Fulvestrant and Ibrance

Ladies, first things first. You can find all about fulvestrant in the Faslodex Girls 2014 thread. The first few posts give you the tips and tricks and normal side-effects. You already know the side effects of Ibrance.

I did letrozole plus fulvestrant for three years. When the TMs started climbing we added Ibrance. It boosted the other two drugs for another year. So it does seem to help.

So you could do any of the three options Charlotte was given.

I wouldn't switch to Verzenio. I'd save it. It works a little differently so may be another hormonal option down the road. I AM actually doing Verzenio and Ibrance after a year on Xeloda. Normally one wouldn't go back to hormonals but we decided to give it a try. It seems to be working. Not really sure yet -- I'll know more at my next appointment. And it probably won't last long but I'll take it over iv chemo.

Here's my philosophy on how to choose a next line. This may not twin with your views or your doctor's views, but here it is for what it's worth. Stall, stall, stall. Once you're done with a treatment generally you're done with it. So don't stop until you really have to.

I would do either "add Ibrance to letrozole" or "Fulvestrant alone". Then when fulvestrant alone starts looking dicey, add Ibrance with the hope of extending the use the fulvestrant. The overall survival studies on palbociclib, ribocilcib and abemaciclib are starting to come out. They are extending survival.

Making these decisions is really hard. What is right for you may not be right for others. Some women want to hit the cancer hard. others want to do the least they can do (raising my hand here -- I hate side effects). The second part of my philosophy on picking treatments is not to look back. Don't second-guess yourself. Except. Make the decision the night before you tell the doc and sleep on it. If you're stomach hates you in the morning maybe you need to re-think.

Wishing you the best of luck, whatever you decide.

funthing42,


I’m sure someone more informed than me will come along soon with a more definitive answer but I will try to give my .02 cents based on what I’ve read around here.

From what I read, most people try to get as much distance from hormone therapy as they can because they’re easier on your body. Idk if you’ve had further biopsies that suggest your hormone receptor status has changed, but that would be a reason to move to another treatment. I also read that chemo is more effective for visceral metastases than hormone therapy so maybe your MO wants to blast the liver mets. There are a lot of factors that could be governing their decision making, but they should definitely be explaining it to you as thoroughly as you want! I don’t like that they’re not informing you, thats a big part of an oncologist’s job in my opinion.

Most insurance plans, including Medicaid, will cover a 2nd opinion for BC. Someone on the boards suggested finding an oncologist at a research hospital, since they will be more plugged into trials that are going on if that’s what you’re interested in. But I know a lot of folks don’t live near a big university hospital and any second set of eyes would probably be good.

I don’t think it’s true that immunotherapy trials are ONLY for triple negatives, although I think they tend to be the most responsive. This was the first questions I asked on the board.

Hi FloridaRN. When I progress, I think I will be doing the same as you..Faslodex and continue the Ibrance.

Charlotte, in my experience Ibrance is a booster. I added it on when Femara/Faslodex (the combo I was on) started to fail. Ibrance made it last a whole year longer.

Ibrance doesn't really seem to work by itself. It boosts the hormonal treatments. Verzenio does, in theory, work on it's own but I'm still taking it with Faslodex. Better safe than sorry.

Pajim, How are you doing?!!

Charlotte, that seems an entirely reasonable thing to do. I hope it works well for you.

Cure-ious, you mean on abemaciclib and fulvestrant? What I say when someone asks is "it's not NOT working". TMs have stopped rising though they are not falling. Scans in a month to see what is happening but we all suspect they'll say 'stable'. SIde-effects-wise I have a little diarrhea but no other problems. I'd be happy to stay on this stuff for as long as possible. I'm trying for next summer when the IMU032 Phase 3 trial will open up. One month at a time. . .

Pajim- Ditto to Chemokaze's question, and yeah! to Abemaciclib, its the strongest of the CDK4,6 inhibitors. It seems like it worked well for you to have the break (Xeloda) between the anti-hormonal treatments, and now you want to try immunotherapy?

Pajim, Do you know that you have to change treatments already, or are you just getting ready in case? The treatment you are on seems a good choice because the Abemaciclib could be working on its own (ie even if the faslodex doesn't work). Below is a link to a study of IMMU-132 on TNBC, though you've probably already seen it- they got a great response and it went to FDA fast-track, but this was with patients averaging five prior therapies, so it seems like this might be a better drug to use later, no? You are almost six years out (!!!) and maybe still bone-only (?) and have not tried the new PI3K inhibitor (Alpelisib) or mTOR inhibitor (Affinitor), what if your next biopsy shows the PI3KCA mutation? Because if that is the cause of endocrine resistance, then pushing down the Pi3K/mTOR pathway can make the cancer cells become estrogen-dependent again, and you stay away from the chemos for longer...

PS- I laugh when they report "acceptable safety profile"-- acceptable to WHO?!

http://cancerres.aacrjournals.org/content/78/4_Sup...

Second reply as a rant against two phrases:

"Acceptable safety profile" & "Generally well-tolerated"

As you say. . .TO WHOM?? BY WHOM?? Actually probably by some people, to be fair. But these are judgment calls by people who aren't taking the drug!! And it's hysterical what drug companies think their patients were happy with. These are marketing terms, not medical terms!!!

Let me tell you a story. I work at a medical journal and one of the things I do is to attend the manuscript meetings. Recently our two oncologists were discussing the merits of Faslodex vs Ibrance. Let's just say that these are men of a certain age. Those two have no idea that they have an MBC patient in their midst. They're stating firmly that Ibrance is better because it's oral and the other is a shot. I soooo wanted to tell them they were full of s---. You have to go into the cancer center every four weeks anyway, Ibrance tanks your neutrophils causing fatigue and infections, grrrr. and you have to remember to take it every day instead of forgetting you're a cancer patient for four whole weeks. Meanwhile the few folks in the room who do know are wondering why I don't have anything to say. It just wasn't worth coming out of the closet.

Luckily my boss hates both those terms and edits them out of any paper we publish.