Expert: Claes-Gustaf Nordquist, M.D. - 4/29/2010

Question
I am a 64 y.o. female with metastatic breast cancer. The tumor cells are ER(+), PR(+), HER-2(-), GCDFP-15(+), and TTF-1(-). My cancer treatment started with anastrozole and I have been taking it for 2 years and 3 months now. I had radiation therapy done on my spine 6 months ago and so the doctor temporarily stopped the anastrozole and continued it again after the radiation ended in 2 weeks. My upper-back and shoulders stopped hurting after radiaton therapy. However, my CEA and CA15-3 BR CA markers have now started to move up significantly. This has made my doctor conclude that anastrozole is no longer working for me. Could this have occurred because of the radiation therapy where I stopped the anastrozole and restarted it?

What treatment options do I have now? Should I continue with hormone therapy? If so, which is the next recommended drug after anastrozole? I am dreading chemotherapy because of the hair-losing aspect. What options do I have?

Currently, I am getting fever daily, like I did when I was initially diagnosed with cancer. This is in addition to significant pain while standing or walking.

Answer
I would recommend that you continue to try hormone therapy but with another drug. I'm a Swede living in Sweden so I do not know what is available where you are. So this is something your doctor must help you with. If hormone drugs do not work at all any more your remaining option is chemotherapy. I have nothing else to offer unfortunately. It is possible - but not certain - that your therapy pause played a role.




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