Ibrance (Palbociclib)
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If my platelets are up on Friday I am supposed to be able to start Ibrance. A few days ago my back started to be really painful where the naphostomy tube goes in. Visiting nurse said it is very red around the site. Going to out patient tomorrow to have new tube put in. Will an infection delay my start
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Dianarose~ it all depends on those numbers. I had been coughing and sniffling for the past two weeks and I was worried about starting the ibrance for round five. They were within range and even though I felt under the weather, I went on to take the fifth. As long as you don't have a temperature and the redness isn't too infected, I can't imagine they would want to wait anymore. Just make sure they tell you how to care for it because even if they switch to a new tube irritation still remains. I am praying you will have the numbers you need and finally start the ibrance. I know you have been through the ringer. ~M~0
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micmel- I am wondering if they will start a new site and let that one heal. I have had this dam thing since August. I am so hoping that Ibrance does its thing and I can get rid of i
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Dianarose~ demand a new spot. It is your body. You know best. I just hope you're not in anymore discomfort, you have had quite enough! Maybe antibiotics to make sure that other spot heals. I just don't want any type of infection gaining any traction!!! I think of you everyday and you ladies are always in my prayers. ~M~0
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Robin and Z- i did not know this about PPI and my doctors never said anything to me about it. I was prescribed prisolec by PCP and informed my MO who did not say a word. This will be the 2nd time my Docs did not catch a drug interactions. Thank you very much for posting about it. I am going to follow up.
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Z are we really above average? Or median whatever they want to call it, in regard to months/years without disease progression while taking ibrance and femara? I've been concerned that because of my multiple met locations (lung, chest and liver) that I might be somewhere in the lower half. Since I don't know what their average patient looked like in that study, it's hard for me to understand the results as it relates to me.
I go on March 23 for my 3 month PET. Obviously, I'm having scanxiety. But, I know these results will be very important. I am praying for evidence that meds are working.
I have never heard about PPI's interaction with ibrance, Ill be sure to ask on the 28th when I see MO (yes I have to wait 5 days to find out results of PET).
I'm so glad I have this group to keep my spirits up during the next 2 weeks. I'm gonna need it.
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Grannax - Whenever I read trial results that report a median result for their population, I think of the Prairie Home Companion and Lake Wobegon where all the children are above average. It was a joke, but trial results are always hard to translate to your individual situation. All they are trying to prove in trials is that they can get a certain clinical benefit that will support FDA approval.
The populations in clinical trials do vary from the "general" population, even in Phase III trials for first line treatments. My MO says that she had been getting 2 years+ out of letrozol alone as a first line treatment for ER+PR+, so the trial results that show 14-16 months on letrozol alone suggest that the people in the trial are sicker than the average patient that my onc sees. It would make sense that doctors would suggest trials for their higher risk patients, since we have had a solid first line treatment for ERPR+ cancer for some time.
It makes most sense to ignore the statistics. Multiple met locations is not good, but aggressive cancers can be more responsive to drugs. It probably washes out. I expect you will have a great scan, but nothing but that positive scan result will relieve the stress. I am one of the people who had a very fast response to Ibrance, but remember that Ibrance can take 6-9 months to work. If it has even stopped growth at this point, you are in good shape.
I have no advice for scanxiety as they make me a wreck. It is common to feel this way at scan time. On the edge of our seats for your results.
>Z<
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I spoke to a pharmacist at Prime Therapeutics where I get my Ibrance. She said there was no known interaction with Ibrance and Omeprazole. She said vitamins were ok but not to get into taking herbal supplements as there are no studies. She also said to stay away from St Johnswart because there is a known interaction. Still going to ask my MO on Friday. I like more then one opinion.
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I decided to go to the Ibrance site to look at the information about PPI's. They do say something about PPI's but I was too tired last night to comprehend it. My MO said it was a topic at the Breast Cancer Conference in Miami, that MO's need to warn their patients! I'm going to take the warning seriously and take pepcid AC as suggested. If I can copy and paste the info on Ibrance site I will do that. I have a Macbook and still after 5 years of use...trying to figure this computer out!!!
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Regarding PPI's --- This is straight from the Ibrance website under full perscribing information.
Gastric pH elevating medications: In a drug interaction trial in healthy subjects, coadministration of a single 125mg dose of IBRANCE with multiple doses of the proton pump inhibitor (PPI) rebeprazole under fed conditions decrease palbociclib C-max by 41%, but had limited impact on AUC(under the curve) 13% decrease when compared to a single dose of IBRANCE administered alone.
I then called Phizer to make sure that the information I was passing on to everyone was correct. The agent I spoke with said "the absorption of IBRANCE is lowered when taking PPI's."
I think if our MO's are going to prescribe a drug, they should read the drug prescribing information. But since they do NOT, going forward I will read through the lengthy small type to get this valuable information myself!!! If anything I am taking lowers the absorption of my important drugs for my disease, then I want to know about it.
If you want to read the entire paragraph regarding PPI's, go to the Phizer website and click on full prescribing information and scroll down to Gastric pH elevation medications, and you can read the entire paragraph.
Hope everyone is having a great day!!!
Robin
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Rpoole- thanks for sharing the information.
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Thanks to all for the info on PPI, and welcome to the new guys... I'm 71 and very hopeful, feel very informed because of you guys. Read up on the new approved(!) kisser drug and will stay with ibrance for a while.... There's another few in the works that might be more promising... Just on week 1of my second round and feeling great. Had dehydration headaches the first round even with 1/2 gallon h2o/day. This time don't wake up with a headache and have not had any other see! Off to Disneyland next week with grandkids.....
Think of you all often... You're all in my prayers
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Robin, I read the same thing as you in the pamphlet for Ibrance. I then called the pharmacist at the specialty CVS which handles my Ibrance and she told me there was a moderate interaction. I asked why this was not caught as I have been prescribed prisolec for the past two months. She told me they only notify if it is a severe interaction. Seriously??? You have got to be kidding me! I think she got nervous that they did something wrong and was just covering herself. As I said earlier this is the 2nd drug interaction that neither the pharmacy or MO caught.
Thank you again for posting this Robin!!
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singlemom, the specialty pharmacy where I get my Ibrance asked me what medications I take. I mentioned omeprazole and he said all my meds were good. It amazes me how little some people know and will just say anything! It just shows that even the pharmacists have not read the Ibrance information. A moderate interaction??? Seriously!!! I don't call decreases in the drug absorption moderate when it relates to cancer treatment!! I am always my own advocate, so I feel I let myself down by not reading the prescribing information in full. I only hit the high points and trusted the MO and Pharmacist!! Shame on me!! I knew better than that! Never again.....lesson learned!!
The funny thing is.....My MO would have never mentioned this if I had not complained about my heartburn yesterday!!!!
Robin
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these drug interaction studies are all pretty underpowered. But 41% decrease in cmax is a hit and that will vary so some people will see a greater reduction in effective dose.
I don't get overly concerned about interactions and I take a huge number of supplements but I would avoid ppis.
Nice work Robin... you are so on top of things.
Z
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If you really need the PPI's you have to weigh the moderate interaction with the need for them; so, I understand them not flagging it when it was a moderate interaction. I desperately need the PPI's as I've had Barrett's esophagus (stage 0 for esophageal cancer) along with such inflamed vocal cords that I had difficulty talking and had a major surgery to try to correct it. The surgery worked for 20 years, but things have slowly opened up and I require the meds again. If you just had minor heartburn then you might be able to go off them, but I can't without huge problems, and another surgery for the reflux is not an option bc of the stress that can have on the body and cancer. The other types of meds don't work for mine. Anyway that is long winded just to say that I understand the side of the pharmacist in a moderate reaction.
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I have read that Ibrance can really lower platelets. Has anyone experienced this? I have been waiting weeks for my platelets to be high enough to start so I am ner
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DianaRose - It seems to lower platelets in 61% of the people in this study, but very few severe reactions.
I honestly did not know that there was a minimum platelet requirement for Ibrance.
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Hello Dianarose,
My platelets have dipped down to 66,000 and 67,000 (labs drawn Cycle 1 and 2 on day 26, 27 respectively). I am on Ibrance 125 and Letrozole.
By 1st week of cycle 2 and 3, platelets have recovered to low normal range.
Sandi
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Amen to Judy & Z. I haven't posted for quite a while. I am doing fine, just finished cycle 5. Crazy busy at work. Exhausted. Have an appt. next week with MO and may ask about ritalin. As someone (forgive me for not remembering who) suggested a few months ago, I am now taking the Ibrance in the evening with dinner and I sleep through most of the nausea. I have to say that I really appreciate the discussion about - what next? - and the clinicial trials and the latest research. It helps allay some of the feeling that taking ibrance means waiting around for the next big thing. And, having someone to talk to or listen to means we are not alone.
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my platelets has dropped to 37 back in November and my other red counts were crazy too. They didn't think I would live through the weekend. Three weeks ago back down from normal to 56. MO thinks the cancer is causing it so I have been doing more weekly infusions of A/C to try to get things under control. I cut myself today and didn't bleed long so I am taking that as a good sign. I had five blood transfusions back in November too. Don't want to have to repeat that.
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Dianarose- i am so sorry you are going through this and hope you receive health stability soon!
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Just spoke with my MO and it appears the Ibrance is not working. I take my last pill tonight to finish my fourth round. The PET I had done Tuesday shows extensive progression of the bone mets. She was telling me all of the new areas where the bone progression occurred and I couldn't keep up writing them down.
I have been having severe back pain and spasms this past week, so I will see the Radiologist in the morning for a consult. I think it's time to zap a few of those spinal mets.
I have an appointment with my MO already for next Wednesday so she said she will review everything and we'll discuss the new plan then. Any ideas what might be next ladies???? I had so hoped to get some quality time with the Ibrance and Femara as I have responded so well to all of my past treatments, and just had 5 years on Faslodex before progression last November.
I'm so bummed.........
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Susan, that is hard to hear, especially after five years on Faslodex. With such an extensive progression, will they try to biopsy to see if it is still ER+? If it is they might give you Aromasin + Afinitor.
Dianarose, I would want to talk to the onc about what treatments would be best with low platelets. Mine were low on Ibrance.
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Susan, I am sending you a big hug and will be praying that your next plan will give you your next five years. I hope you will get another biopsy in case something has changed. My cancer has been all of the following at one time or another: ER-PR-, ER+PR+HER2+, and the latest ER+PR+HER2-. Yours also could have morphed, leaving you open to different treatments. That is my prayer for you today, friend.
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Susan -
I am sorry you are dealing with this news. The question in my mind is whether you have become resistant to hormonals. You may want to check for the ESR1 genetic mutation. I have become wary of genetic testing generally, but that particular mutation seems to predict people who will no longer respond to hormonal treatment. If so the whole hormonal sequence is past for the moment, then you are on to Xeloda and the easy chemos or trials.
If you and your doctor think that you might still respond to hormonals, then you do want to stay on them as long as you can. Here is the hormonal therapy sequence for ER+ cancer from BestBirds MBC guide which everyone should request and read.
- First line treatment may consist of a combination of either Arimidex and Faslodex (500mg), or Letrozole and IBRANCE
- Second-line treatment might be a combination of either Faslodex (500mg) and IBRANCE, or Aromasin and Afinitor.
- Third line treatment could be Tamoxifen and Afinitor
- Fourth line treatment, which is a single agent, may be either Toremifene (Fareston), Estradiol, Megestrol Acetate (Megace), or Halotestin (Fluoxymesterone)
If you and your onc think you are have not become resistant to hormone therapy, then I think this trial may be of interest because I am not sure that Ibrance failed in your case.
Ribociclib, exemestane, everolimus clinicial trial
Letrozol is not usually used after faslodex because it's a weaker drug in some sense. Faslodex destroys the estrogen receptors, so if the cancer has damaged estrogen receptors but it is still growing... then why would estrogen suppression help? Ibrance doesn't work as a singlet therapy. Hormone therapy has to be working to get the extra boost from Ibrance. So I suspect the hormone therapy (letrozol) failed, not ibrance.
Exemestane is the drug that normally follows faslodex in the hormonal sequence. RIbociclib is a CDK 4/6 inhibitor that is pretty much the same as Ibrance. Exemestane is normally combined with affinitor/everolimus for a doublet therapy as a third line hormonal treatment. In the trial referenced above, they add ribociclib to this standard third line hormonal treatment in hopes of getting an extra boost. Many people are doing well on it.
Lots of options. Let us know how your discussion with the oncologist goes.
>Z<
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I had my naphostomy tube changed out today . Painful experience as The scrubbed the infected area with alcohol followed by several shots. On a strong dose of antibiotics for two weeks. They will change it our again in 8 weeks . He put dye in to see if it would pass through the urerter but did not work. I go to cancer center tomorrow and pray my platelets are up so I can start Ibrance. The thought of never getting rid of this dam pee bag strapped to my leg is depressing. Doesn't have much sex appeal
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Dianarose, I'm so sorry for all you're going through. Sending prayers that your platelets are good tomorrow and healing can begin.
Faith(in the future)
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Dianarose~ you amaze me. Here you are sharing this with us all. I am glad you got some good antibiotics and hopefully that will alleviate some discomfort in that area. I've had a yucky day also. Lymphedema screaming at me and a day of what I call tumor flare. Where the pain is able to be felt. Hopefully that is the medicine kicking butt! I will keep you in my prayers that you will be able to begin the ibrance ! Let's stay strong together. Because we have no choice!,And as far as sex appeal. Being courageous is pretty darn sexy if you ask me!!
Rest well ladies. ~M~
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Susan~ sending prayers and hugs of strength and hope, that you will find your next treatment that will make another difference for you. They will find something!! You ladies are amazing to share all of this with us. It's such support to see all the shared information and kindness.
Bless you all. ~M~0
