ER+ PR+ HER2- Lines of Treatment

dorimak

I am five years post DX with mets in nodes under sternum ,nodes in one lung and had brain mets treated with stereotactic radiation. My most recent scan showed progression on Xeloda which I have been taking for two years. MO says next step IS iv chemo. I am in a SHARE MBC support group where we have a ZOOM call ever other week and I have come across others who have done a variety of treatments. i realize we are all different with involvement in different organs with different extents of disease but I am curious how so many seem to have a different path of treatments. My main question is what were your treatments? For example I have taken IBRANCE and my MO says Verzinio is in the same class so not worth trying, but found some promising info. on this site. There is one lady in the group who has MBC since 1998 and has recycled treatments with success. With my t wo years on Xeloda and no AI, I wondered if my ER receptors would be responsive after being off AIS for two year.s Welcome input on what you have taken so far.

My Path

Femara - 3 months with pgogression

IBRANCE & Femara 15 months

Faslodex only 6 months

Aromosin & Affinitor 4 months

Xeloda Amost 2 years

Thanks for input.

x

7of9

I had Adriamycin, Cytoxin 4 followed by Taxol 4 then surgery first go round. Recurrence just under 3 yrs though symptoms armpit swelling showed up at 2 1/2 yrs to axillary I had surgery, then rads, then Taxotere 4 ( was my choice) that or Xeloda, my onc thought Taxotere was too close to Taxol which shrank tumors by more than 1/2 originally but not complete. Adriamycin didn't seem to do much though I heard that is common when its note agressive. I felt along with 2nd opinion that we didn't exhaust the Taxanes first time. Arimidex 5 yrs this month, Zometa 2x yr for 4 1/2 yrs.

I am very worried that I did these chemos but none to the point of progression, just following a standard schedule. I've heard multiple chemos can eliminate me from trials someday if, when needed ???. I need to drag this tired achy body along at least another 4 1/2 yrs until my son can drive. Hopeful more....

candy-678

Dorimak- You said you have had recent progression. How about another biopsy for ER/PR HER2 status. See if it has changed. Also check for ESR mutation--- that will show if hormonals will work for you now. Or PIC3CA mutation for the drug Piqray-- a pill. And I am thinking Verzenio can be used as a monotherapy. So, in short, ask if can rebiopsy to find a pill form that could work before you go to chemo.

Cure-ious

Dorimak- Thanks for starting this thread!! We all start out with the same therapy but then it can rapidly diverge because there is no fixed sequence of treatments and different MOs have different strategies.

1) you can get a Foundation One blood biopsy to check for ESR1 mutations, which are responsible for about 30-40% of cases where the cancer has become endocrine resistant; and 2) there are very strong estrogen degraders that work better than Faslodex on ESR1 mutant cancers now in clinical trials, like ARV-471 that AlabamaDee is taking- plus they work on cancers that have already become resistant to Ibrance, Femara and Faslodex. Are you open to a clinical trial? This one is ongoing and does not exclude prior chemo. Another trial for ESR1 mutant cancers uses Lasofoxifene, a tamoxifen-like drug that inhibits ESR1- they combine that with Verzenio. 3) new data came out showing good results for androgen receptor booster drugs, they work at least as well as estrogen inhibitors- phase thre tirals will start later this year presumably phase two is ongoing now. Boosting the Androgen Receptor is a completely different way to counteract estrogen signaling, and most breast cancers express the AR. Also, these drugs have positive side effects on muscle and bone. 4) As Candy mentioned, Verzenio can also be used as monotherapy, even if the cancer is not estrogen driven anymore, and Piqray is there for PI3KCA mutations. 5) Rather than start on an IV-chemos, there are antibody-conjugated drugs, where a chemo payload is linked to an antibody that targets the turmos. These drugs like Enhertu and Trodelvy have a much longer PFS than conventional chemo, and there are fewer side effects because of the targeting. SusaninSF has been taking Trodelvy with great success. Also, of course, there is immunotherapy- although not a lot of great trials for ER-positive patients, however different combinations with new drugs are in the pipeline and may be game changes.KattySmith took Opodivo with EP4 (a next-gen NSAID) in clinical trial and got nine months, which is terrific for ER-positive cancer and for a treatment with few side effects and a possible overall survival benefit too. So although it is slow, it seems there are quite a few new things come out in the past five years.

It seems that now is the time for a second opinion, preferably from someone involved in clinical trials at a major cancer center. There are so many new treatments most MOs cannot keep up with what is going on and are used to moving to conventional chemo after Xeloda. Hopefully you will hear from people who cycled on and off of endocrine therapy with success.

PS Also, for anyone else who wants to post about their experience, I like how you did "My Path", giving the treatments in order and how long each lasted..