Ibrance (Palbociclib)
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so happy to hear this wonderful news Jen
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Great news Jen!
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Z - I always appreciate your informed posts. Thanks for your generous spirit in sharing your knowledge.
Jen - amazing news, so happy for you!
Lilliemillie, I'm on the same watchlist as you. My scans showed a 6mm change in my liver as well. MO said she's not convinced it's progression and set me up for a follow up scan in 2 months. Good luck Monday.
I was out of town and came home to Atlas Fire in Northern California. My neighborhood was under evacuation advisory, which has just been lifted. Thankfully community had minimal damage and is getting back to normal. Thank God for all first responders!
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Jen, WOW, such great news!!
And Jaylea, thank God your neighborhood was spared. Such a terrifying time for you in California!
Would love to hear about Dianarose-
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Cure-ious - Thanks. I wasn't sure about the relationship between HER2+ and ERBB2. Also, I am confused by what the category "Additional Disease-relevant Genes with No Reportable Alterations Identified" means. I think it means I have "wild type" ERBB2 which is NOT HER2+ ?!? Anyone know what this category is on a foundaiton one report?
In any case, one more reason to get a another biopsy when I get back to determine immuno-histochemistry. PET scan scheduled for a week after I get back and we'll go from there.
Jen - I am so happy that your scan is clear. Congratulations.
>Z<
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My wife (53-yr old) has been on Letrazole with Ibrance for the past 20 months. Diagnosed with ER+ PR+ HER2-negative metastatic breast cancer. After one year, spread to lungs and bones. on the Letrazole/Ibrance combination -Tumor markers went way down into normal range for past 20 months. Recent PET shows no indications any longer in lungs and some lesions in bones are gone. Unfortunately, it show new lesions in spine and bones and appears to be spreading. Tumor marker went up on last bloodwork. Trying to figure out next treatment options. Doctor recommending Fulvestrant and to discontinue Ibrance and Letrozole. What we are still discussing is since Ibrance does not work alone it works in conjunction with hormonal therapy to extend the effectiveness -- why not stay on the Ibrance -- in my mind, there is no way to know that Ibrance is still not working -- it could simply be that the Letrazole stopped working. I also, see there are two new drugs similar to iBrance -- any info on if switching to a different brand of drug would produce a different result would be helpful to combine with the Fulvestrant. Thanks.
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Consultguy, the latest cdk4/6 inhibitor, abemaciclib (verzenio) was in fact tested with fulvestant in the clinical trial,and shown to be effective.
I don't think there is any data yet on whether switching from one cdk4/6 inhibitor (palbo/ibrance) to another resumes effectiveness. The other two cdk4/6 inhibitors, kisquali and verzenio have only been available outside of a clinical trial for a very short time period.
Kisquali is very similar to Ibrance. Verzenio is quite different, and targets cdk 4 16 times more potently than the others, so it is quite different. More effective? Not if you go by the clinical trials, but, it might work differently enough to be effective upon a switch. No one has that tested yet and is a question a lot of us want answered.
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Consultguy, agree with staying on ibrance and adding the faslodex. As for the other two, insurance denied Kisqali for me after ibrance because it is meant to be first line therapy. My onc said some people did benefit from taking K after Ibrance but they would not approve. As for the other one, abemaciclib, that one works by itself in heavily pretreated patients, so I am hoping that will be an option.
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My MO has already told me that if I progress on Ibrance/letrozole, he will switch me to Ibrance/fulvestant.
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Hi Z- I think its always wild-type HER2/ERBB2 in cancer (ie not some mutation), the question is whether the protein is over-expressed (often due to gene amplification) and made it out to the cell surface. Your genetics test probably means you have hi levels of HER2/ERBB2 mRNA, but the question is whether that translates to hi levels of protein- and only immunohistochemistry can tell that. Because there is no specific indications about it on your report, I guess the levels are not high enough to signify high levels of HER2/ERBB2 likely to be found on the cell surface
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Hobbes - had to scroll and find the sewing circle comment. conversation starts top of pg 325 for those wondering..... Augh! What a raw and unemotional human being she must be.
Husband.... this is a thought, you said "I wonder if the letrozole produces the initial results, and the palbo, for some, some secondary action, later?" I was on Femara and Ibrance and now I question which was working on the liver.
Been reading back on several pages..... On TMs - mine was quite perfect and the cancer was raging and trying to suffocate me. Grain of salt now, and when an MO is excited they are low I have to point this out. But I still like to see them. It is a gauge on the dashboard.
I was on Ibrance / Femara for about 4 mo. The liver lesions disappeared. The lymph node masses improved, a base of thyroid cancer node disappeared from SUV. But then about 2 1/2 mo in the lymph node masses took off and tried to kill me (suffocate). So I want to go on the Ibrance for the liver lesions that are now back and w partner, the Xeloda did nothing for them. But I want to remain on the Xeloda since it worked for the lymph node messes.
Has anyone ever heard of toxicity with Ibrance and Xeloda at same time? Or of cycling through one then the other? Asking everywhere someone may know. Thanks.
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thanks for all the support over the sewing circle comments. They beat my husband's " just ignore her" comment.
I have my first scan after starting Ibrance on the 20th so I am anxious. I have had three cycles so far. I had to have the dose reduced to 100 mgs die to low blood values.
I did 22 months on capcitabine (xeloda) after the stage IV diagnosis. It shrank the liver mets considerably but was less effective on the bone mets. I also moved from Saskatchewan to a British Columbia during this time. In Saskatchewan, TMs were not done. I was told that they are unreliable and not recommended by ASCO. In BC they are done monthly and taken seriously. The main side effect of cape was hand foot syndrome which made walking painful at times and fatigue.
I am fatigued on Ibrance too but cannot tell how much is age, disease or treatment. I work out 2/wk for an hour with a personal trainer at a gym and paddle for 2 hours a week with a breast cancer dragon boat team. I did this while on cape too. I am not aware of any studies combining cape and Ibrance.
Jo
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Cure-ious - I've seen foundation on reports with ERBB2 mutations and on those report they include ERBB2 among the actionable mutations and suggest HER2+ drugs and clinical trials. On my report they note the wildtype ERBB2 presence but they don't treat it as something actionable and they don't provide drug suggestions, etc. I don't believe that it is amplified and therefore I don't believe my immuno-histochemistry will show I am positive for HER2-.
That said, I don't know why they report a gene as present ... doesn't everyone have ERBB2?
What would it mean if the genetic test is positive for ERBB2 and immunohistochemistry negative? could HER2+ drugs still be effective?
>Z<
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Good news Jen. Good to hear positive results.
Jaylee, glad the fires didn't reach your home. So tragic for all involved. I loved visiting Sonoma.
Z you really give lots of info and it is great to have access. It helps me frame my questions. My 3 red week on Ibrance. Shots & mo on Friday. TMs rose a little bit. Hope it's a sign they are dying.
Mair
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thanks for all the support over the sewing circle comments. They beat my husband's " just ignore her" comment.
I have my first scan after starting Ibrance on the 20th so I am anxious. I have had three cycles so far. I had to have the dose reduced to 100 mgs die to low blood values.
I did 22 months on capcitabine (xeloda) after the stage IV diagnosis. It shrank the liver mets considerably but was less effective on the bone mets. I also moved from Saskatchewan to a British Columbia during this time. In Saskatchewan, TMs were not done. I was told that they are unreliable and not recommended by ASCO. In BC they are done monthly and taken seriously. The main side effect of cape was hand foot syndrome which made walking painful at times and fatigue.
I am fatigued on Ibrance too but cannot tell how much is age, disease or treatment. I work out 2/wk for an hour with a personal trainer at a gym and paddle for 2 hours a week with a breast cancer dragon boat team. I did this while on cape too. I am not aware of any studies combining cape and Ibrance.
Jo
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Marian.. from Victoria... I live in Casper, WY... (couldn't figure out where to put that in my profile) My daughter lives in Oak Harbor Washington so may be visiting Victoria someday... I see that my reaction to my first dose of Ibrance is very normal and it makes me feel better to chat with others that have experienced these same things. I'm usually so ready to try the next thing.. but this just felt like the beginning of the end to me...but now realize it really means more time...love all the discussion about trials and new studies and new drugs...
But I digress.. so I am on day 7 of my first cycle of Ibrance. Has anyone else experienced hip pain or discomfort.. it may be from the faslodex.. and I may need to get out and walk more.
I'm also worried about the low white counts since I'm a teacher and work at a school... purell is going on my desk I guess
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Frenchhorn654 ....I'm coming to the end of my seventh cycle of Ibrance with Femara. I do have pain in my left hip and have been wondering why so it could possibly be because of Ibrance. I'll also be interested to know if others have the same experience. I'm not sure that walking more will improve it if it's caused by Ibrance but that's entirely your choice. Moving around as much as I can despite my bone mets does help with circulation and therefore stiffness though i'm very limited by the mets.
I have significant fatigue from the last few tablets of the Ibrance cycle for at least two weeks but my neutrophil counts is lowered so much that I need a two week break from Ibrance instead of one week and I've recently been lowered from the 125mgm dose of Ibrance to the 100mgm dose because of Grade 4 Neutropenia.
Not a lot of good news for you in this, I'm sorry, but we're all different and my experience needn't necessarily be yours. Fingers crossed your fatigue won't worry you too much.
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Z- Most HER2 is the wild-type and becomes a problem for cancer when extra copies of the gene arise as a result of the DNA replication errors causeing gene duplication or multiple gene arrays, and the protein is overexpressed. However activating HER2 point mutations have also been found in a smaller number of breast cancers. There's a 2015 study showing that Her2 levels don't track exactly with response to herceptin (ie, higher Her2 does not mean the cancer is more likely to respond to herceptin) so maybe other proteins are also be important in those cancers, but it seems they don't know what they are? Most ER-positive cancers do not over-express HER2, but of course there are some triple positives. In your case the level might be just marginally higher than normal, but not enough to matter for treatment purposes, because, as you say, why would they bother listing it otherwise?
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Leapfrog, not at all... I appreciate you reaching out, my pain is in the left hip too... interesting, my mets are to lung and it's a new pain and so that's why I was curious about the Ibrance.
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Frenchhorn6...I sometimes wake up in the middle of the night with left hip pain. If I get up and walk around the room a bit, it goes away. I do sleep on my left side. I never thought about it being related to Ibrance, but who knows?
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Bluebird: re Palbo plus xeloda. At least they don't use the same liver enzymes. Palbo is cyp3A, and xeloda is cyp2c9 metabolized. They caution with palbo, that strong cyp3a4 inhibitors are to be avoided, as that makes it stronger.
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Bluebird- do you have a PharmD on your team to discuss this with?
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Husband, does this mean that you CAN or CANNOT use Palbo with Xelota? I'm not there yet but am following all of this with great interest. I am a planner and want to be prepared with my own thoughts for my second] MO when progression does occur. I'm on Ibrance + Faslodex as a first treatment. Don't know why [first] MO skipped right to that treatment and hope that that decision hasn't limited my future options.
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I hate asking foolish questions, but what is a PharmD?
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From Wikipedia:
A Doctor of Pharmacy (Pharm.D.; New Latin Pharmaciae Doctor) is a professional doctorate degree in pharmacy. In some countries, it is a first professional degree, and a prerequisite for licensing to exercise the profession of pharmacist.
From OregonState.edu:
The Doctor of Pharmacy degree (often abbreviated Pharm.D. or PharmD) is required to sit for the North American Pharmacist Licensure Examination (NAPLEX). The NAPLEX is one component of the licensure process required to practice as a pharmacist. The Pharm.D. is a professional degree similar to a Doctor of Medicine (MD) or Doctor of Dental Surgery (DDS). As a doctorate, it represents the increasing responsibility pharmacists have in health care systems and the high trust Americans have in pharmacists. After earning a Doctor of Pharmacy degree and passing licensure examinations, College of Pharmacy graduates can practice pharmacy anywhere in the country.
I can Google with the best of them.
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The comparing of cytochrome enzyme pathways and looking for potential interference is just one of the factors that might rule out using them together. All I can say is that cytochrome enzyme interference isn't there, so at least in that respect, one of the major hurdles to compatibility isn't there. I am not a Doctor or pharmacist, and can't give a proper opinion, but checking for cytochrome intereference is something that needs to be done when looking for drug interactions, and at least in that respect, there doesn't appear to be a problem with xeloda plus palbociclib.
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Thanks, Husband and Janet!
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where I am there are 5 PharmDs who work closely with the MOs and calculate doses, discuss side effects, interactions etc. they call re Meds and order the Meds, know your lab etc. they meet with the MOs every morning to discuss cases. They are pharmacology experts.
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At my oncology practice, there is one. She does all the stuff Nkb mentioned. She does a drug education session with you when you start a new drug regimen. She told me not to take Imodium prophylactically at my chemo education session. Only bad advice she ever gave me.
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My daughter is studying to be a Pharm D. She is in a six year program and will graduate with a doctorate in pharmacy. I think all pharmacists need a doctorate now. She wants to work in a hospital setting as part of a treatment team. I think this is a new avenue hospitals are using and it makes sense. She is required to memorize info about hundreds of drugs. And she is required to intern in many different settings. Can you tell I'm a proud mother ?
I get hip pain that is related to faslodex. I'm not sure why but some injections are much worse than others. But, I also have chronic pain in my right hip that I think might be due to cancer. I won't know until the MRI next month.
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