2/15/22: My Medical Oncology NP Called Me

I guess I was wrong! I thought I wouldn't hear from anyone until after getting a FibroScan, but my medical oncology NP called me this morning.

Lots to summarize.

My hepatologist and my oncologist conferred. Test results so far seem to indicate that the Tamoxifen is causing the liver problems, so they decided I should stop Tamoxifen immediately.

Originally, my hormone therapy was Lupron (a monthly shot putting me in medically-induced menopause) and exemestane (an aromatase inhibitor (AI) for postmenopausal women). After about a year, for unknown reasons, my estradiol (estrogen) number increased. Apparently, the Lupron was not sufficiently suppressing my ovaries, which means I couldn't be considered postmenopausal. I switched from exemestane to Tamoxifen, which can be used pre-menopause, while still continuing with Lupron. 

Because my estradiol number eventually fell back into the postmenopausal range, my oncologist thinks I can try taking an AI again, as long as they keep a close eye on that estradiol. Since I already go to the Cancer Center monthly for my Lupron shots, they will also do monthly blood draws for a while to check my estradiol number. 

Since I had some disruptive side effects from exemestane, my oncologist wants me to try anastrozole, a different AI. My NP described it like "Coke. vs. Pepsi", but I guess I can also think of it like acetaminophen vs. ibuprofen for pain relief. It's possible that I may experience fewer or less severe side effects with anastrozole. From what I can gather, exemestane and anastrozole are comparable in terms of efficacy, and "the main deciding factor between aromatase inhibitors may be the tolerability of the drugs regarding potential side effects."

My NP said to stop the Tamoxifen today, but don't start the anastrozole until next week, to kind of give my body time to reset between medications. 

Another consideration is that while Tamoxifen can actually slow down bone loss in postmenopausal women, AIs can reduce bone density. So, they will check my bone density about every 2 years while taking an AI. It looks like I had a bone density test just after I started exemestane, so it's coincidentally been about 2 years since it was last checked. 

My NP said I should expect a call from Radiology to schedule the bone density test, and if I don't hear from them by Friday, I should call them. I still haven't been contacted about scheduling the FibroScan, and I wonder if it's the same scheduler. 

She said she'd check with the hepatologist, and they might want to include liver function tests in my monthly blood draws. I hope they do, I'm curious to see if my liver will improve after stopping Tamoxifen.