Lupron/triptorelin--quality of life [corrected question]

[platypus1]

I have Stage IIa multifocal IDC (four foci, largest 2.4 cm, ER+, PR+, Her2-neu neg, negative sentinal nodes, grade one, Oncotype DX score 8) + DCIS in right breast. LCIS in left. Have already had wide excision; may have bilateral mastectomy. I'm 53, perimenopausal. Because of negative nodes, low grade, low Oncotype, I probably won't have chemo. My medical oncologist has asked me to consider three hormonal options: 1) standard hormonal therapy (probably tamoxifen first, then AIs, totalling five or more years); 2) TEXT trial (five yrs of triptorilen plus either tamoxifen or Aromasin); 3) standard hormonal therapy plus Lupron for up to five years. I'll of course carefully look at the survival advantages of #2 or #3 over #1 before deciding, and if they're substantial, I'll choose #2 or #3. But if the survival advantages are real but small, I'll put some weight on quality-of-life issues and might choose #1. My questions: 1. How substantially would Lupron or triptorelin (when taken in addition to tamox or AI) impact quality of life, as compared with tamox/AI alone? In other words, would there be little difference, or would the effects be magnified by a factor of 2, or more than 2? 2. Between Lupron and triptorilen, does one have quality-of-life advantages over the other? (Thanks for this excellent site.)

[Cleveland Clinic]

Dear platypus1:  There is strong evidence to support that estrogen suppression is beneficial to women with estrogen and/or progesterone receptor positive women.  There is also evidence to support that ovarian ablation (either surgically or chemically with medications such as zoladex or lupron) may benefit premenopausal women – although most of this research has been done on women under 50.  Triptorilen is a drug similar to zoladex or lupron in that it works to lower estrogen by blocking the leutenizing hormone and the side effect profiles appear similar.  In general, using ovarian ablation along with tamoxifen has been considered an aggressive approach.  Based on trials indicating an advantage of aromatase inhibitors over tamoxifen, some oncologists have recommended ovarian ablation in order to allow premenopausal women the opportunity to use aromatase inhibitors – since these are only appropriate for post menopausal women.  It is not known whether this approach is superior in premenopausal women as the trials were done only in postmenopausal women.  It is not possible to speculate on how each combination of drugs may affect your quality of life.  There is wide variation in how women tolerate these medications just as there are variations in how women tolerate menopause.  We cannot make specific recommendations without a full evaluation, including review of pathology slides etc.  We recommend that you discuss each option with your oncologist in terms of your risk of recurrence and any known benefits.   The clinical trial is being done in order to learn more about both the effectiveness and side effects of the various treatment options -until such trials are complete, we do not know the optimal treatment. When the right choice is unclear, a clinical trial may be a good option.

[Peachy48]

I am 50 and have IDC low grade, also ER/PR++ and her2neu-/ The doctors (have had 2 opinions) have recommended oopherectomy and then the AI. The reason being is that I have liver dis. and they dont want give me Lupron. You have to have a good liver and be prepared for side effects from Lupron. The only reason I know Lupron is my husband has Prostate CA and he's on it along with raditiation therapy, as surgery was not an option for him. He hates the side effects, mostly hot flashes, night sweats and arthritis flares. He already had arthritis, so it has made it worse. I'm hearing the AI's cause bone pain too, so the combo didn't sound great to me. None of it does tho.. :(  Does everyone get these sides? Probably not, but check into it. I am doing the ooph because at 50, I am so near menopause that I can touch it, so why do the shots? Just my personal view. I have heard that some people do ok on the Lupron tho, so its definitely a personal choice. You could always try it, then decide..

Peace and Prayers.