I choose not to do hormone therapy. I'm 65 years old and my poor body been through enough. It's a very personal decision. Thank you Dr. Griggs for educating us with your wonderful videos.
Thank you for sharing your decision. It’s important to do what feels right for you. Do make sure, however, that you understand the risks of recurrence and the possible benefits of endocrine therapy. This surprises a lot of people, but endocrine therapy is actually even more effective than chemotherapy.
I stopped, Arimidex became too debilitating, Tamoxifen caused a Pulmonary embolism, blood thinner was horrendous. As my radiation oncologist said there’s no guarantee with them. These drugs cause bone loss, you need estrogen for brain, heart health. A friend is up to 4 ops for carpal tunnel on Letrozole, another got pancreatic cancer and died .
@@carolbraswell4488 I agree and support you, Carol. It isn’t easy to extend our lives but feeling miserable most of the days. Hope and wish everything goes well for you ♥️
Yes, I’m similar age and have decided to stop letrozole. The NHS (UK) precinct tool has calculated that my benefit would only be 2.8% so I can’t see that suffering side effects is worth it - unless of course an oncologist can tell me otherwise!
I have another suggestion for another video topic, if I may: Tips and suggestions for how to research things for yourself responsibly and reliably. How to evaluate the information you're seeing (such as studies that might seem to say conflicting things, or the difference with a study result & how the study might have been conducted etc. and real world, in office treatment practices/protocols. Balancing how much you need/want to know with being careful and aware of information overload or paralysis. Maybe also dealing with decision fatigue in there too. And how to use what you've learned or how to bring it (and any questions you have as a result) up in an appointment with a provider in a way that might avoid a negative or dismissive reaction. Advocating without alienating is incredibly difficult most of the time, I've found.
Thank you for your suggestion! We'll definitely add these topics to our list of ideas. We also have a video about communicating effectively with your healthcare team that might be helpful: th-cam.com/video/JG8s2LKzhWI/w-d-xo.html.
@@yerbba Thank you. I've seen that video & while it's helpful in many ways, especially if you're just getting started on needing to advocate for yourself, I've already done or am doing the majority of what it covers & still having difficulties. It takes both sides having a desire and willingness to work together. If a member of your team isn't willing or capable, there often isn't much you can do about it (especially if you don't have much choice in providers.)
The worst side effects are the damage to memory, cognitive function, executive function, and other brain functions. There is so little research on this because "women's health" doesn't get financed well.
I am on letrozole and bone infusions since spring. My muscle and bone pain gets so bad that some days I can barely walk. My onco score was only 3 and am considering just going off these meds and taking my chances. Constant pain is no way to live either.
This sounds really hard. It may be the case that changing to another aromatase inhibitor will relieve your symptoms. You may find our videos on "What to do if you want to stop your medications": th-cam.com/video/2pWxVu3g91U/w-d-xo.html and Aromatase inhibitor side effects: th-cam.com/video/ZkNwni7GYDU/w-d-xo.html
That's great to hear! It's always encouraging to hear positive experiences with treatment. This is especially helpful to people who know that these medications are part of their treatment plan.
@@jennfischettoeveryone reacts differently to the same medication. The key is to continue taking it for the duration of your treatment. If the side effects are bothersome, talk to your doctor for advice. Stay strong.
I have the same question, what is the test to diagnose estrogen drop or how do you doctors know the estrogen levels are down? I figure through blood tests but which are the indicators? April last year started with Letrozole, I was miserable for almost 6 months, my oncology changed it to Anastrazole, I well tolerated for about 4 months and went back to the same so bothersome side effects. Sometimes I just want to quit for once and for all sometimes I don’t know what to do. Every other day I end up taking nausea medication. So far my CT DNA has been coming out negative, my surgery and radiation treatment was a year ago. Just venting myself in case there are other women going through the same situation ♥️
Thanks for coming here to vent. You're not alone. There is no need to test your estrogen levels. Data from thousands and thousands of women confirm that these drugs always lower estrogen.
@@gabrielasaez9601 I have been on bother medications and felt very ill at one point I ended up in emergency bc it felt like I was having a heart attack. The amount of sweating in the hands and feet changed them to leathery skin. They have recovered since I stopped these medications. I have been on three different medications with the same side effects, right now I’m not taking anything and my children think I should stop taking them.
Been on Letrozol for six months. Have some bone pain but find getting up and get moving helps. I had a bone scan and now have osteoporosis so am getting Prolia shots soon. Not thrilled with this side affect. Other than that, not to bad so far.
It sounds like you're managing the bone pain well by staying active. Thank you for sharing your story about your osteoporosis. We hope the Prolia helps with your bone mineral density.
Thank you for this. Excellent as always. My suggestion for a video would be to cover intermittent treatment of AI’s. As no one seems to have personalised AI treatment (eg we all get 2.5mg of letrozole irrespective of our actual diagnosis), I am curious to understand how our estrogen levels would be affected by intermittent AI treatment, considering the half life of these drugs. Thank you 🙏🏼
Yes! I'd like more info on this too! I know from pharmacogenetic testing I had done when living in the Netherlands that I am an intermediate metabolizer of the pathway letrozole uses, therefore it could stay in my body longer than "usual." I've wondered if this could cause additional side effects at the standard 2.5mg dose, but no one seems to be willing to even talk to me about every other day dosing or if the drug is effective at less than 2.5mg/day. The other thing I notice is that no one has talked about PROGESTERONE + tumors and if the AI plays a role in that as well as estrogen + ones. Or if you can end up with imbalances of other hormones (progesterone, testosterone etc) when your estrogen is being lowered by an AI.
This is a great question. One study has investigated this and did not find that intermittent treatment was superior or inferior to daily therapy. Intermittent AI therapy did not prove superior to continuous treatment, it appears to be a safe and effective alternative that may be particularly beneficial for patients experiencing significant side effects from continuous AI therapy. The downside is that many people lose track of which days they have taken their medication, so we may see in the "real world" that the effectiveness of intermittent therapy is lower.
Thank you for this, because I was just told "pick one, they are all the same." Not even the difference between exemestane & the other two (which by the way, could you clarify if letrozole & anastrozole both are reversible, while exemestane changes things permanently? Is that accurate?) Well, the same in relation to effectiveness maybe. Those subtle differences can make a difference if you metabolize things differently. I'm also still not clear on: even if the EFFECTIVENESS is the same, and side effects are highly individual, what about BONE HEALTH effects? Might letrozole increase bone loss (if it might increase cardiovascular risks via the same suppression degree mechanism?) faster or to a greater degree? Could those aspects make anastrozole a better choice from those perspectives? I've also been told by medical providers that they see more troublesome nausea with anastrozole and that overall they experienced women tolerating letrozole better. When I was researching my choice, I also came across several studies that seemed to say letrozole might reduce the higher recurrence risk that exists in the first 2 years after diagnosis more than anastrozole. Also, FYI--there are QUITE a few of us out here who DO find things like yellow dyes & filler ingredients problematic or allergic/intolerant. Especially in GENERIC formulations. The manufacturers of the generics only have to "prove" that the ACTIVE ingredient is the same effectiveness as the name brand drug. They save money and produce a cheaper product often by using cheaper fillers or coatings, which CAN cause issues in sensitive individuals. (I do.not.care how often a pharmacist or medical provider tells me there's no difference. THERE CAN BE. And I've also had both pharmacists and medical providers tell me, yes, of course those differences/reactions can happen, even if they aren't common.) Another thing to try if you're not doing well on one manufacturer's generic is to try one from a different manufacturer. I had bad side effects on Breckenridge and am now doing fine on Accord. I know others who can't tolerate Accord but do tolerate Teva etc. I discovered during my research of this that even the name brand FEMARA for letrozole uses lactose as a filler. (WHY?!?!) And that can cause issues even in a 2.5mg pill for some. I'd also love to see you discuss timelines with these drugs. When is it usual to start them in your treatment course or what are those options? Is it ever too late to start them for them to be effective (like how long after surgery/radiation/chemo etc. is ideal or less than ideal?) Also, more info on the test that can be done to determine if more than 5 years is beneficial or not.
You are correct that side effects can differ according to the medication. The drugs are equally effective. While exemestane binds irreversibly to the target molecule, its effects are not permanent. Stop the drug and your estrogen levels in the tissues will go back up. We agree that colorings and other inactive binders can cause problems for some people. Bone health effects and nausea are similar regardless of the medication. In general, the preference is to start endocrine therapy within a year of surgery, but it is most likely not to late to start even after that. Regarding the test that can help determine if extended endocrine therapy (more than 5 years), you are referring to the Breast Cancer Index. We discuss this in our video on genomic tests: th-cam.com/video/Ag2HcpSXz2o/w-d-xo.html
@@ruthwolf1958 exemestane made me so dizzy I couldn’t see where I was going let alone stand up.. was on for three weeks and had to stop. I think they all have some kind of side effects, I think you have to find one you can tolerate.
Generic drugs are inferior, my GP read a book by an investigation journalist Katherine Eban who with a whistleblower uncovered a rort, different compositions for different countries. I’ve tried genetics with other drugs and they are inferior . A mature female Pharmacist told me that. They make more money pushing these generic brands, my Surgeon told me that, which I already knew. Check out the new Predict Breast V3, taking more than 5 yrs was not a bonus. In fact taking or not taking with my information only 1% difference at 5,10,15 years
@@ruthwolf1958 you are correct and Pharmacists have told me the generics can differ, I find this unacceptable. I took on a Company for Frusemide Lasix, can’t get real brand here anymore. I tried a generic did nothing, tried another generic, nothing (they’re diuretics) the generic company rang me, he said were Australian companies, I said yes but where manufactured (I knew the answer, India) he conceded they may not be sourcing a reliable product. My Dr told me about Katherine Eban an investigation journalist who wrote a book, she uncovered a rort where they were making a different composition for the USA market to the India market. I refuse generic. As an example I noticed in USA you can’t get real brand Tamoxifen, why?? Because Astra Zenica pulled out, they were losing $14 mil in sales. My surgeon told me the Pharmacies make more money on generics, that’s why they push them (that’s here anyway) Having said all that, no matter the brand they should all be the same, no exceptions.
I was on Tamoxifen for 4 years and didn't have any side effects. March last year, I was switched to Anastrozole as I am already in menopause. Within 2 months, I started to have bone and joint pains, severe CTS. I have gained 15 pounds in one year. I see my PT once a week and been on rehab for one year now. My onco is making me switch to Letrozole. Will see if I have a different and better reaction to it. Oh, and I also see a neurologist for my chronic headaches, which started in April this year.
Dr Griggs thanks so much. I am confused as would think that if Letrozole is 98% effective in reducing estrogen then it should be better than Anastrozole at 70%. Can you please clarify. Also I saw a study that stated that Letrozole provides better whole body protection. Is this accurate?
I’ve had tamoxifen for few months as I refused chemo. But it had no effect on me as after 6/7 months I had 3 metastases. After that, I started targeted therapy and I take letrozol and enantone injection + Kisqali. Letrozol gives me hot flashes every hour during the day and every 2 hours at night. It is the only side effect I cannot handle with the treatment. 4 days ago I switched to exemestane but in one day it was worse. I had nausea, vomiting and vertigo all day and night. And hot flashes still. So I returned to letrozol today. I still try to lower those hot flashes as my blood pressure goes low during the hot flashes. It’s too much to handle. The last pet scan (4 days ago) was good. Only one meta left. But it doesn’t respond anymore. My breast is still decreasing. Same for lymph nodes.
It sounds like you’ve been through a lot with your treatment. Managing these symptoms is tough, and it’s important to keep discussing them with your medical team to explore all possible options. Your perseverance is admirable. We know it must be hard to go from a good scan to hearing that it's not responding now. You may find our video on how to manage hot flashes helpful, as it offers tips that might provide some relief: th-cam.com/video/Gc7qrHGkh08/w-d-xo.html.
Thank you Dr Griggs. My primary cancer - breast tumor - was 11mm HER2-positive. Cancer spread to one lymph node and pathology report showed that it was HER2-positive and ER-positive. I had chemo, operation and radiotherapy. I also continue with targeted therapy. QUESTION: would the treatment with the Aromatase Inhibitor be beneficial for me? What is the protocol in US? Many thanks
I have been taking Letrozole for 2 years. My main complaint is I’m totally exhausted. 68 years old. My cancer found on a routine mammogram. I had a lumpectomy, chemo and radiation. My oncotype score is 32. Stage 1. Clear margins. Is Letrozole the reason for my exhaustion?
Interested to hear response to your question…also exactly how much does this drug improve risk of return in Stage 1 with clean margins? I’m in same boat, to start radiation this week and then start drug ( not sure which one yet) in August. I’m worried about my bones as I have early osteoporosis and have avascular necrosis of both hips, spinal stenosis etc…
@@marcialane8235 I was diagnosed with osteopenia in September after a dexi scan. At my next appointment with my Oncologist we will decide what Bisphosphonates for treatment….I had to be sure any and all invasive dental work done. I had an implant which is now finished.
I’m looking forward to this answer too. I’m stage 1c or 2 a, no node involvement, chemo for HER2+, 7 yrs out. Had lumpectomy and radiation as well. Now my lipid profile is elevated and my blood pressure is up. I’m wondering at what point the risks outweigh the benefits. My oncologist wants me on this 3 more years (10 total). 😢
Wondering if your Onco score of 32 is what guided chemo as part of your treatment even though you were Stage 1? I’ve been on Anastrazole for 2 years. I don’t experience fatigue, but may be because I take it at 8pm and sleep through it?
@@LindaLopez-i3r I initially was told I would just need surgery and radiation but once they got my oncotype score since it was over 25 they said I would need chemo.
Thank you Dr. Griggs for this great video. Based on the recent study that was published in Lancet oncology it showed that anastrozole is more effective on women who have a higher level of estradiol and has very minimum effect on women with low level of estradiol. Does it mean that only postmenopausal women with higher levels of estradiol are going to be prescribed AI ?
@RoseGarden86 when you reference higher level of estradol do you mean higher percentage of estrogen and progesterone found in the surgery biopsy report?
@@DeeMartin-t4u I was referring to the blood test. They usually do a blood test for ER positive breast cancer to confirm menapausal status. If a patient is pre menapausal they put them on temaxofin and if post menapausal they put them on AI. Based on this recent study I read not all the post menapausal women can benefit from AI equally. If the estradiol level is too low then side effects of AI may not be worth the benefit
The study you are referring to was in people who did not have breast cancer but were at higher risk of getting breast cancer. Thus the findings do not apply to people who have already have had breast cancer.
You are correct that the side effect profile is extremely similar. The purpose of the aromatase inhibitors is to reduce the risk of cancer recurrence and cancer-specific death.
The aromatase inhibitors do not seem to provoke or worsen insulin resistance. Please let us know if this is helpful or if you were looking for something else.
We're sorry to hear about your mother's diagnosis. Letrozole is typically prescribed for postmenopausal women, but in some cases, it can be used in premenopausal women along with medications given by injection to suppress ovarian function. It's important to discuss this with your mother's doctor to understand the specific reasoning behind this prescription and to ensure it's the best course of action for her.
Are there studies on taking an aromatase inhibitor every other day? I took anastrozole and had to switch to letrozole and now have the same side effects. I found online that some doctors do prescribe them that way when there are problems (particularly Letrozole).
We're glad to hear that letrozole is working better for you without the bone pain. Finding the right medication can make such a difference! And thanks for sharing this with our other viewers.
I started Letroze recently for 5 years and my Oncologist recommended for zometa twice a year for 3 years. Can you please advise what are the benefits for this treatment. Thank you
Letrozole helps reduce the risk of breast cancer recurrence by lowering estrogen levels, and Zometa (a bisphosphonate) is often recommended to help strengthen bones and reduce the risk of bone complications, which can be especially important during hormonal therapy with the aromatase inhibitors. It also has been shown to potentially lower the risk of cancer spreading to the bones. We actually have a video about bisphosphonates that explains this class of drug in more detail [th-cam.com/video/S2KJnxjKpJg/w-d-xo.html].
You can have blood levels of estradiol, testosterone & progesterone tested, but many insurance companies will not cover this except in certain specific circumstances. In many places (in the US at least, Quest Labs, Rupa, AccessLabs are all companies to consider looking into) you can actually pay cash for the tests yourself, although you may need a doctor's order and you will have to find a place to take the draw, which usually involves a fee for that service too. However--one caveat here: blood levels are NOT tissue levels and blood levels can fluctuate even if you are not menstruating or are menopausal or even if taking hormone suppression therapy drugs. But blood levels still be an indicator of if your levels have dropped or at least what is circulating in your bloodstream and can provide useful information or monitoring. It seems like not many oncologists bother to do a blood test of this nature however. I personally worked with my naturopath to still do these tests and we have found it helpful to my treatment plan (and my "regular" doctors, even when they wouldn't order the tests, still used the information when I made it available & it did factor into treatment decisions for me.)
If you are referring to a test to see if you are postmenopausal, there are a series of tests that can be done (estrogen and FSH levels). In people who are on an aromatase inhibitor, there is no need to test to see if the medication is lowering estrogen because the levels will be lowered to unmeasurable levels.
I just started on Letrazole on 7/1, and I'm wondering how long it takes for estrogen to be fully lowered and how long before I should see all of the side effects I'll have. You may answer these questions before I see my oncologist again at the end of the month lol. Thank you for this channel. I've learned so much!
@@jennfischettolong story short, I think he was happy if I stopped altogether, he then said he’d write to my medical oncologist to plant the seed she put me on Tamoxifen, ok at 1st, I did get bleeding from other breast (he and her said wasn’t the Tamoxifen, but an advanced registrar in radiation oncologist said it probably was, I think so too) got oh bad leg cramps in bed about 4 times, hot and sometimes cold, extra hair (I was mortified when I discovered it, hair on my face, more left side, especially across jaw, other ladies on a forum I’m on said same, I now go for facial waxes every 7 weeks, hair springing up around temples hairline, I thought hair was thickening, not so) I lost weight heaps, only did half hour exercise about 5 days a week, only benefit, another lady on forum same, but it got to having to take a 50mg Voltaren before I could do next day exercise as aches/pains came in. 15 months in at a review I had a whinge on aches/pains, I had no symptoms but she sent me for scans, well she’s cold, blunt but was trying to ring me as radiologist thought he saw something. Stop the Tamoxifen and a more in depth scan after weekend. There was a Pulmonary Embolism, they were panicking trying to get me to come to get a prescription for anticoagulant, got into that and eventually felt really weird like going to blackout, got severe spinning, ended up by ambulance to ER. All of the medical personnel said I had vertigo, never in my life. A Dr sent me for brain scan, found a Meningioma, off to Neurosurgeon, very calcified, it wasn’t that causing the spinning, got 2nd opinion from a great NS. The last anticoagulant I took I had a scan to see if PE was gone, walked out and did not feel well, looked down blood streaming out of arm, went back in, they bandaged it up, sat ne down, took 2 nurses. The PE was gone I didn’t take another Zarelto. The medical oncologist plan was stay on the blood thinner and go back on Tamoxifen with the premise it “might” stop a PE. She must have changed her mind and wanted me to try Exemestane. I have not. I have spent the last 3 plus years with horrendous back/side pain which these drugs have exacerbated. Yes scans show a disc out here and there and arthritis but as I said to her nothing before these drugs, didn’t know I had any arthritis. Still trying to get it somewhat under control as it’s so debilitating and can’t exercise, have tried many drugs, am over it. I watched a talk where lack of estrogen can cause arthritis and or exacerbate it, bones, brain, heart etc need estrogen for good health. I have a review Thursday, if she gives me grief I’m walking out. My radiation oncologist knows I haven’t taken the 3rd drug and she said there is no guarantee with them. I watched director at Washington state cancer centre give a talk and he spoke very well, he said if he’d prescribed 2 and caused problems he said he would not prescribe a 3rd. I’ve done so much research, even a Dr specialist who had BC and went back on hormone replacement therapy (HRT) because of the benefits of estrogen. A side note at an unrelated appointment I bumped into an oncologist Nurse, she said she has many patients on Xarelto and it causes spinning out. I’m not doing these drugs.
@@jennfischettoalso have had a friend on Letrozole get pancreatic cancer and has passed, she had the works, lumpectomy, mastectomy, chemo, radiation, Letrozole 4 years, exercised, it came on hard and fast and believes it was from the drug, another had had 4 carpel tunnel ops. Her husband looks after everything for her, we email each other. There is a new Predict Breast V3 out and radiation is now taken into account pros/cons, my information and his wife there is only 1% difference between taking/not taking these anti estrogen drugs, I didn’t have chemo but if I put in I did it made no difference.
Good info! I would think Letrozole would be more effective than anastrazole since it reduces estrogen a lot more therefore less estrogen to fuel any cancer cells to prevent a recurrence?
I have taking Letrozole and have been suffering from severe joints pain which affects my daily life . I could hardly perform my personal daily activity by simply changing my clothes, and as simple way wearing my bra , my shoulder joints is so painful whenever there is simple movements. Would it be fine for if I stop taking my Letrozole😪
We're sorry to hear about the severe joint pain you're experiencing. It's important to discuss any changes to your medication with your medical team before making a decision to weigh the pros and cons. You might find our video on managing joint pain helpful: th-cam.com/video/1j6pCagUeBs/w-d-xo.html and our video on what to do if you want to stop treatment: th-cam.com/video/2pWxVu3g91U/w-d-xo.html
I struggled dreadfully when originally put on Tamoxifen last October after chemo and radiation. The side effects were so awful, after a month I couldn’t stand it anymore. My oncologist told me, tamoxifen wouldn’t cause joint and bone pain (among other things). So I was put in Letrozole, also agony.l.went off for a month, and within two days was just as bad. Anastrozole ugh, then Exemestane, again no go. So, my Oncologist has put me back on Tamoxifen and after a week, I’m ready to throw in the towel. Is there ANY solution….my body has become a big, swollen, painful blob and I’m so over it.
This sounds so difficult. It is likely that any endocrine therapy will cause similar problems. It is possible that you may be offered ovarian suppression injections if you have functioning ovaries.
@@yerbba thanks so much….unfortunately I’m past my use by date, everything down there is done and dusted. 🥹🤦🏻♀️ I’m 62, so I now know my options are very limited. Thanks again for your help 😊
I listened to Co Director from Washington state Cancer Centre, he was not against the drugs however said if 2 had caused problems he would not prescribe a 3rd. He was extremely interesting and spoke really well.
@@L-ash777 thanks so much. I’m definitely going to check it out. Being in my early 60s, means this is about it for me. So I’ll have a listen, he might have something that may help thanks again 😊
I’ve been told Letrozole and Anastrazole are equal in their effectiveness and oncologists typically prescribe the one they prefer. Change can be made to the other or to exemestane if side effects make an AI not tolerable.
Thank you for your comment! In the video, we mentioned that letrozole and anastrozole are generally equal in effectiveness and that oncologists often choose based on preference.
@@yerbba Yes, but what would drive that preference? Maybe the reason they choose one over the other would be something a patient should also take into consideration. The "why" might matter.
You are so helpful and informative, thank you so much! I have a couple of questions: I am HER2 Score 0 for both ductal and lobular tumors Negative, ER Positive, PgR positive, DCIS Left Breast, Stage 0, Right Breast, invasive mammary carcinoma Grade 02 with 1 lymph node positive. I have a 16 score for recurrence. My question is: why do I need hormone treatment if I am HER2 Negative and only have a 15% chance of recurrence in 9 years? Also, I am post menopausal and have been to 2 oncologists: one said to take Tamoxifen because of my osteoarthritis, the other said to take Letrozole, which is causing severe joint pain and nausea after 4 days. Do you think I should ask to go on Tamoxifen?
Hormonal therapy is often recommended for ER-positive breast cancer to reduce the risk of recurrence, even with a relatively low score. That recurrence number you were given is in people who take endocrine therapy. Since you’re post-menopausal and letrozole is causing severe side effects, discussing the option of tamoxifen with your oncologist could be a good idea. Many people find that switching to a different aromatase inhibitor can be helpful and be much better tolerated. If you're based in the U.S. visit yerbba.com for your Yerbba Report and personalized treatment options to understand the pros and cons of tamoxifen in your specific case.
I have just finished chemotherapy and did take Anastrozole but had to stop as it caused alotvof bone pain , what happens if i dont take them again does that mean the cancer will definitely come back ?i had her2 positive breast cancer
The risk of recurrence is lower in people who take endocrine therapy. Switching to another aromatase inhibitor or trying tamoxifen is generally considered best practice.
Pls clarify- if the efficacy is the same, why use the Letrozole? Can I switch and reduce the intensity of symptoms with have some estrogen rather than none? I have osteopenia and severe family history of osteoporosis
I was put on Anastrozole, but my oncologist took me off it after one month because my liver enzymes (ALT & AST) became so elevated. A liver biopsy showed a drug induced liver injury. Is there research showing that Anastrozole affects the liver this way? Last week I was put on Letrozole. I am so afraid that it might affect my liver enzymes, too. If Letrozole elevates my liver enzymes, what can I do? I want to take an aromatase inhibitor. I have had endometrial cancer, so I can't take tamoxifen.
This happens in a small percentage of people. It is possible that the letrozole will be better for you. If you have had a hysterectomy and had a low risk of recurrence of the endometrial cancer, tamoxifen may be an option for you. It may also be worth asking about toremifene, a medication that can be hard to get but that has less "tropism" (attraction) to the uterine lining.
I too would love more info on custom dosing, but there doesn't seem to be enough data on this to filter through to clinical practice, other than being told "doing something is better than nothing." I wondered where the "standard" dose amounts actually came from (study/science-wise) but couldn't get answers. Due to my dye/filler sensitivities, I looked into a compounded product with both local and national compounding pharmacies & was told that they can't source the active letrozole powder or even if they could, it would be so expensive no one could afford it (most insurance will not cover compounded medications.) I didn't look into anastrozole, although I think I recall being told that one might be possible to source but the expense issue would remain.
As with most medication, there is very little variation according to individual people. That is, the doses are likely to be equally effective at the same dose for everyone. Intermittent therapy with an aromatase inhibitor (every other day) has shown to be effective in one study. rest.neptune-prod.its.unimelb.edu.au/server/api/core/bitstreams/98be342d-cbba-5b24-8d0f-24655a223253/content
Hi! My mom is taking Letrozole for a week now and she is having severe constipation due to the medication,is it ok if she skips the medication for a few days and then restarts it ,does skipping this medication for a few days reduces its effect??
I have been on Letrozole for 2 years and am having dreadful problems with my joints. I tried anastrozole but no different and the third one too. I have gone from being able to walk miles to struggling to walk around the block. Pain at night is such that I wake every couple of hours. I feel I have lost my quality of life. Sorry this isn't very encouraging.
We wish you weren't having the pain and mobility issues you’ve been experiencing on letrozole and the other AIs. It’s so hard when side effects affect your quality of life like this. Don’t hesitate to talk to your oncologist about managing the joint pain or exploring other options to help improve your comfort. It's important to let your team know the impact this is having on your everyday life--what are you unable to do that you could do before? Sometimes our doctors don't really hear us until we paint a picture of the impact of the side effects.
Hi there! Yes, Arimidex is the brand name for anastrozole. It's wonderful that you've found a treatment option that works for you. Wishing you the best in your treatment journey.
Thanks. We'll add this topic to our list. For our other viewers, capecitabine is a chemotherapy drug used to treat advanced breast cancer and offered to some people who have cancer remaining after chemotherapy given before surgery.
Thank you, Dr. Griggs, for your continuous support for breast cancer ( health).
Thank you for being part of the Yerbba community. We appreciate you!
I choose not to do hormone therapy. I'm 65 years old and my poor body been through enough. It's a very personal decision. Thank you Dr. Griggs for educating us with your wonderful videos.
Thank you for sharing your decision. It’s important to do what feels right for you. Do make sure, however, that you understand the risks of recurrence and the possible benefits of endocrine therapy. This surprises a lot of people, but endocrine therapy is actually even more effective than chemotherapy.
I stopped, Arimidex became too debilitating, Tamoxifen caused a Pulmonary embolism, blood thinner was horrendous. As my radiation oncologist said there’s no guarantee with them. These drugs cause bone loss, you need estrogen for brain, heart health. A friend is up to 4 ops for carpal tunnel on Letrozole, another got pancreatic cancer and died .
@@yerbbathen why give people chemotherapy??
@@carolbraswell4488 I agree and support you, Carol. It isn’t easy to extend our lives but feeling miserable most of the days. Hope and wish everything goes well for you ♥️
Yes, I’m similar age and have decided to stop letrozole. The NHS (UK) precinct tool has calculated that my benefit would only be 2.8% so I can’t see that suffering side effects is worth it - unless of course an oncologist can tell me otherwise!
I have another suggestion for another video topic, if I may: Tips and suggestions for how to research things for yourself responsibly and reliably. How to evaluate the information you're seeing (such as studies that might seem to say conflicting things, or the difference with a study result & how the study might have been conducted etc. and real world, in office treatment practices/protocols. Balancing how much you need/want to know with being careful and aware of information overload or paralysis. Maybe also dealing with decision fatigue in there too. And how to use what you've learned or how to bring it (and any questions you have as a result) up in an appointment with a provider in a way that might avoid a negative or dismissive reaction. Advocating without alienating is incredibly difficult most of the time, I've found.
Thank you for your suggestion! We'll definitely add these topics to our list of ideas. We also have a video about communicating effectively with your healthcare team that might be helpful: th-cam.com/video/JG8s2LKzhWI/w-d-xo.html.
@@yerbba Thank you. I've seen that video & while it's helpful in many ways, especially if you're just getting started on needing to advocate for yourself, I've already done or am doing the majority of what it covers & still having difficulties. It takes both sides having a desire and willingness to work together. If a member of your team isn't willing or capable, there often isn't much you can do about it (especially if you don't have much choice in providers.)
The worst side effects are the damage to memory, cognitive function, executive function, and other brain functions. There is so little research on this because "women's health" doesn't get financed well.
I am on letrozole and bone infusions since spring. My muscle and bone pain gets so bad that some days I can barely walk. My onco score was only 3 and am considering just going off these meds and taking my chances. Constant pain is no way to live either.
@@amara1954 I stopped after I had the same problems.
This sounds really hard. It may be the case that changing to another aromatase inhibitor will relieve your symptoms. You may find our videos on "What to do if you want to stop your medications": th-cam.com/video/2pWxVu3g91U/w-d-xo.html and Aromatase inhibitor side effects: th-cam.com/video/ZkNwni7GYDU/w-d-xo.html
I have been on letrazole for10 months and honestly I don’t notice any side effects at all.
Wow!!👌 .That's great. 😊
You’re so lucky!! 😳
That's great to hear! It's always encouraging to hear positive experiences with treatment. This is especially helpful to people who know that these medications are part of their treatment plan.
I hope I follow this path too. I've only been on it for 2 weeks lol. Thanks for sharing. I always look for the positive comments & reactions.
@@jennfischettoeveryone reacts differently to the same medication. The key is to continue taking it for the duration of your treatment. If the side effects are bothersome, talk to your doctor for advice. Stay strong.
I have the same question, what is the test to diagnose estrogen drop or how do you doctors know the estrogen levels are down? I figure through blood tests but which are the indicators? April last year started with Letrozole, I was miserable for almost 6 months, my oncology changed it to Anastrazole, I well tolerated for about 4 months and went back to the same so bothersome side effects. Sometimes I just want to quit for once and for all sometimes I don’t know what to do. Every other day I end up taking nausea medication. So far my CT DNA has been coming out negative, my surgery and radiation treatment was a year ago. Just venting myself in case there are other women going through the same situation ♥️
Thanks for coming here to vent. You're not alone. There is no need to test your estrogen levels. Data from thousands and thousands of women confirm that these drugs always lower estrogen.
@@gabrielasaez9601 I have been on bother medications and felt very ill at one point I ended up in emergency bc it felt like I was having a heart attack. The amount of sweating in the hands and feet changed them to leathery skin. They have recovered since I stopped these medications. I have been on three different medications with the same side effects, right now I’m not taking anything and my children think I should stop taking them.
There’s a new Predict Breast V3 out which now takes into account radiation, which the previous version did not
Could you please also do a video on EXEMESTASANE. Thank you.
Yes we will. Thank you for the suggestion.
@@kathyg8535 it’s an Al just like Anastrozole and Letrozole
Been on Letrozol for six months. Have some bone pain but find getting up and get moving helps. I had a bone scan and now have osteoporosis so am getting Prolia shots soon. Not thrilled with this side affect. Other than that, not to bad so far.
It sounds like you're managing the bone pain well by staying active. Thank you for sharing your story about your osteoporosis. We hope the Prolia helps with your bone mineral density.
Thank you for this. Excellent as always. My suggestion for a video would be to cover intermittent treatment of AI’s. As no one seems to have personalised AI treatment (eg we all get 2.5mg of letrozole irrespective of our actual diagnosis), I am curious to understand how our estrogen levels would be affected by intermittent AI treatment, considering the half life of these drugs. Thank you 🙏🏼
Yes! I'd like more info on this too! I know from pharmacogenetic testing I had done when living in the Netherlands that I am an intermediate metabolizer of the pathway letrozole uses, therefore it could stay in my body longer than "usual." I've wondered if this could cause additional side effects at the standard 2.5mg dose, but no one seems to be willing to even talk to me about every other day dosing or if the drug is effective at less than 2.5mg/day. The other thing I notice is that no one has talked about PROGESTERONE + tumors and if the AI plays a role in that as well as estrogen + ones. Or if you can end up with imbalances of other hormones (progesterone, testosterone etc) when your estrogen is being lowered by an AI.
This is a great question. One study has investigated this and did not find that intermittent treatment was superior or inferior to daily therapy. Intermittent AI therapy did not prove superior to continuous treatment, it appears to be a safe and effective alternative that may be particularly beneficial for patients experiencing significant side effects from continuous AI therapy. The downside is that many people lose track of which days they have taken their medication, so we may see in the "real world" that the effectiveness of intermittent therapy is lower.
Como sempre, excelente explicação!❤
Thank you so much! We're glad you found the explanation helpful!
Thank you for this, because I was just told "pick one, they are all the same." Not even the difference between exemestane & the other two (which by the way, could you clarify if letrozole & anastrozole both are reversible, while exemestane changes things permanently? Is that accurate?) Well, the same in relation to effectiveness maybe. Those subtle differences can make a difference if you metabolize things differently. I'm also still not clear on: even if the EFFECTIVENESS is the same, and side effects are highly individual, what about BONE HEALTH effects? Might letrozole increase bone loss (if it might increase cardiovascular risks via the same suppression degree mechanism?) faster or to a greater degree? Could those aspects make anastrozole a better choice from those perspectives? I've also been told by medical providers that they see more troublesome nausea with anastrozole and that overall they experienced women tolerating letrozole better. When I was researching my choice, I also came across several studies that seemed to say letrozole might reduce the higher recurrence risk that exists in the first 2 years after diagnosis more than anastrozole. Also, FYI--there are QUITE a few of us out here who DO find things like yellow dyes & filler ingredients problematic or allergic/intolerant. Especially in GENERIC formulations. The manufacturers of the generics only have to "prove" that the ACTIVE ingredient is the same effectiveness as the name brand drug. They save money and produce a cheaper product often by using cheaper fillers or coatings, which CAN cause issues in sensitive individuals. (I do.not.care how often a pharmacist or medical provider tells me there's no difference. THERE CAN BE. And I've also had both pharmacists and medical providers tell me, yes, of course those differences/reactions can happen, even if they aren't common.) Another thing to try if you're not doing well on one manufacturer's generic is to try one from a different manufacturer. I had bad side effects on Breckenridge and am now doing fine on Accord. I know others who can't tolerate Accord but do tolerate Teva etc. I discovered during my research of this that even the name brand FEMARA for letrozole uses lactose as a filler. (WHY?!?!) And that can cause issues even in a 2.5mg pill for some. I'd also love to see you discuss timelines with these drugs. When is it usual to start them in your treatment course or what are those options? Is it ever too late to start them for them to be effective (like how long after surgery/radiation/chemo etc. is ideal or less than ideal?) Also, more info on the test that can be done to determine if more than 5 years is beneficial or not.
You are correct that side effects can differ according to the medication. The drugs are equally effective. While exemestane binds irreversibly to the target molecule, its effects are not permanent. Stop the drug and your estrogen levels in the tissues will go back up. We agree that colorings and other inactive binders can cause problems for some people.
Bone health effects and nausea are similar regardless of the medication.
In general, the preference is to start endocrine therapy within a year of surgery, but it is most likely not to late to start even after that.
Regarding the test that can help determine if extended endocrine therapy (more than 5 years), you are referring to the Breast Cancer Index. We discuss this in our video on genomic tests: th-cam.com/video/Ag2HcpSXz2o/w-d-xo.html
@@ruthwolf1958 exemestane made me so dizzy I couldn’t see where I was going let alone stand up.. was on for three weeks and had to stop. I think they all have some kind of side effects, I think you have to find one you can tolerate.
Generic drugs are inferior, my GP read a book by an investigation journalist Katherine Eban who with a whistleblower uncovered a rort, different compositions for different countries. I’ve tried genetics with other drugs and they are inferior . A mature female Pharmacist told me that. They make more money pushing these generic brands, my Surgeon told me that, which I already knew. Check out the new Predict Breast V3, taking more than 5 yrs was not a bonus. In fact taking or not taking with my information only 1% difference at 5,10,15 years
@@ruthwolf1958 you are correct and Pharmacists have told me the generics can differ, I find this unacceptable. I took on a Company for Frusemide Lasix, can’t get real brand here anymore. I tried a generic did nothing, tried another generic, nothing (they’re diuretics) the generic company rang me, he said were Australian companies, I said yes but where manufactured (I knew the answer, India) he conceded they may not be sourcing a reliable product. My Dr told me about Katherine Eban an investigation journalist who wrote a book, she uncovered a rort where they were making a different composition for the USA market to the India market. I refuse generic. As an example I noticed in USA you can’t get real brand Tamoxifen, why?? Because Astra Zenica pulled out, they were losing $14 mil in sales. My surgeon told me the Pharmacies make more money on generics, that’s why they push them (that’s here anyway) Having said all that, no matter the brand they should all be the same, no exceptions.
Can you make a video like this one, including exesmestane, and what are the differences with the ones included here
We will add a more in-depth video about exemestane and its differences from anastrozole and letrozole. Thanks for your suggestion.
I was on Tamoxifen for 4 years and didn't have any side effects. March last year, I was switched to Anastrozole as I am already in menopause. Within 2 months, I started to have bone and joint pains, severe CTS. I have gained 15 pounds in one year. I see my PT once a week and been on rehab for one year now. My onco is making me switch to Letrozole. Will see if I have a different and better reaction to it. Oh, and I also see a neurologist for my chronic headaches, which started in April this year.
Fingers crossed that the second aromatase inhibitor is better for you!
Dr Griggs thanks so much. I am confused as would think that if Letrozole is 98% effective in reducing estrogen then it should be better than Anastrozole at 70%. Can you please clarify. Also I saw a study that stated that Letrozole provides better whole body protection. Is this accurate?
While one would think that lower levels of estrogen would offer greater protection, that has not been shown to be the case. Thanks for watching.
@@yerbba Dr Griggs how about the study that states that Letrozole provides greater whole body protection. Thanks so much!
I’ve had tamoxifen for few months as I refused chemo. But it had no effect on me as after 6/7 months I had 3 metastases.
After that, I started targeted therapy and I take letrozol and enantone injection + Kisqali.
Letrozol gives me hot flashes every hour during the day and every 2 hours at night. It is the only side effect I cannot handle with the treatment.
4 days ago I switched to exemestane but in one day it was worse. I had nausea, vomiting and vertigo all day and night. And hot flashes still.
So I returned to letrozol today.
I still try to lower those hot flashes as my blood pressure goes low during the hot flashes. It’s too much to handle.
The last pet scan (4 days ago) was good. Only one meta left. But it doesn’t respond anymore.
My breast is still decreasing. Same for lymph nodes.
It sounds like you’ve been through a lot with your treatment. Managing these symptoms is tough, and it’s important to keep discussing them with your medical team to explore all possible options. Your perseverance is admirable. We know it must be hard to go from a good scan to hearing that it's not responding now.
You may find our video on how to manage hot flashes helpful, as it offers tips that might provide some relief: th-cam.com/video/Gc7qrHGkh08/w-d-xo.html.
Thank you Dr Griggs. My primary cancer - breast tumor - was 11mm HER2-positive. Cancer spread to one lymph node and pathology report showed that it was HER2-positive and ER-positive. I had chemo, operation and radiotherapy. I also continue with targeted therapy. QUESTION: would the treatment with the Aromatase Inhibitor be beneficial for me? What is the protocol in US?
Many thanks
Endocrine therapy is extremely effective and rivals chemotherapy and targeted therapy in terms of reducing the risk of recurrence.
I have been taking Letrozole for 2 years. My main complaint is I’m totally exhausted. 68 years old. My cancer found on a routine mammogram. I had a lumpectomy, chemo and radiation. My oncotype score is 32. Stage 1. Clear margins. Is Letrozole the reason for my exhaustion?
Interested to hear response to your question…also exactly how much does this drug improve risk of return in Stage 1 with clean margins? I’m in same boat, to start radiation this week and then start drug ( not sure which one yet) in August. I’m worried about my bones as I have early osteoporosis and have avascular necrosis of both hips, spinal stenosis etc…
@@marcialane8235 I was diagnosed with osteopenia in September after a dexi scan. At my next appointment with my Oncologist we will decide what Bisphosphonates for treatment….I had to be sure any and all invasive dental work done. I had an implant which is now finished.
I’m looking forward to this answer too. I’m stage 1c or 2 a, no node involvement, chemo for HER2+, 7 yrs out. Had lumpectomy and radiation as well. Now my lipid profile is elevated and my blood pressure is up. I’m wondering at what point the risks outweigh the benefits. My oncologist wants me on this 3 more years (10 total). 😢
Wondering if your Onco score of 32 is what guided chemo as part of your treatment even though you were Stage 1? I’ve been on Anastrazole for 2 years. I don’t experience fatigue, but may be because I take it at 8pm and sleep through it?
@@LindaLopez-i3r I initially was told I would just need surgery and radiation but once they got my oncotype score since it was over 25 they said I would need chemo.
If letrozole cuts estrogen 98 percent and anastrozol cuts by 78 percent , then does it mean that anastrozol will give less bone and joints pain ??
One would think that would be the case, but they are equally likely to cause joint pains. Great question.
Thank you Dr. Griggs for this great video. Based on the recent study that was published in Lancet oncology it showed that anastrozole is more effective on women who have a higher level of estradiol and has very minimum effect on women with low level of estradiol. Does it mean that only postmenopausal women with higher levels of estradiol are going to be prescribed AI ?
@RoseGarden86 when you reference higher level of estradol do you mean higher percentage of estrogen and progesterone found in the surgery biopsy report?
@@DeeMartin-t4u I was referring to the blood test. They usually do a blood test for ER positive breast cancer to confirm menapausal status. If a patient is pre menapausal they put them on temaxofin and if post menapausal they put them on AI. Based on this recent study I read not all the post menapausal women can benefit from AI equally. If the estradiol level is too low then side effects of AI may not be worth the benefit
@@RoseGarden86 thanks so much for your reply. Can you please share name of study so I can review.
The study you are referring to was in people who did not have breast cancer but were at higher risk of getting breast cancer. Thus the findings do not apply to people who have already have had breast cancer.
@@yerbba Thank you Dr. Griggs for your reply and clarification.
I have been on both and the side effects were horrendous! Why prescribe them when they have the same side effects!
Every breast cancer patient reacts differently to medications. ✌️
@@bosslady5163 right
You are correct that the side effect profile is extremely similar. The purpose of the aromatase inhibitors is to reduce the risk of cancer recurrence and cancer-specific death.
@@bosslady5163 I’ve been on both and stop because of the horrible sides effects
Same!!! I stopped taking them. Both made me SO sick
What do you recommend regarding insulin resistance with aromatise inhibitors? Pre-diabetes etc
The aromatase inhibitors do not seem to provoke or worsen insulin resistance. Please let us know if this is helpful or if you were looking for something else.
Mam, my mother diagnosed with hr positive breast cancer,she is still menstruating.but doctor prescribed letrozole
Now what to do?.
We're sorry to hear about your mother's diagnosis. Letrozole is typically prescribed for postmenopausal women, but in some cases, it can be used in premenopausal women along with medications given by injection to suppress ovarian function. It's important to discuss this with your mother's doctor to understand the specific reasoning behind this prescription and to ensure it's the best course of action for her.
Are there studies on taking an aromatase inhibitor every other day? I took anastrozole and had to switch to letrozole and now have the same side effects. I found online that some doctors do prescribe them that way when there are problems (particularly Letrozole).
I had bone pain on anastrozole. My onco switched me to letrozole and I have had no side effects from it that I can tell.
We're glad to hear that letrozole is working better for you without the bone pain. Finding the right medication can make such a difference! And thanks for sharing this with our other viewers.
I started Letroze recently for 5 years and my Oncologist recommended for zometa twice a year for 3 years. Can you please advise what are the benefits for this treatment. Thank you
Letrozole helps reduce the risk of breast cancer recurrence by lowering estrogen levels, and Zometa (a bisphosphonate) is often recommended to help strengthen bones and reduce the risk of bone complications, which can be especially important during hormonal therapy with the aromatase inhibitors. It also has been shown to potentially lower the risk of cancer spreading to the bones. We actually have a video about bisphosphonates that explains this class of drug in more detail [th-cam.com/video/S2KJnxjKpJg/w-d-xo.html].
What's the test to diagnose estrogen drop?
You can have blood levels of estradiol, testosterone & progesterone tested, but many insurance companies will not cover this except in certain specific circumstances. In many places (in the US at least, Quest Labs, Rupa, AccessLabs are all companies to consider looking into) you can actually pay cash for the tests yourself, although you may need a doctor's order and you will have to find a place to take the draw, which usually involves a fee for that service too. However--one caveat here: blood levels are NOT tissue levels and blood levels can fluctuate even if you are not menstruating or are menopausal or even if taking hormone suppression therapy drugs. But blood levels still be an indicator of if your levels have dropped or at least what is circulating in your bloodstream and can provide useful information or monitoring. It seems like not many oncologists bother to do a blood test of this nature however. I personally worked with my naturopath to still do these tests and we have found it helpful to my treatment plan (and my "regular" doctors, even when they wouldn't order the tests, still used the information when I made it available & it did factor into treatment decisions for me.)
If you are referring to a test to see if you are postmenopausal, there are a series of tests that can be done (estrogen and FSH levels). In people who are on an aromatase inhibitor, there is no need to test to see if the medication is lowering estrogen because the levels will be lowered to unmeasurable levels.
2:01 @@yerbba
I just started on Letrazole on 7/1, and I'm wondering how long it takes for estrogen to be fully lowered and how long before I should see all of the side effects I'll have. You may answer these questions before I see my oncologist again at the end of the month lol.
Thank you for this channel. I've learned so much!
I was fine till 16 months in, could barely walk, crawled into my Surgeons office, he said stop them
@@L-ash777 I'm sorry you went through this. Did he put you on something else?
@@jennfischettolong story short, I think he was happy if I stopped altogether, he then said he’d write to my medical oncologist to plant the seed she put me on Tamoxifen, ok at 1st, I did get bleeding from other breast (he and her said wasn’t the Tamoxifen, but an advanced registrar in radiation oncologist said it probably was, I think so too) got oh bad leg cramps in bed about 4 times, hot and sometimes cold, extra hair (I was mortified when I discovered it, hair on my face, more left side, especially across jaw, other ladies on a forum I’m on said same, I now go for facial waxes every 7 weeks, hair springing up around temples hairline, I thought hair was thickening, not so) I lost weight heaps, only did half hour exercise about 5 days a week, only benefit, another lady on forum same, but it got to having to take a 50mg Voltaren before I could do next day exercise as aches/pains came in. 15 months in at a review I had a whinge on aches/pains, I had no symptoms but she sent me for scans, well she’s cold, blunt but was trying to ring me as radiologist thought he saw something. Stop the Tamoxifen and a more in depth scan after weekend. There was a Pulmonary Embolism, they were panicking trying to get me to come to get a prescription for anticoagulant, got into that and eventually felt really weird like going to blackout, got severe spinning, ended up by ambulance to ER. All of the medical personnel said I had vertigo, never in my life. A Dr sent me for brain scan, found a Meningioma, off to Neurosurgeon, very calcified, it wasn’t that causing the spinning, got 2nd opinion from a great NS. The last anticoagulant I took I had a scan to see if PE was gone, walked out and did not feel well, looked down blood streaming out of arm, went back in, they bandaged it up, sat ne down, took 2 nurses. The PE was gone I didn’t take another Zarelto. The medical oncologist plan was stay on the blood thinner and go back on Tamoxifen with the premise it “might” stop a PE. She must have changed her mind and wanted me to try Exemestane. I have not. I have spent the last 3 plus years with horrendous back/side pain which these drugs have exacerbated. Yes scans show a disc out here and there and arthritis but as I said to her nothing before these drugs, didn’t know I had any arthritis. Still trying to get it somewhat under control as it’s so debilitating and can’t exercise, have tried many drugs, am over it. I watched a talk where lack of estrogen can cause arthritis and or exacerbate it, bones, brain, heart etc need estrogen for good health. I have a review Thursday, if she gives me grief I’m walking out. My radiation oncologist knows I haven’t taken the 3rd drug and she said there is no guarantee with them. I watched director at Washington state cancer centre give a talk and he spoke very well, he said if he’d prescribed 2 and caused problems he said he would not prescribe a 3rd. I’ve done so much research, even a Dr specialist who had BC and went back on hormone replacement therapy (HRT) because of the benefits of estrogen.
A side note at an unrelated appointment I bumped into an oncologist Nurse, she said she has many patients on Xarelto and it causes spinning out. I’m not doing these drugs.
@@jennfischettoalso have had a friend on Letrozole get pancreatic cancer and has passed, she had the works, lumpectomy, mastectomy, chemo, radiation, Letrozole 4 years, exercised, it came on hard and fast and believes it was from the drug, another had had 4 carpel tunnel ops. Her husband looks after everything for her, we email each other. There is a new Predict Breast V3 out and radiation is now taken into account pros/cons, my information and his wife there is only 1% difference between taking/not taking these anti estrogen drugs, I didn’t have chemo but if I put in I did it made no difference.
@@jennfischettoI answered in depth to you, it’s obvious she is deleting comments that she doesn’t want you to see.
Good info! I would think Letrozole would be more effective than anastrazole since it reduces estrogen a lot more therefore less estrogen to fuel any cancer cells to prevent a recurrence?
While we might think it would be more effective, the clinical data indicates equivalent efficacy.
I have taking Letrozole and have been suffering from severe joints pain which affects my daily life . I could hardly perform my personal daily activity by simply changing my clothes, and as simple way wearing my bra , my shoulder joints is so painful whenever there is simple movements. Would it be fine for if I stop taking my Letrozole😪
We're sorry to hear about the severe joint pain you're experiencing. It's important to discuss any changes to your medication with your medical team before making a decision to weigh the pros and cons. You might find our video on managing joint pain helpful: th-cam.com/video/1j6pCagUeBs/w-d-xo.html and our video on what to do if you want to stop treatment: th-cam.com/video/2pWxVu3g91U/w-d-xo.html
I struggled dreadfully when originally put on Tamoxifen last October after chemo and radiation. The side effects were so awful, after a month I couldn’t stand it anymore. My oncologist told me, tamoxifen wouldn’t cause joint and bone pain (among other things). So I was put in Letrozole, also agony.l.went off for a month, and within two days was just as bad. Anastrozole ugh, then Exemestane, again no go. So, my Oncologist has put me back on Tamoxifen and after a week, I’m ready to throw in the towel. Is there ANY solution….my body has become a big, swollen, painful blob and I’m so over it.
This sounds so difficult. It is likely that any endocrine therapy will cause similar problems. It is possible that you may be offered ovarian suppression injections if you have functioning ovaries.
@@yerbba thanks so much….unfortunately I’m past my use by date, everything down there is done and dusted. 🥹🤦🏻♀️ I’m 62, so I now know my options are very limited. Thanks again for your help 😊
I listened to Co Director from Washington state Cancer Centre, he was not against the drugs however said if 2 had caused problems he would not prescribe a 3rd. He was extremely interesting and spoke really well.
@@L-ash777 thanks so much. I’m definitely going to check it out. Being in my early 60s, means this is about it for me. So I’ll have a listen, he might have something that may help thanks again 😊
@@dawngreen1219Dr David Lee Haematologist/Oncologist
Is an estradiol level of 19 normal while being on lupron and anastrazole? I thought it was supposed to be below 5?
I’ve been told Letrozole and Anastrazole are equal in their effectiveness and oncologists typically prescribe the one they prefer. Change can be made to the other or to exemestane if side effects make an AI not tolerable.
So this does beg the question what causes them to have a preference? What are they basing that preference on?
I asked that and it was described as they have a “go to” medication based on their experience of success, side effects, patient experiences shared.
Thank you for your comment! In the video, we mentioned that letrozole and anastrozole are generally equal in effectiveness and that oncologists often choose based on preference.
@@yerbba Yes, but what would drive that preference? Maybe the reason they choose one over the other would be something a patient should also take into consideration. The "why" might matter.
@@ruthwolf1958money!
How many times in a year can I take one week flush out time for ai ???
Ideally, no more than once or twice, but this has not been tested in clinical trials.
You are so helpful and informative, thank you so much! I have a couple of questions: I am HER2 Score 0 for both ductal and lobular tumors
Negative, ER Positive, PgR positive, DCIS Left Breast, Stage 0,
Right Breast, invasive mammary carcinoma Grade 02 with 1 lymph node positive. I have a 16 score for recurrence. My question is: why do I need hormone treatment if I am HER2 Negative and only have a 15% chance of recurrence in 9 years? Also, I am post menopausal and have been to 2 oncologists: one said to take Tamoxifen because of my osteoarthritis, the other said to take Letrozole, which is causing severe joint pain and nausea after 4 days. Do you think I should ask to go on Tamoxifen?
I meant to say I am HER2 Negative
Hormonal therapy is often recommended for ER-positive breast cancer to reduce the risk of recurrence, even with a relatively low score. That recurrence number you were given is in people who take endocrine therapy. Since you’re post-menopausal and letrozole is causing severe side effects, discussing the option of tamoxifen with your oncologist could be a good idea. Many people find that switching to a different aromatase inhibitor can be helpful and be much better tolerated. If you're based in the U.S. visit yerbba.com for your Yerbba Report and personalized treatment options to understand the pros and cons of tamoxifen in your specific case.
I have just finished chemotherapy and did take Anastrozole but had to stop as it caused alotvof bone pain , what happens if i dont take them again does that mean the cancer will definitely come back ?i had her2 positive breast cancer
The risk of recurrence is lower in people who take endocrine therapy. Switching to another aromatase inhibitor or trying tamoxifen is generally considered best practice.
Put your information into the updated predict Breast V3
Can you please comment on which one is better combined with Lupron for OS for pre-menopause women?
They are equally effective.
Pls clarify- if the efficacy is the same, why use the Letrozole? Can I switch and reduce the intensity of symptoms with have some estrogen rather than none? I have osteopenia and severe family history of osteoporosis
Switching to a different aromatase inhibitor is an option because of the equivalent efficacy, yes. Thanks for watching.
I was put on Anastrozole, but my oncologist took me off it after one month because my liver enzymes (ALT & AST) became so elevated. A liver biopsy showed a drug induced liver injury. Is there research showing that Anastrozole affects the liver this way? Last week I was put on Letrozole. I am so afraid that it might affect my liver enzymes, too. If Letrozole elevates my liver enzymes, what can I do? I want to take an aromatase inhibitor. I have had endometrial cancer, so I can't take tamoxifen.
This happens in a small percentage of people. It is possible that the letrozole will be better for you. If you have had a hysterectomy and had a low risk of recurrence of the endometrial cancer, tamoxifen may be an option for you. It may also be worth asking about toremifene, a medication that can be hard to get but that has less "tropism" (attraction) to the uterine lining.
Is there a risk in taking a week of to try to mitigate side effects? Why is there no custom dosage or compounding to tailor the dose to a patient?
I too would love more info on custom dosing, but there doesn't seem to be enough data on this to filter through to clinical practice, other than being told "doing something is better than nothing." I wondered where the "standard" dose amounts actually came from (study/science-wise) but couldn't get answers. Due to my dye/filler sensitivities, I looked into a compounded product with both local and national compounding pharmacies & was told that they can't source the active letrozole powder or even if they could, it would be so expensive no one could afford it (most insurance will not cover compounded medications.) I didn't look into anastrozole, although I think I recall being told that one might be possible to source but the expense issue would remain.
As with most medication, there is very little variation according to individual people. That is, the doses are likely to be equally effective at the same dose for everyone. Intermittent therapy with an aromatase inhibitor (every other day) has shown to be effective in one study. rest.neptune-prod.its.unimelb.edu.au/server/api/core/bitstreams/98be342d-cbba-5b24-8d0f-24655a223253/content
Hi! My mom is taking Letrozole for a week now and she is having severe constipation due to the medication,is it ok if she skips the medication for a few days and then restarts it ,does skipping this medication for a few days reduces its effect??
In general, stopping an aromatase inhibitor for a week or two is okay, but checking with her medical team is crucial.
I have been on Letrozole for 2 years and am having dreadful problems with my joints. I tried anastrozole but no different and the third one too. I have gone from being able to walk miles to struggling to walk around the block. Pain at night is such that I wake every couple of hours. I feel I have lost my quality of life. Sorry this isn't very encouraging.
We wish you weren't having the pain and mobility issues you’ve been experiencing on letrozole and the other AIs. It’s so hard when side effects affect your quality of life like this. Don’t hesitate to talk to your oncologist about managing the joint pain or exploring other options to help improve your comfort. It's important to let your team know the impact this is having on your everyday life--what are you unable to do that you could do before? Sometimes our doctors don't really hear us until we paint a picture of the impact of the side effects.
Hi Dr. In Mexico there is Ameridex. Is this Anasttozol? Or a third med? Do you know. Ive decided on it since I was stage 1, level 1.
Hi there! Yes, Arimidex is the brand name for anastrozole. It's wonderful that you've found a treatment option that works for you. Wishing you the best in your treatment journey.
@@yerbba the jury is out. Haven´t ordered it yet. We shall see. Thanks!
mam pls make video on capecitabine
Thanks. We'll add this topic to our list. For our other viewers, capecitabine is a chemotherapy drug used to treat advanced breast cancer and offered to some people who have cancer remaining after chemotherapy given before surgery.