Afinitor/Aromasin before Faslodex/Ibrance

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tropa23
tropa23 Member Posts: 14
edited April 2019 in Stage IV/Metastatic Breast Cancer ONLY

Good morning ladies,

I’m wondering if anyone has tried Afinitor/Aromasin combo before trying out Faslodex/Ibrance combo.

I was kept on femara alone for 10 months since my diagnosis( after I have finished 8 rounds of 2 different chemos). but my bone mets showed progression now so my Onc. decided to change me to A/A although I have never tried Faslodex or Ibrance .. he justified that no trials have stated which one of them is better in second line therapy . But i’m worried that I would not gain benefit from Faslodex/Ibrance if i use them in third line. So what’s your opinion and how should i prdceed if any of you have expierience with that. Thank you

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  • pajim
    pajim Member Posts: 2,785
    edited April 2019

    Hi Tropa, so far as I know the order doesn't matter at all. The usual reason for Fas/Palbo before A/A is that the side-effects are less. If you're going to respond you'll respond later too.

    Usually we go from the least SE to the most. Though on an individual level that means squat, as each patient has his or her own side-effects to each treatment.

    It's possible that someone else knows different but I don't know of any evidence backing it up.

    Did you ask his or her thinking? Maybe it's that A/A is a bit more like a chemo so s/he wants you to alternate. Fas/Palbo is definitely more hormonal. There's a theory! [no idea or evidence to back that up either. I just made it up]

    Edited to add: you're the patient. You don't have to agree. Or you can go for a second opinion.

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  • Cure-ious
    Cure-ious Member Posts: 2,626
    edited April 2019

    Tropa, No way I'd take the less effective drug (AA) first, esp as Ibrance and other CDK4,6 inhibitors are reported to be less effective on mTORC1-resistant cancers, which is what yours would be following progression on AA (if you respond to it). Hope you get a second opinion. SEs are also worse, is this oncologist giving you some specific reason? The AA is hitting mTORC1, and in principle should be working best on PI3K mutant cancers, even tho they don't test for that- normally cancers do not have PI3K mutations until they become endocrine-insenstiive, so the AA is more likely to work better at later stage..

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  • ann273
    ann273 Member Posts: 209
    edited April 2019

    Tropa, I took A/A for 3+ years before Ibrance. This happened before Ibrance was approved where I was. I agree with pajim and Cure-ious that it might be better to go with Ibrance first. I have definitely read literature that suggests that the efficacy of Ibrance is reduced after being on afinitor. I am on Ibrance now and we are already suspecting progression after just 7 months. Afinitor also has more side effects in my experience.

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  • tropa23
    tropa23 Member Posts: 14
    edited April 2019

    Thank you pajim, Cure-ious and ann. I also agree with you about the possible resistance to ibrance after afinitor . My Onc. justified this by saying that it’s financially more tolerable as I’m not insured and actually ibrance is four times the price of afinitor where I live. He has no problem with prescribing this combo for me but as i said that he stated that no head to head comaprison showed that one is better as second line but he did not mention their response as third line . i think I am gonna discuss the options withhim again.

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