Usually Oncologists wold continue with Tamoxifen and help pts with their symptoms.
I had a similar 46 F, patient last month, who developed knee pains, a year or two after initiation of Tamoxifen.
Bone scan was negative.
The coctail, I give her was:
50mg Diclofenic Sodium three times a day OR Ibuprofen 400 mg TDS ( along with PPI of course )
Co-Codamol [Codeine + Paracetamol (2 tabs up to 8 a day)
Cod-Liver-Oil
Glucosamine & Chrodontin
The last 2 supplements, i never used to believe , but recently have started believing in after my colleagues used this. (Of course this is NOT evidence based, so dont you go after me on this one).
Option 2: Changing brand of Tamoxifen
Personally i ve never seen this working, but we always try to convince pts, it may work.
Option 3: If her menses have ceased , check her LH, FSH and Estradiol levels
You need to have 2 such readings at least 3-4 weeks apart and if they consistently indicate Menopausal levels, consider
Switching Hormones to Aromatase inhibitor (Letrozole 2.5 mg OD)
( Caution: The incidence of Joint aches & Pains are higher with AI compared to Tamoxifen)
So use your convincing capabilities that this knee pain MAY disappear with this this new magic drug.
Option 4: Even if she is premenopausal, you can use Aromatase Inhibitors " OFF LICENSE " along with GnRH Analogues (Zoladex).
The rationale being, Zoladex would cause a reversible suppression of the ovarian function mimicking postmenopause
allowing Letrozole to work . There is retrospective evidence for its use in such a fashion, but no Ph III data.
Option 5: If you ve done all of the above, i m sure you ll be in the fall of 2011, and guess what " HURRAY " you ve finished 5 years
of hormonal manipulation and you can safely stop Tamoxifen.
But seriously speaking, the incidence of recurrence for women who have taken tamoxifen for 4 years like this one,
compared to women who take it for 5 years is small and if the lady is prepared to take that small risk, Stop Tamoxifen.
And if you can appreciate, this advice is the last resort i would give. And it ll be interesting to follow up these women to
see whether this knee pain would disappear with cessation of Tamoxifen or not. Just to ensure, you were not a fool to
have stopped it for a Benign Stupid cause like Ligament, meniscus or cartilage tear or Patellar tendonitis or bursitis or
osteochondritis or chondromalacia. So of course consult an Orthopedic in the very beginning to avoid embarassment.
