Hot Flashes,,,WOW

These hot flashes with the Tamoxifen are really a BIG bother.  And I have a feeling that needles are sticking me in my legs,  arms,  and the top of my bald head.  At times I have to go outside (when in church or other meetings)  and cool off or take the wig off.
I was talking to a lady yesterday that said her doctor took her off tamoxifen,  and substituted Arimedex.  But I looked Arimedex up on internet and it seems to be given for other reasons.  I did not find where it was substituted for Tamoxifen.  Ir would be great to get some relief,  but I most certainly do not want to do anything that will not do the job (keep me from having a recurrance)  I am  high risk.
    Thank you for your reply

[CCF-RN,MSN-JS]

Dear seven7, Arimidex is an aromatase inhibitor that has been approved as treatment of metastatic breast cancer in post-menopausal women, it has also being used in the adjuvant setting for post-menopausal women.  It's use as adjuvant hormonal therapy is based on results of the ATAC trial in which anastrozole(Arimidex) was directly compared to tamoxifen for 5 years and to five years of the combination of anastrozole and tamoxifen.  In December 2001, at the San Antonio Breast Cancer Symposium, the first results were presented and in December 2002 the data were updated.  After a follow up of 47 months, anastrozole shows a reduction of the rate of breast cancer recurrence when compared to tamoxifen (14% for all patients and 18% reduction for patients with known receptor positive tumors).  There was also reported a reduction in the rate of breast cancer in the opposite breast.  Anastrozole also showed a favorable toxicity profile over tamoxifen in several side effects such as endometrial cancer (0.1% vs. 0.7%), blood clots (2.2% vs. 3.8%) and stroke (1.1% vs. 2.3%), hot flashes (35% vs. 40.3%), vaginal bleeding (4.8% vs. 8.7%) and vaginal discharge (3% vs. 12.2%).  However, anastrozole induced more skeletal complaints (30.3% vs. 23.7%) and increased rate of fractures (7.1% vs. 4.4%).  The data is only based on 47 months of follow up so currently Tamoxifen is often still being recommended by many oncologists, as it is a more known entity and we have long term information on side effects etc. and want to see if these numbers will continue to hold as time goes on.

Regarding your specific question, it is uncertain that a switch to Arimidex would change your experience of hot flashes as this is still a common side effect of this medication also.  You need to discuss this all with your oncologist, to see if perhaps there is more you could try to help with the control of the hot flashes, as well as the advisability of a change in medication.  As this all needs to be discussed based on your individual situation.

I've copied the answer to your last querry below, particularly because of the information on control of hot flashes.



Dear seven7, The goal of treatment with hormonal therapies is to decrease estrogen whether by blocking it at receptor sites (as tamoxifen does), or interfering with conversion of androgens to estrogen (as aromatase inhibitors do). This decrease in hormones is what contributes to hot flashes occurring. A common side effect with all of these types of medications is hot flashes. How severe they are in one individual to another can vary alot.

Other factors that may contribute to experience of hot flashes are: psychological stress, hot weather, caffeine, spicy foods, or alcohol.

There are a number of nonhormonal medications available for the treatment of hot flashes. Their goal is not to eliminate hot flashes altogether but to diminish their intensity and frequency. There has been some research with the use of the medications; venlafaxine (effexor) an anti-depressant, bellergal and clonidine, for treatment of hot flashes, these would need to be prescribed by your physician.

Vitamin E 800IU daily, Vitamin B6 200mg daily or Peridin-C 2 tablets 3 times a day, are over the counter agents that may be of help. It is important to talk to your physician before you take any medications or supplements, to be sure there is no contraindication of any of these treatments in your individual situation.

Regarding who to see for routine follow-up; for the breast cancer; possibly alternating between the surgeon and oncologist, these issues regarding tamoxifen and hot flashes I would discuss with the oncologist. For other general health problems see your internist. Any of the physicians when you see them will do a breast exam, and if there is a problem refer you to the appropriate person.