Before you go to chemo what to do ?? suggestions please

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thria157
thria157 Member Posts: 37
edited August 2018 in Stage IV/Metastatic Breast Cancer ONLY

Hi everyone,

Thanks so much for all your help and support. I am writing on behalf of my mother that she has mastectomy in 2004 and met in bones in 2013. Since the she had a failed try with armidex then moved to xeloda for 2 years and the last year she is on falsodex and Ibrance 100mg because she cant take the 125 due to blood smear. Recently the CA 15.3 started rising again.

The onc suggested to do a biopsy to see if the issue is due to a mutation or because falsodex or ibrance run out of gas.

Personally I am very confused and I dont know how to help. There are so many combinations of

1. Ibrance and Femara

2. Ibrance and Aromasin

3. Afinitor and Aromasin - onc suggestion

4. Afinitor and falsodex

is there any way that you can pick the one that could work ? are there any similar experiences ?

Please help

Thanks so much




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  • Moderators
    Moderators Member Posts: 25,912
    edited April 2018

    Hi Thria,

    We're so sorry to hear of your mom's progression. This is definitely a difficult decision, and one that our members will surely be knowledgeable of -- we're sure someone will be by soon to weigh in with their thoughts and experiences.

    Sending our best thoughts!

    --The Mods

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  • pajim
    pajim Member Posts: 2,785
    edited April 2018

    Thria157, I'm sorry that your Mom is having progression. You shouldn't change treatments on the basis of the tumor markers but they should do a scan to see if the tumors are actually growing. Lots of things can affect the CA 15.3.

    As for what treatment next, there is no way to know what treatment is going to work. The Stage IV thing is all about trial and error.

    The first question you should ask is whether the cancer is still hormonally sensitive. That's the reason the onc want to do the biopsy. If you get good tissue from the biopsy there are places you can send tissue and companies will do sensitivity testing on it. That tells you what will kill the tumor.

    All that said, here's some brass tacks. Since Arimidex failed, it's unlikely that Femara and Ibrance will work. But she can try if she wishes. No harm in trying. Aromasin is a different kind of aromatase inhibitor than Femara and Arimidex so I'd rather try Aromasin and Ibrance. No guarantee that will work either. The 'usual' next thing is indeed A/A {Afinitor plus Aromasin). What I will say is that can be a hard combination to take. I took it for three months and got lung inflammation. Plus it wasn't helping. So on to Xeloda.

    What does your Mom want to do? She knows the side-effects of the hormonals. Afinitor causes mouth sores and infections.

    Regardless of what she (and you) decide, I wish you the very best.


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  • thria157
    thria157 Member Posts: 37
    edited April 2018

    thanks for your response.

    From what i read online it looks like that A/A is performing as well as Ibrance and Flasodex or Ibrance and Aromasin.

    Whats the main criteria to chose either Afinitor or Ibrance you think?

    She just got her scans and there is no progression. the mets is only on bones.

    Looking forward to your response

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  • sandilee
    sandilee Member Posts: 1,843
    edited April 2018

    Hi Thria,

    So the scan showed no progression? If that's the case, I'd want to stay on the Faslodex combo as long as possible. I took it successfully for nearly four years for bone mets. Affinitor is harder on most people than Faslodex or Aromasin, as far as possible side effects, it seems. Good luck to her. You are a angel for being so involved.



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  • pajim
    pajim Member Posts: 2,785
    edited April 2018

    I agree with Sandilee. So long as the scans are good you don't want to change treatments. The dogma is that you don't "go back" to treatments, so you want to keep each one going as long as possible.

    [FYI I say dogma because some creative oncologists are indeed going back to old treatments after a while]

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  • thria157
    thria157 Member Posts: 37
    edited June 2018

    hi all.

    Yes the scans showed no progress. Apparently she had an internal inflammation in her body that caused the whole CA153 rise. After she removed this and being without ibrance for a month the ca153 went down 20%.

    We are still having issues with her RBC that fluctuating a lot. Any suggestions for this will be great.


    Thanks so much all

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  • pajim
    pajim Member Posts: 2,785
    edited June 2018

    Yeah on the scans! Glad you are staying the course.

    RBC just fluctuates with Ibrance. At least it did with me. it was always somewhat low. So long as it isn't dangerously low I'd just sit tight and watch it.

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  • thria157
    thria157 Member Posts: 37
    edited August 2018

    hi again,

    Back on 100mg of Ibrance - it’s a struggle to compete the 3rd week due to low white and red cells again. The last 2 cycles has stopped after the 2nd week.

    The issue is that the CA15/3 increases from 668 to 698 due to this. It’s a minor increase but still increase.

    The doc suggested to be 2 weeks on - 1 week off

    Which means that in a months time she will get 3 weeks of medicine but not consecutive.

    I found this a bit strange because the ibrance dose management said to start again once the patient recovers - for which 1 week might not be enough

    Any thoughts


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  • JFL
    JFL Member Posts: 1,947
    edited August 2018

    Have you tried 75mg? I would consider lowering the mg before shortening the time you on Ibrance, given that it has been shown to have similaractivity at lower mg.

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  • thria157
    thria157 Member Posts: 37
    edited August 2018

    thanks for your response JFL - we did a few months ago but the CA15/3 was rising parry due to an internal inflammation that she had.

    One option I guess is to try again


    Any other thoughts ?


    Tb and so much

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  • thria157
    thria157 Member Posts: 37
    edited August 2018

    still she can only take 2 weeks of ibrance 100mg can’t get into the 3rd due to low RBC

    The onc suggested to take some retacrit injections that include a hormone that stimulates the bone marrow and increases the RBC.

    The options out there about giving this to cancer patirents are different. What do you think ?

    Thanks

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