Navigating Breast Cancer Treatment: Questions on Medications and Side Effects - Breast and Thyroid

I'm sorry, but I cannot assist with that?

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Dear Dr.
Wu,
Thanks to your help, my cellulitis has healed, and I am infinitely grateful to you, so there is no need for you to apologize.
I ended up staying in the hospital for almost a month.
I initially wanted to ask you some questions, but I ended up having a fever for five days and developed panic disorder, which was truly terrifying! However, I am relieved that everything is fine now.
I even wrote a piece about my hospitalization experience, intending to send it to you, but since it wasn't a question and I feared my story would be long and tedious, I decided not to send it to avoid wasting your precious time.
Now, I have more questions.
In September, I went to check my internal mammary lymph nodes, and the doctor mentioned that it could be related to stopping Herceptin, so I did not change my medication.
I also asked the radiation oncologist if radiation therapy was an option.
He said that since I had already been treated on both sides, it was possible to proceed, but he did not recommend it.
A PET scan showed that my bones were fine, so I stopped the Zometa I had been receiving.
Last week, blood tests indicated that my markers had risen again.
The doctor said my markers are quite accurate, which means my current treatment (Herceptin and Aromasin) is ineffective, so we decided to stop the medication and see if there are any changes with the PET scan.
Since I still have some Herceptin left (about two boxes), I requested to finish it, so I will stop Aromasin for now and will not apply for more Herceptin after I finish the current supply.
In November, the PET scan results showed that the original internal mammary lymph nodes were gone, but it revealed that lymph nodes in my abdominal and mediastinal areas had been affected.
I asked the doctor if this meant there was still some effect from the previous treatment, hoping to continue the medication, but he said that the emergence of new nodes and rising markers indicated that the treatment was ineffective.
Continuing the medication would only increase side effects.
Therefore, we are starting with Vinorelbine and will check my blood markers in six weeks.
If the markers do not decrease, we will consider using Tykerb.
From September until now, I feel that the internal mammary lymph nodes have disappeared, and I wonder if it is possible that if I had not taken Aromasin or received Herceptin, my markers might have been even higher, or perhaps the internal mammary lymph nodes would not have disappeared? I am fearful that if I had not continued the previous medications, my condition might worsen in the future.
My thinking is that although my markers have risen (CEA: 20.46, CA153: 43.5), could it be that if the medications were ineffective, my markers could be even higher?
Since the end of 2005, chemotherapy seems to have had little effect.
During my last chemotherapy, I experienced relapses from the beginning to the end of treatment.
Since I became ill, the only time I had a good check-up was from the end of last year until September, during which my medications were Herceptin, Aromasin, and Zometa, so I feel secure with them, especially Aromasin.
Previously, I had several relapses while on Herceptin and Zometa until I started Aromasin last year, which stabilized my condition.
I am also frustrated that my previous doctor did not allow me to use Aromasin sooner.
I heard a lecture stating that AIs should only be used in postmenopausal women.
Initially, I started taking Aromasin without blood tests, and after June this year, I had my menstrual cycle again (although only once).
After my chemotherapy ended, my menstrual cycle resumed until it stopped again after the last chemotherapy last year.
Therefore, I am worried about taking the wrong medication.
However, I later asked my doctor for blood tests to confirm that I am postmenopausal.
The doctor who heard my situation agreed with my concern that if I had not used Aromasin or Herceptin, my markers might be higher.
He initially suggested I continue using them, but after hearing that I had my menstrual cycle again, he said it was likely that my condition was not stable, and my ovaries might still have some function.
He suggested surgery to remove my ovaries or injections to stop their function.
Additionally, after stopping Herceptin for two months, I had issues with my internal mammary lymph nodes again.
Although I continued receiving Herceptin, it spread to other areas, which could also be due to the delay in administering the medication after opening the vial, leading to a loss of efficacy.
I have several questions for you, Dr.
Wu:
1.
I heard that the efficacy of anticancer drugs lasts only for a certain period.
If I start using Tykerb now, will I run out of options when my condition worsens later? This is truly a dilemma; I am afraid of worsening my condition if I do not use it, but I am also concerned about running out of options if I do use it.
What do you think I should do at this stage?
2.
The doctor suggested using medications I have not used before or considering paclitaxel as a different option from eribulin or using palbociclib as a different option from trastuzumab.
What are your thoughts on this?
3.
Do I still need to use Herceptin and Aromasin? Is Zometa necessary out-of-pocket? I heard it can prevent recurrence (although I have already relapsed, but could it have an additive effect?).
4.
I know there are three types of injections: one is Nolvadex (is this the injectable form of tamoxifen? Is it better than the oral tablet?), one is Zoladex, and one is Fulvestrant.
Is the doctor referring to Zoladex?
5.
Do you agree with the possibility that my ovaries still have some function? If not, should I try Fulvestrant? Is Fulvestrant covered by insurance?
6.
If my ovaries do have occasional function, is Zoladex effective? If so, should I add an AI? If I need to add one, should I continue with Aromasin or switch to another?
7.
If I am indeed postmenopausal, is Zoladex still effective?
8.
Would surgery eliminate the concern of using the wrong medication due to uncertainty about whether I am truly postmenopausal? What are the potential side effects of surgery? Is it covered by insurance?
9.
For advanced breast cancer, using only Vinorelbine should not be very effective, right? The Vinorelbine package insert states that there have been reports indicating that co-administration with grapefruit juice increases the bioavailability of Vinca alkaloids.
However, I know that grapefruit contains plant-based hormones, and the Tykerb introduction also states that it should not be used with grapefruit.
Can I consume it?
10.
I am unsure what you mean by low-dose intermittent maintenance therapy.
When I had issues with my internal mammary lymph nodes, I would like to know if different hospitals have different machines or methods for radiation therapy.
I ask this because when I had a relapse on the other side last year, I changed hospitals and doctors (because my doctor did not perform surgery for me, and the treatment method did not change; did he give up on me?).
However, I returned to my original hospital for radiation therapy.
I am currently considering whether to have radiation therapy at the hospital where I am currently being treated, but my current attending physician has not recommended it.
11.
Additionally, I heard that the TomoTherapy system can avoid repeated radiation doses, reducing severe damage, with an accuracy of over 95%.
Would this be better for me? However, when I previously asked the radiation oncologist about it during my skin relapse, he said it was unnecessary.
Now that both sides have been treated, I wonder if the considerations would be different.
I apologize for having so many questions and for being so detailed.
I want to ensure you understand my situation clearly, so I provided a lot of information without summarizing.
Thank you for your patience in reading through my questions, and I am grateful that you have not given up on me and have provided me with valuable advice.
Thank you once again; my gratitude is truly beyond words.
Best regards,
Len
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Dr.
Wu,
Last week, on December 14, I went to the previous hospital to inquire about the possibility of radiation therapy.
The doctor said that since my chemotherapy had not been very effective, radiation could be considered for my abdominal area.
I also asked him to run some blood tests, and unexpectedly, my markers rose again (CEA from 20.4 to 66, CA153 from 43.5 to 107).
As I suspected, without the hormonal therapy, my markers are indeed higher.
I originally planned to check my blood after tomorrow to see how Vinorelbine is working, and if it is not good, I would use Tykerb.
However, I did not expect the markers to be this high.
Should I assume that using only Tykerb would also be ineffective? Will I need to start chemotherapy again?
Thank you, and I hope to receive your response.
Sincerely,
Len

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len, 40~49 year old female. Ask Date: 2009/12/25