ארימידקס לצעירות - שאלה לד"ר לאופר

ד"ר לאופר שלום, בהמשך לתשובתך בנוגע לנושא מתן ארימידקס לצעירות (http://www.doctors.co.il/forums/read.php?f=146&i=74456&t=74269) נתקלתי בפורום אמריקאי שמיועד לנשים צעירות (בעיקרון מתחת לגיל 30) לאחר סרטן שד. בלא מעט מההודעות שקראתי בפורום זה, מספרות הבנות הצעירות שהן מטופלות בארימידקס, למרות שלא מדובר בנשים שהגיעו לגיל אל-וסת (או שהטיפול בטמוקסיפן כשל), אלא בנשים צעירות ללא וסת (ע"י זריקות זולדקס או לופרון או בעקבות כימוטרפיה). הנה רק כמה דוגמאות: http://members5.boardhost.com/under30/msg/4880.html http://members5.boardhost.com/under30/msg/5218.html http://members5.boardhost.com/under30/msg/5046.html http://members5.boardhost.com/under30/msg/5193.html http://members5.boardhost.com/under30/msg/5148.html האם ישראל "מפגרת" בנושא זה ?

הקישור הנכון לתשובתה של ד"ר לאופר: http://www.doctors.co.il/forums/read.php?f=146&i=74456&t=74269

שרית, מצאתי את הקטע הבא מפברואר 2003 באתר של ד"ר סוזאן לאב: *Endocrine Therapy in Premenopausal Women Typically an aromatase inhibitor would not be given to a premenopausal woman. (They aren't effective in premenopausal women because their ovaries make large amounts of estrogen). But because Zoladex shuts down the ovaries and puts a woman into temporary menopause it should, theoretically, allow the Arimidex to be as effective in premenopausal women as it is in women who have become menopausal naturally--and a handful of trials now being conducted in Europe and the U.S. are looking to see if this is true. [Combined endocrine therapy--Zoladex (goserelin) and tamoxifen--is used more frequently in Europe than in the U.S. as adjuvant treatment for hormone-sensitive breast cancer in premenopausal women. To learn more about studies comparing endocrine therapy using tamoxifen to chemotherapy, click here...] Austrian researchers are conducting a trial in 1,250 premenopausal women with hormone-sensitive disease that compares the use of Zoladex and tamoxifen with Zoladex and the aromatase inhibitor Arimidex (anastrazole). Because aromatase inhibitors are known to increase the risk for bone fractures, a major concern has been the impact theses drugs will have on bone mineral density in premenopausal women. To address this, the Austrian study is exploring whether adding a bisphosphonate (a drug used to treat osteoporosis) to the hormone combination will decrease bone loss. [To date, some studies have suggested that bisphosphonates may decrease relapses from breast cancer while others have found this not to be the case. More studies are currently underway.] The Austrian researchers designed a four-arm trial. One group of women is receiving tamoxifen and Zoladex. A second group is receiving tamoxifen, Zoladex, and the bisphosphonate Zometa (zoledronate). A third group is receiving Arimidex and Zoladex. And the fourth group is receiving Arimidex, Zoladex, and Zometa. All of the women will receive treatment for three years. The researchers reported that a preliminary analysis that looked specifically at bone loss after six months of treatment found that the women given Arimidex lost more bone density than did the women on tamoxifen. However, the women receiving Zometa had significantly better lumbar spine measurements than did those not receiving the bisphosphonate. The women will have to be followed longer to see if the effects on bone mineral density continue. And while there was a significant difference in bone loss between the two groups, it's important to point out that the amount of bone loss at six months was very small, and that none of the women developed osteoporosis.To learn more about osteoporosis and osteopenia read our feature story here.. A second presentation by researchers from Spain described a randomized trial of Zoladex and tamoxifen compared with Zoladex and Arimidex in pre/perimenopausal women with hormone-dependent advanced breast cancer. From January 1999 through December 2001, 119 women were enrolled in the trial. The researchers found that the women on Zoladex and Arimidex survived about four months longer than the women on Zoladex and tamoxifen--a statistically significant finding. This may lead to the Arimidex and Zoladex combination being considered as first-line therapy for premenopausal women with advanced disease. Susan says... What does this mean for premenopausal women? Premenopausal women who have advanced disease may find Arimidex (or another aromatase inhibitor) and Zoladex to be a better choice than tamoxifen and Zoladex. Women may also want to take Zometa to help decrease bone loss. [Zometa is often recommended for women who have bone metastases as it can help decrease fractures and reduce bone pain.] For premenopausal women with early stage disease the choice may be more difficult. Based on the data showing Arimidex to be slightly more effective than tamoxifen in postmenopausal women, some U.S. oncologists have already begun recommending that premenopausal women use an aromatase inhibitor with Zoladex as adjuvant therapy. Other oncologists are concerned about going ahead with this combination in premenopausal women because the trials are still underway and there is no data to support its use. Premenopausal women who do decide to try Arimidex or another aromatase inhibitor as adjuvant therapy should have their bone density monitored. And while preliminary results from this study showed that a bisphosphonate did help decrease bone loss, there is concern about what the long-term effects of bisphosphonates will be in women who take them before they have osteoporosis. The current recommendation is that women only begin taking bisphosphonates once they have osteoporosis. Read more about these recommendations here... While we wait for more data from this and other studies, some premenopausal women may decide to be treated with an aromatase inhibitor. Others may decide to be treated with tamoxifen. I would encourage any premenopausal woman who chooses to go on an aromatase inhibitor to enroll in a clinical trial. And I would encourage all women taking tamoxifen or an aromatase inhibitor to do weight-bearing exercise and to get adequate amounts of vitamin D and calcium in their diet, taking supplements if necessary. את המקור תמצאי ב: http://susanlovemd.com/conferences/feature030214.html

לא!! איני סבורה שישראל מפגרת בנושא הארימידקס הטיפול האנטי הורמונלי האופטימלי לנשים צעירות אינו מוסכם היום בעולם וברוב במקומות לא מקובל לטפל בארימידקס בנשים אלה

שלום לאונקולוגיות ולכל הפורום, יש לי שאלות שנוגעות לכל מי שחלתה בתקופה האחרונה והן: 1.מדוע לא מספיק מחקר עם תוצאות חד משמעיות לגביי יעילות הארימידקס בהשוואה לטמוקסיפן? 2. מדוע צריך לחכות לעוד מחקרים? {כמו במחקר לגביי מתן הורמונים חלופיים לגיל המעבר, ברגע שהייתה תוצאה חד משמעית לגביי הנזק שבמתן הורמונים, יצאה המלצה גורפת להפסיק לתת באופן רוטיני חלופה הורמונלית לנשים בגיל המעבר, ולשקול היטב התועלת לעומת הסיכון לפני מתן והופסק המחקר לפני תום המועד המתוכנן}. 3. מדוע כל כך קשה לקבל ארימידקס כשמדובר בסיכויי הישרדות יותר טובים? בריאות לכול, בברכה אילה