Re: Treatment decisions: is speculating a good idea? (Ovarian v. Breast cancer treatment)
From: Tim Jackson (tim_at_tim-jackson.co.uk)
Date: 01/25/05
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Date: Tue, 25 Jan 2005 14:09:39 +0000
Paul@anon.com wrote:
> I'd like to get your opinion on this.
>
> My mom has ovarian cancer, and has just finished
> initial chemo. She has responded, and right now is in
> the 'watchfull waiting' period. (Where no treatment
> has been clearly proven to help, so many doctors do
> nothing else but "watch" without treating.)
>
> In her case, her doctor prescribed tamoxifen (20mg/day)
> in the hope that it might have some effect.
>
> I just saw the results of the large ATAC study, which
> says that Arimidex is better than tamoxifen for breast cancer.
>
> Since the mechanism by which these drugs are supposed to
> act on cancer cells is the same for both BrCa and OvCa, I speculate
> that it could be better for OvCa too. So I would like to recommend
> to my mom that she switch from Tamoxifen to Arimidex.
>
> What do you all think? Is such speculation warranted?
>
> It's not like I'm giving up a sure thing to go with a dark
> horse. As far as I'm concerned, they're both uncertain
> remedies, and so why not pick the one that looks more promising?
>
>
>
> Also, I've seen a lab study that says that aspirin can have
> strong effects on OvCa. Since aspirin (81mg/day) can be prescribed
> to >50 y.o. people to protect their hearts anyways, I'd like to
> recommend to my mom that she take it too.
>
> Considering the reduced life expectancy of patients with OvCa,
> I really don't care that we don't currently know what the 10 year
> side effect profile is for either Arimidex or aspirin.
>
> Opinions? Comments?
I'm usually answering questions on the breast cancer group, but while
I'm here on another matter...
ATAC showed that aromatase inhibitors appear more potent than Tamoxifen
in reducing the risk of breast cancer recurrence in post-menopausal
women. However there are two things which mitigate against widespread
prescription of Arimidex etc. One is cost, the other is the long term
side effects issue, eg osteoporosis.
As far as I know there is little evidence that Tamoxifen is particularly
effective in ovarian cancer anyway, mostly speculation from the presence
of estrogen receptors, and some small studies that suggest there may be
a small effect. Somehow it seems to me counter-intuitive that estrogen
should be a significant growth factor for ovarian tissue. So I am not
confident that one can extrapolate the parallel. It seems to me more
likely that the effect is due to the Tamoxifen binding to the receptors
than to it blocking the estrogen, in which case aromatase inhibitors
wouldn't work.
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