Life after Faslodex & Ibrance - Which treatment?

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syl65
syl65 Member Posts: 2
edited April 2019 in Stage IV/Metastatic Breast Cancer ONLY

I have MBC, ER+, HER2-. I've had 22 cycles of Faslodex & Ibrance. My CA27-29 markers steadily increased from 48 in July 2018 to 104.9 in March 2019. I have mets to lungs & bone. CT of chest, abdomen & pelvis & bone scans have been consistent throughout. On Monday, in addition to these scans, I also had a PET scans. Got results on Tues. I now have mets to liver & hip and femur show more cancer activity. No wonder my hips and legs hurt. My oncologist stopped my F/I treatment and I am now receiving 10 sessions of radiation to alleviate the hip and leg cancer activity and relieve pain.

I am sorry to say goodbye to F/I. I felt free to live my active life with it. This is a new chapter. I'm upset, but not freaking out because I knew this would happen. My Oncologist wanted me to participate in an immunotherapy Clinical Trial, but I don't qualify. She has recommended moving on to either Taxol or Xeloda. She is thinking of doing a liver biopsy to see if the Breast Cancer has remained the same.

I have found such good information on this site. I would appreciate it so much if those of you who have been in a similar situation would share your experiences with either Taxol or Xeloda after F/I. Have you had one & then the other; in which order, etc. I'm concerned that the weekly infusion Taxol will limit my freedom and active life. Would Xeloda first be a good option & when that stops working move on to Taxol??

I'll share a little history. I was Dx with BC in 1995 (stage one, 11 lymph nodes clear) & had CMF chemo followed by 5 years Tamoxifin. In 2013, I had a local regional recurrence of 5 tumors near my axilla. After surgery, I received 8 weeks of AC, 12 of Taxol & months of Radiation. I continued with Anastrozole until metastasis to the Lungs in Dec 2016. I got sick on a clinical trial and started Exemestane in Feb 2017. In July 2017, progression to bones. That's when I went on F/I. It's been a long journey, but I've had a good life. At 70, I've had a great family, wonderful career & active physical life. I feel blessed, even now, although I am frightened of the future treatment and side effects.

Any help, advise that you can give, is so greatly appreciated.
Thanks,
Syl65

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

    Hi Syl, Yes you have had remarkable responses to therapy so far, and great for you to consider very carefully the next step because you want to continue this winning streak. You progressed to mets in 2016 when you were on exemestane, and yet you still got two good years on Ibrance-Faslodex. Do you know which immunotherapy trial your MO recommended, and why you were not eligible?

    There is general enthusiasm for Xeloda as you can read in the thread here, owing to the relatively few side effects, however if you prefer to continue with the targeted drugs before moving to the chemo train, then there are still other good options you may consider. Will there be a biopsy of the liver mets? Because the cancer mutates when it escapes the I-F treatment, and how it has mutated can determine which drugs you are eligible for. One common way it mutates is through an activating mutation of the PI3K kinase, which can be treated with Alpelisib. Some people from the trials have been able to take it for 2+ years. The drug is not currently available however FDA approval is expected at anytime, so you could try that without entering a trial- you would need a biopsy to show that you have the mutation. There are significant side effects, especially elevated levels of blood sugar, but this is managed by diet and addition of metformin, if necessary.

    Otherwise, in clinical trials you could try out Alisertib, which has also had some responders for 2-3 years, or the immunotherapy Opodivo with EP4 inhibitor, offered at MD Anderson and some places on the east coast, which is a new combination designed to improve response in solid tumors. Kattysmith's cancer is ER-positive and she has responding to that, as you can read about on the clinical trials thread here. There is a trial called MORPHEUS offered at UCSF and some other places that is designed especially for those who are coming directly off of I-F combos, and will test Ipatisertib (PI3K inhibitor) or Entinostat (HDAC inhibitor) in combination with immunotherapy, and there is also a trial testing Abemaciclib (a different, stronger CDK4,6 inhibitor than Ibrance) in combination with immunotherapy. Good luck, and let us know what you find and how you choose, there are many of us also considering what's next!

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

    Cure-ious has given you some good advice. But to answer your question directly, when Fas/Femara/Ibrance failed me I entered a clinical trial of A/A/Ibrance. Ugh. Lasted three months then pneumonitis.

    So next I chose Xeloda. Basically because its oral and the SEs aren't bad. Taxol (which is still in my future) requires three trips a month to the cancer center plus at least an hour in the chair each time. No thank you. Didn't fit my lifestyle. In fact, when Xeloda failed I chose Halaven over Taxol. It's 2/1 instead of 3/1 and only requires 5 minutes in the chair.

    But with Xeloda you aren't tied to anything. You can take it from anywhere. Continue to live your life. Please.

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

    supporting Pajim's experience, a recent retrospective analysis of hospital reccords indicated that AA treatment had on a 4 month PFS (much lower than in the trials) when used on patients who previously had Ibrance, so its up inthe air as to whether AA is much of a good option right after I-F.

    Hopefully we will get an update at ASCO, but last year they reported encouraging results for a Abemaciclib-Keytruda combination for MBC patients treated with two or fewer chemo treatments in the metastatic setting:

    https://www.onclive.com/onclive-tv/dr-tolaney-on-a...


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  • syl65
    syl65 Member Posts: 2
    edited April 2019

    Thank you all for your responses. I was dismissed from a clinical trial with combo Entinostat/Exemestane due to pneumonitis. I had 2 treatments and became horribly sick. In the Phase II of this combo, 1 person was discontinued b/c of pneumonitis. Because of my history of pneumonitis, I do not qualify for the Peppy Clinical Trial with combo Taxol/Pembrolizumab (Keytruda). I’ve read reports of anywhere from 3 to 5% pneumonitis cases in people taking Keytuda. In one study of 5 people 1 died.

    So I’m back to the following - 1) liver met biopsy with foundation one testing; 2) Barring any metabolic change in liver Mets, I must decide between Taxol first or Xeloda. If they are both as effective in shrinking tumors and keeping cancer under control, then I must decide between less freedom (Taxol) & more freedom (Xeloda).

    Right now I’ve received 2 radiation sessions (out of 10) to treat the pelvic & femur bone Mets. I was told to expect a lot of pain at the beginning. Boy! Did I have pain. It is starting to ease up a bit. I’ll check into the other options that Cure-ious noted. Thanks

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  • Bestbird
    Bestbird Member Posts: 2,818
    edited April 2019

    I am sorry to hear you are dealing with a treatment change and hope that whatever you decide will work beautifully!

    First, an observation: with bone mets you should be given a bone directed therapy such as Xgeva or Zometa in addition to your systemic therapy.

    If you possibly can, have your liver tumor tested for ER, PR and HER2 expression since one or more of these may have changed.  And as you mentioned, obtaining a genomic analysis to determine which mutation(s) may exist will be helpful, and also get a BRCA analysis because HER2 negative MBC
    patients in the US with BRCA germline mutations are approved to takeTalazoparib or Olaparib.

    As a next step regarding hormonal treatment, Tamoxifen may be considered since you've been off it for a while and it works differently than an AI (such as exemestane) or a SERD (Faslodex).  

    Cure-ious mentioned Alpelisib, which is a viable consideration if there is a PIK3CA mutation.  Below from my book,
    "The Insider's Guide to Metastatic
    Breast Cancer,"     is an excerpt about it. The book is available in paperback and eBook formats (eBook is free when
    the paperback is ordered) as well as in a complimentary .pdf.      All three versions (paperback, eBook, and .pdf)
    are kept updated and can be procured by visiting the ORDER tab at:  https://www.insidersguidembc.com/



    · 
    Alpelisib (BLY719)     (Available
    in a Managed Access Program):     In the SOLAR-1 Phase 3 clinical trial which compared
    Faslodex plus the targeted therapy Alpelisib (BLY719) versus Faslodex and
    placebo, postmenopausal patients with PIK3CA mutations (found via liquid or
    tumor biopsy) in the Faslodex/Alpelisib arm fared substantially better (median
    PFS 11.0 months) than similar patients in the Faslodex plus placebo arm (median
    PFS 5.7 months). Patients in this trial had received 1 or more lines of prior
    hormonal therapy but no chemotherapy. 
    The results, assessed after a median follow-up of 20 months, translated
    into a 35% reduction in the risk of progression or death in favor of
    Faslodex/Alpelisib arm.      Due to the
    encouraging results of this trial, a new “Managed Access Program”
    (NCT03706573) has been established to allow access to Alpelisib for eligible
    patients diagnosed with HR+ MBC who have a PI3KCA mutation.      From: https://www.targetedonc.com/conference/esmo-2018/solar1-trial-results-demonstrate-a-benefit-for-genomic-testing-in-breast-cancer and https://clinicaltrials.gov/ct2/show/NCT03706573

    As far as chemotherapy is concerned, as others have said, Xeloda tends to be an easier therapy to take and tolerate than IV chemo, and it can be very effective!

    With good wishes.


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