteriorating is great news.

Any insight from others on Connect is appreciated.

Laurie

Hi. I was diagnosed at age 47 Stage 3 IDC PR/ER+ HER2- in 2018. Bilateral mastectomy, no reconstruction, dense dose AC/T chemo, radiation, Anastrozole, and decided to due 4 rounds of Zometa to be as aggressive as possible in preventing a recurrence as I have a young child and that 1-2% reduction in risk seemed worth it to me. Well after 3 treatments I had to have a tooth out and I turned out to be in the unfortunate group of people who get Osteonecrosis (ONJ) as a side effect . My oncologist had told me there was a 1% risk of this. The ONJ specialist however says he has seen a substantial increase in this side effect. My case is mild to date and hopefully will never require reconstruction if I am super careful and able to avoid any additional jaw trauma for the next 12 years (which is how long the drug stays in your system). If I never get a recurrence in my bones it will still have been worth it! These decisions are all so hard and I probably made it harder for you but I think if I were Stage 1 or 2 I would think really hard about using these drugs and talk to an oral surgeon who has expertise dealing with ONJ as well as your oncologist to get a clearer picture of the cost/benefit of this course of treatment. I have horrible bone pain with Anastrozole but have started taking 30 mg of Duloxetine daily and it has helped me tolerate the AI for 9 months at a time then when the bone pain returns I take a 2-4 week holiday from the AI but stay on Duloxetine and then when pain subsides I start up again. It’s my understanding that the AIs have a far greater impact on reducing recurrence so if at all possible, I’d try really hard to use those. Best of luck and good health to you!
Tess

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@tessfair1

Hi. I was diagnosed at age 47 Stage 3 IDC PR/ER+ HER2- in 2018. Bilateral mastectomy, no reconstruction, dense dose AC/T chemo, radiation, Anastrozole, and decided to due 4 rounds of Zometa to be as aggressive as possible in preventing a recurrence as I have a young child and that 1-2% reduction in risk seemed worth it to me. Well after 3 treatments I had to have a tooth out and I turned out to be in the unfortunate group of people who get Osteonecrosis (ONJ) as a side effect . My oncologist had told me there was a 1% risk of this. The ONJ specialist however says he has seen a substantial increase in this side effect. My case is mild to date and hopefully will never require reconstruction if I am super careful and able to avoid any additional jaw trauma for the next 12 years (which is how long the drug stays in your system). If I never get a recurrence in my bones it will still have been worth it! These decisions are all so hard and I probably made it harder for you but I think if I were Stage 1 or 2 I would think really hard about using these drugs and talk to an oral surgeon who has expertise dealing with ONJ as well as your oncologist to get a clearer picture of the cost/benefit of this course of treatment. I have horrible bone pain with Anastrozole but have started taking 30 mg of Duloxetine daily and it has helped me tolerate the AI for 9 months at a time then when the bone pain returns I take a 2-4 week holiday from the AI but stay on Duloxetine and then when pain subsides I start up again. It’s my understanding that the AIs have a far greater impact on reducing recurrence so if at all possible, I’d try really hard to use those. Best of luck and good health to you!
Tess

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@tessfair1
I tried Anastrozole first and it was horrendous with my joints, switched to letrozole and still problems, and finally to exemestane which I have hardly any side effects. Maybe talk over the different AIs with your oncologist to see if you can switch. Hoping for the best for you.

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I have also recently been advised by my oncologist to consider the Zoledronic acid and I am torn. I had lumpectomy and radiation for stage 1B IDC and started on Anastrozole in January. The joint pain really bothered me and we are just now switching to exemestane after a short break. I hope that it is more tolerable. I am very physically active (running and strength training) and only 51. I want to protect my bones for the future. But, like many people who post I am beginning to feel like one drug just leads to another and more side effects.

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I was Diagnosed with ductile carcinoma stage one breast cancer in March. I had the 2cm tumor removed and three lymph nodes. My lymph nodes were clear. My Oncotype test score was a 9 so I didn’t have to do Chemo. I did however do three weeks of radiation and then started on Anastrozole. The side effects of the Anastrozole were so debilitating I had to stop. I’m scheduled to see my Oncologist this week to look at my options . I was wondering if anyone has looked into an Osteopath for treating your breast cancer in addition to the radiation and not taking aromatase inhibitors?

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@bethab

I was Diagnosed with ductile carcinoma stage one breast cancer in March. I had the 2cm tumor removed and three lymph nodes. My lymph nodes were clear. My Oncotype test score was a 9 so I didn’t have to do Chemo. I did however do three weeks of radiation and then started on Anastrozole. The side effects of the Anastrozole were so debilitating I had to stop. I’m scheduled to see my Oncologist this week to look at my options . I was wondering if anyone has looked into an Osteopath for treating your breast cancer in addition to the radiation and not taking aromatase inhibitors?

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Hi Beth, I moved your message to this discussion started by @roch who was asking similar questions about bone health when not taking an aromatase inhibitor. @cmd03 @cindylb @tessfair1 @aestongmay also have some experiences to share regarding your questions about seeing an osteopath and options for protecting bone health through radiation and breast cancer treatments.

You may also be interested in these related discussions:

– Invasive ductile breast cancer: What should I expect? https://connect.mayoclinic.org/discussion/invasive-ductile-breast-cancer/
– Invasive ductal carcinoma (IDC): Anyone else? https://connect.mayoclinic.org/discussion/invasive-duct-ca/
– Aromatase Inhibitors: Did you decide to go on them or not? https://connect.mayoclinic.org/discussion/arimidex/
– Muscular skeletal side effects from radiation https://connect.mayoclinic.org/discussion/muscular-skeletal-side-effects-from-radiation/

Beth, did you try any other AI besides anastrozole?

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Hi Colleen, Thank you for your help. I saw my oncologist this week and she is having me try Exemestane. I'm a bit apprehensive about taking it because the side effect of the anastrozole was so debilitating. She said exemestane was sometimes better tolerated by patients who could not tolerate the anastrozole. I start them on Monday. Fingers crossed I can tolerate them.

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@bethab

Hi Colleen, Thank you for your help. I saw my oncologist this week and she is having me try Exemestane. I'm a bit apprehensive about taking it because the side effect of the anastrozole was so debilitating. She said exemestane was sometimes better tolerated by patients who could not tolerate the anastrozole. I start them on Monday. Fingers crossed I can tolerate them.

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Beth, it's quite common that some people can tolerate one AI over another. You might be interested in this discussion that @trixie1313 started:
– Aromasin (exemestane) https://connect.mayoclinic.org/discussion/aromasin-exemestane

I'm crossing my fingers and toes with you.

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