Chemo or clinical trial advice

kayrnic

So I just found out I have progression after 14 months on palbociclib/Faslodex combo. My onc has said before that this was the last anti-hormonal option. My question is, what chemo do you think will come next? Or does anyone know of clinical trials for er/pr+ her2- ? Ive been on tamoxifen, arimidex, palbo/Faslodex combo.

exbrnxgrl

Hi Kay,

So sorry to hear about the progression. No tx advice, but please know I'm thinking about you.

Caryn

pajim

Hi Kay, So sorry about the progression. I was where you are in February. There was a Phase 1 of the new oral SERD (like Faslodex) but no openings in my area. There is a trial for A/A/iclib going on. I'm not sure the sites but it's ribociclib so you can find the trial in clinicaltrials.gov.

I was on a twin of that trial for three months but ran into trouble with my lungs so my onc (and I) pulled me out. Other options included estrogen or Megace, but both of them can be hard to take. In the end I decided no. If you don't have trouble with your weight you could seriously consider Megace. It's an old trick, not used much anymore.

It feels like such a step when the hormonals stop working. . .my husband, my onc and I all had a lot of trouble moving to Xeloda. That is the logical next step.

If anyone else has an even good idea, I'd love to hear it myself.

Bestbird

I am very sorry to hear of the progression. There are still many options available, and below from my MBC Guide is a list of hormonal therapies and a summary of the best way to search for mbc clinical trials. You (and others) are welcome to request a complimentary copy of the 140 page booklet by visiting the top of this page: https://community.breastcancer.org/forum/8/topics/831507?page=3#idx_73

• Hormonal Therapy Sequence for Postmenopausal Patients

The sequence of providing hormonal (endocrine) therapy for postmenopausal patients will vary, as much of it depends upon what - if any - hormonal therapy drugs the patient has previously taken.Generally, there is a choice of providing single drugs or a combination of drugs, with combination drugs generally precipitating more side effects.Patients are urged to discuss the various options with their doctor and to verify insurance coverage, since it is possible that some of the combination drug regimens listed below may not yet be covered by insurance.

The following sequence of single or combination hormonal therapy drugs has been lifted from a presentation made by Dr. Maura Dickler of Memorial Sloan Kettering at the 2015 San Antonio Breast Cancer Symposium. Her recommendations are based upon the results of clinical trials as well as her own clinical practice. From: https://sabcs.cmeoncall.com/OnlinePlayer/153

• Single Agent Hormonal Therapy Sequence:
  • First line treatment should consist of a non-steroidal Aromatase Inhibitor (AI) such as Letrozole or Arimidex
  • Second-line treatment should be either Faslodex (500mg) or Aromasin
  • Third line treatment should be Tamoxifen
  • Fourth line treatment may be either Estradiol, Megestrol Acetate (Megace), or Halotestin (Fluoxymesterone)
• Combination Hormonal Therapy Sequence:
  • First line treatment may consist of a combination of either Arimidex with IBRANCE, Arimidex with Faslodex (500mg), Letrozole with IBRANCE (Palbociclib), Letrozole with Kisqali (Ribociclib), or Aromasin with IBRANCE.
  • Second-line treatment might be a combination of either Faslodex (500mg) with IBRANCE or possibly Letrozole with IBRANCE, or Aromasin with Afinitor.Note:In second-line treatment, the combination of Faslodex and IBRANCE more than doubled progression-free survival (PFS) compared with Faslodex alone, and this was also true for people with ESR1 mutations.From: http://www.medpagetoday.com/MeetingCoverage/ASCO/51855and http://www.healio.com/hematology-oncology/breast-cancer/news/online/{5613496d-1ad3-4e71-a70a-ce9180310965}/mutation-status-may-guide-endocrine-therapy-for-advanced-breast-cancer
  • Third line treatment could be Tamoxifen with Afinitor
  • Fourth line treatment, which is a single agent, may be either Toremifene (Fareston), Estradiol, Megestrol Acetate (Megace), or Halotestin (Fluoxymesterone)

An excellent link for finding Clinical Trials designed specifically for patients with mbc is located at this link (please be patient, as the website is slow).https://www.breastcancertrials.org/BCTIncludes/AvonPfizer/BCTDemo.html

Note: There are several issues with this mbc clinical trial search tool that may prevent a full list of applicable trials from being displayed.To bypass these issues so that a complete list of relevant trials will be displayed, please follow the directions below.

After launching the tool, please enter information only in the following sections and nowhere else.

•Year of Birth

•Female or Male

•Pre-menopausal or Post-menopausal (presented if "Female" was selected above)

•Breast cancer type

The results can be filtered by type of therapy, such as hormonal therapy, vaccines and immunotherapy, etc.

Once the list of clinical trials is displayed, patients can refine the list by selecting the specific type of trials they are interested in (such as Chemotherapy, Hormone Therapy, Targeted therapy, Vaccines and Immunotherapy, etc.) by clicking on the desired category next to the "Jump to" prompt near the top of the page.

JFL

Kay, sorry to hear about progression. What about Aromasin or Afinitor/Aromasin? For chemos, Xeloda is a likely choice. Very effective and convenient since it is oral. No hair loss, and not any more harsh than Ibrance/hormone therapy in my experience. Just different. You can keep taking it as long as it works and I know people for whom it has worked 5+ years. Also, there are a lot of targeted therapies in the "fast track" approval category that should be coming out this year and the next few years. That won't help you today but could be options in the near future once approved. Abemiclib is expected to be approved in the next six months. And Entinostat might be approved in the next year or two. There are others as well. You could also request testing to confirm if you would be a candidate for Keytruda, which was recently approved for all solid tumor cancers with certain characteristics. I requested this testing. It is generally thought to be more of a treatment for triple negative but there have been ER+ patients in trials who have had a durable response - very few respond overall but those who do REALLY respond, for many, many years.

kayrnic

pajim......what do you mean by "if you don't have trouble with your weight?" I am overweight, as each hormonal therapy seems to have packed on 20 pounds per drug that I can't get off.

bestbird.....you always make things so easy! Thank you! I have used the search and found some trials to ask my doctor about!

Cure-ious

Hi Kay,

You have progression, but is it still confined to bone?

kayrnic

I have one soft tissue met in my sternum. They think that's what it is as it does respond to treatment, but it has never been biopsied. Other than that it's only in the bones at this point.

pajim

kaymic, the major side-effect of Megace is weight gain. These days it is prescribed for patients who are wasting from cancer or AIDS. I'm 25 pounds+ overweight so decided I couldn't afford to put on more. That's what stopped me from trying it. But for women who are underweight, they might do fine in the drug.

I'd be very interested if you find any alternatives.

RosesToeses

After I failed the anti-hormonals I went on Xeloda which worked well for over a year and a half for me.  When my onc told me she recommended chemo (Xeloda) rather than some other anti-hormonal it felt like defeat but in truth the Xeloda did good things for me and was much easier to take than Afinitor or Ibrance for me--I had assumed it would be much worse because chemo but that wasn't the case at all.

Good luck!