just reporting on my MO visit and my stable scans. Thank you, faslodex. I was his healthiest patient all day.

All we really talked about was stopping the xgeva cause my jaw lit up on bone scan. Had one root canal monday and another 1 tomorrow. Some antibiotics and Dr and oral surgeon thinks it'll pass. I thought he might switch me to tamoxifen for a while. I should have asked. I think I will send a message about that.

Best of luck to you with Faslodex. It's been crazy easy for me.

Update on jaw. I never got the 2nd root canal it was the first endodontist I went to and she refused cause she hadnt gotten a letter of referral from oncologist. So back to first guy. He believes tooth 18 needs it more than tooth 29. Um yes, it's been a bit sore there too. So is that the kind of work that should be fine before starting xgeva? He says yes. Other dentist says no. I'm Going with yes. If this jaw heals I may well go back on xgeva tho maybe at a reduced rate. Jaw feeling much better since root canal 2 weeks ago.

I’m reading here too, and will have my first injections next week. Thanks to everyone on this thread for helping us newbies learn from your experiences

I had my first set of shots today. Silly me thought I’d be in and out since the shots were pretty quick. There was a lot of waiting and more introductory stuff than I expected, including labs. Anyway, I had both shots at the same time, like ilowen. One of the nurses said her special trick was telling people to stand pigeon toed because you can’t tense your butt muscles in that position. We’ll see how the soreness is tomorrow.

Well, I don't know if standing pigeon toed helped or not but neither shot hurt this time! Yay! Last time the second one did....ouch...

It also helped that the nurse this time was a very handsome, friendly fellow from the Caribbean with a beautiful island accent. I could have sat in there all day chatting with him. Lol.

I’m not sure if the pigeon toed feet did anything to help, but I didn’t have any serious pain with the shots. It was a new experience having the “perm solution” pee smell for a couple days. I even thought I smelled it on myself in bed the first night and asked DH and he laughed about the perm solution description and said, yes, it was there. (I believe I read that from someone on this thread.

I told my oncology nurses that my pee smelled like diesel or some kind of petroleum product and they said that they never have heard of that. I believe them. I told them their other patients probably never said anything because they have better manners than to talk about their pee.

I lookedit up and from the inactive ingredients, you can see why it smells:

Each injection contains as inactive ingredients: 10% w/v Alcohol, USP, 10% w/v Benzyl Alcohol, NF, and 15% w/v Benzyl Benzoate, USP, as co-solvents, and made up to 100% w/v with Castor Oil, USP as a co-solvent and release rate modifier.

GoKale,

Re: the facial numbness: Do you have a Primary Care Provider? These generalists have a wider grasp than oncologists of the everyday/weird ailments that can afflict us. Tell your MO, by all means, but I would expect him/her to be more knowledgeable abut SOB on exertion.

Tina

GoKale,

Your MO sounds like he is paying attention. Getting test results and putting a a plan in place is a good way to start the new year.

I wish you all the best.

Tina

Hi, Rosie24. I'm on Faslodex and Xeloda, so I'm not sure which, if any, caused it, but both of my liver enzymes were high last month for the first time. I have to say I did have alcohol just prior to the testing, so I have not had anything to drink since last week. I am going to see if that makes a difference. I can let you know what happens after my next visit, which is this Monday, the 10th. I usually get the results the next day.

I can't help with your second question. I have chronic low back and hip pain, but it worsens for me because I sit on a hard floor playing with my grandson all day a few days a week. I know exactly where mine is coming from.

Rosie24, please keep me posted as well

cowgal, the oral form is supposed to be coming out this year. Let’s all hope. I’ve only been on it since September 20th. I’ll take oral over injections. My fingers are crossed that it’s soon

I believe the oral SERD is an oral form that is similar to Faslodex. There is someone in my Zoom meetings on Monday who has been in a clinical trial of the oral SERD, which didn't have a name. I will ask her on Monday. I'm so new to Faslodex, I might be wrong. I'll let you know.

edited to add I did find this. It was from March of last year.

https://www.clinicaltrialsarena.com/comment/sanofis-astrazenecas-and-radius-oral-serds-could-establish-clinical-worth-in-er-breast-cancer-by-showing-similar-efficacy-to-faslodex-experts-say/

Fanny Pack,

"Elacestrant" is the new SERD. I have been interested since first learning about it from my oncologist. I feel, as Cowgal does, that fulvestrant/Faslodex injections have exacerbated my arthritis, causing considerable pain in my back, hips and legs, and affecting my mobility.

This was published last month by the American Association of Cancer Research:

Elacestrant May Improve Outcomes for Patients Whose Metastatic Breast Cancers Progressed on Prior Endocrine Therapy

Elacestrant is the first oral selective estrogen receptor degrader to show clinical benefit over standard of care in a phase III clinical trial for this patient population

SAN ANTONIO – The investigational oral selective estrogen receptor degrader (SERD) elacestrant significantly decreased the risk of death or disease progression and increased progression-free survival compared with standard-of-care endocrine therapy for postmenopausal patients with estrogen receptor (ER)-positive/HER2-negative metastatic breast cancers that progressed on prior endocrine and targeted therapies, according to results from the phase III EMERALD trial, which were presented at the San Antonio Breast Cancer Symposium, held December 7-10, 2021.

Patients with metastatic ER-positive breast cancer are typically treated with endocrine therapy, such as aromatase inhibitors or fulvestrant (Faslodex); however, resistance to these treatments commonly develops, in some cases due to mutation of the ESR1 gene. Fulvestrant, which is delivered through intramuscular injections, is currently the only SERD approved for patients with breast cancer.

"There is an urgent unmet need for alternative SERDs that are effective against ER-positive metastatic breast cancer, including those with ESR1 mutations," said Aditya Bardia, MD, MPH, director of the breast cancer research program at Mass General Cancer Center, and associate professor at Harvard Medical School.

Elacestrant is an investigational SERD that, unlike fulvestrant, is administered orally. Bardia explained that elacestrant has greater absorption, improved pharmokinetics, and enhanced inhibition of ER compared with fulvestrant. In addition, elacestrant has demonstrated greater antitumor activity in mouse xenograft models of ER-positive breast cancer. A phase I clinical trial found that elacestrant treatment had an acceptable safety profile and led to responses in heavily pretreated postmenopausal patients with ER-positive/HER2-negative metastatic breast cancer.

To understand how elacestrant compares to the current standard –of care, Bardia and colleagues initiated the phase III EMERALD trial, making elacestrant the first oral SERD to be studied in a randomized phase III clinical trial.

The trial enrolled 477 postmenopausal patients with ER-positive/HER2-negative metastatic breast cancer who had received one or two prior lines of endocrine therapy without chemotherapy in the metastatic setting, and who had progressed on prior treatment with a CDK4/6 inhibitor. Patients were randomly assigned to receive either elacestrant or standard of care (investigator's choice of fulvestrant or an aromatase inhibitor). Among the enrolled patients, 228 had tumors with mutated ESR1 (115 in elacestrant arm and 113 in standard-of-care arm).

Bardia and colleagues found that patients in the elacestrant arm had a 30 percent lower risk of death or disease progression compared with those in the standard-of-care arm. Among patients whose tumors had ESR1 mutations, those in the elacestrant arm had a 45 percent reduced risk of death or disease progression. Subgroup analyses showed that elacestrant improved outcomes regardless of the presence of visceral metastases, the number of prior lines of therapy, pretreatment with fulvestrant, or geographic region.

At 12 months, patients in the elacestrant arm had a significantly higher rate of progression-free survival than those who received the standard of care (22.32 percent vs. 9.42). Among patients with ESR1-mutated tumors, 26.76 percent of those treated with elacestrant had progression-free survival at 12 months compared with 8.19 percent of patients treated with standard of care. An interim analysis of overall survival showed a trend in favor of elacestrant, including in patients with ESR1-mutated tumors, according to Bardia.

Certain grade 1 or 2 treatment-related adverse events were more common among patients treated with elacestrant compared with standard of care, including nausea (25.3 percent vs. 8.7 percent), vomiting (11 percent vs. 2.6 percent), and fatigue (11 percent vs 7.9 percent). Grade 3 or higher treatment-related adverse events were observed among 7.2 percent of patients in the elacestrant arm and 3.1 percent of those in the standard-of-care arm. There were no treatment-related deaths in either arm.

"Elacestrant is the first oral SERD to demonstrate a statistically significant and clinically meaningful improvement of progression-free survival in patients with ER-positive/HER2-negative metastatic breast cancer in the second- and third-line settings, including for patients whose tumors harbor ESR1 mutations," said Bardia. "Elacestrant was well tolerated with manageable and reversible side effects. This therapy has the potential to become the new standard of care for patients with this cancer."

Bardia noted that future studies will aim to understand the efficacy of elacestrant during earlier lines of treatment and in combination with other therapies. A planned phase II trial will examine the impact of elacestrant in combination with abemaciclib specifically for patients with brain metastases.

A limitation of this study was that all enrolled patients had received prior treatment with a CDK4/6 inhibitor; thus, the efficacy of elacestrant in patients without prior CDK4/6 inhibitor treatment remains unknown.

The study was supported by Radius Health. Bardia has served as a consultant or on an advisory board for Radius Health, Pfizer, Novartis, Genentech, Merck, Immunomedics/Gilead Sciences, Sanofi, Daiichi Sankyo/Astra Zeneca, Phillips, Eli Lilly and Company, and Foundation Medicine. He has conducted contracted research or received grants from Genentech, Novartis, Pfizer, Merck, Sanofi, Radius Health, Immunomedics/Gilead, Daiichi Sankyo/Astra Zeneca, Natera Inc., and Eli Lilly and Company.

Oral sure would be nice though. No more butt shots? Sign me up!!