After months of indecision, I called my oncologist last week and told him I was ready to switch from exemestane (Aromasin) to letrozole (Femara). He’d suggested several months ago that if I wanted to, I could make the change because the letrozole might have fewer, milder side effects. And I’ve been wrestling with the decision ever since.
With the exemestane I’ve had several stiff, achy, sometimes painful fingers, hot flashes, and unrelenting fatigue that makes just getting off the couch an effort. Trouble is, those issues may or may not be caused by the exemestane. And they, plus many other side effects, are common to most of the modern aromatase inhibitors (the first three drugs on the chart below, and the only ones my doctor is currently considering).
The achy fingers might also be just a normal onset of arthritis that was suppressed last winter by all the prednisone I was taking. Or it could be overuse from playing video games (yes, that’s a distinct possibility given the particular fingers involved).
The hot flashes are to be expected with menopause, and the drugs suppress even the slightest production of estrogen in the body.
That leaves only the fatigue, and I finally decided if I could get relief from that by changing drugs, it would be worth a try. Sitting on the couch for the next five years doesn’t sound like a great way to live if I can avoid it.
Of course, there are no guarantees. I might feel a lot better taking letrozole. Or I could feel much, much worse. The list of possible side effects from AIs seems endless. I could end up with worse joint pain, nausea, weight gain, bone loss, etc. (And I absolutely don’t do nausea!) That makes mere fatigue look pretty benign.
Anyway, I finally decided to try it. I’ll be off the exemestane for two weeks to get it out of my system, and then I’ll start the letrozole. If I don’t like the results, I’ll switch back to the exemestane, PDQ.
(The plan is that I’ll have been on the letrozole for two weeks when I see my oncologist again, so together we can evaluate its effects.)
Meantime I’ll be trying not to think of the woman who said she felt so much better during her two-week break that she couldn’t bring herself to resume any AI treatment. I’d love to feel that good, but without any Herceptin treatment, I dare not skip the hormonal therapy too.
It did give me an idea, however. If it’s okay to take a two-week break between drugs, why wouldn’t an occasional two-week “drug vacation” be okay? I plan to ask the doctor about that.