Ibrance (Palbociclib)
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Hi Leapfrog , I am so happy for you, that dispide feeling pain and fatigue , you have stable deseas. Do you know the reason the Australia government turn the Ibrance down? Is it money?....I hope, soon a new medicin will be discovered that will stop the Monster and we all go back to our old good lives.
My love and hugs to y
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Blueshine, before you order the NAC, better go back and read through the string. I, too, ordered it but am not going to take it for now. Some very reasonable concerns were raised by some of the more knowledgeable among us.
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Good Morning (here in Las Vegas anyway) All...
I have a question for any of you regarding bone met pain. I have mets to my spine and ribs in multiple places and femur/hip, as well as some in my skull. I only have pain from the mets to one area of my spine but at times, it's almost debilitating. I have a very high pain threshold so I put up with it without medicatiion 98% of the time. My MO has prescribed oxycodone 5mg every 6 hours. Because I have two liver mets, he has told me not to take any pain relievers with acetaminophen or ibuprofen. I do not want to get back on the oxy merry-go-round again (landed me in the hospital previously, and, no, I'm not worried about addiction) so I only take one before I go golfing on Thursdays. I only get about an hours worth of relief from taking that one oxy and it does not make me dizzy or feel like I should crawl into bed. My question is: do any of you take anything different than oxy for pain that does not wipe you out but actually relieves the pain for more than an hour?
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Gadzooks Wallaby, sorry to hear about the pain. When I am in pain they let me have Tramadol, I don't know how that relates to oxycodone,
Ladies, what gives ? I'm on week two of my second cycle. I certainly feel like crawling into bed and staying there. Whether it is related to Ibrance, or to something else I don't know. I could sleep for ever, but I force myself to get up once in a while. I have a concert to sing on Sunday, and feel like canceling. So tired, I feel half dead.
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I just started cycle 5 of the Ibrance/Femara duo, and my recent scans show disease is stable. I love hearing about those of you in the dozens. I lost about 10 pounds pre-diagnosis, gained back 5. I take that as a good omen, that my body has the upper hand over the cancer at present. Tanya, yes, I had terrible SOB prior to tx, then it resolved, but now on cycle 5 it has somewhat returned. I notice it when I first get up and during my morning walks, but it's not debilitating.
Schoolmom, welcome. I didn't have strong bone pain, but severe exhaustion, SOB, and cough. I noticed immediate relief on all fronts even on the Femara, I'm talking within 4 days. It took another month to clear the path for Ibrance, and after a couple of cycles the pressure I felt in my sternum flared, then started to resolve. Now, mostly gone, although I get twinges of occasional pain in various spots.
Cure-ious, very, very good news, good on ya!
I'm heading up to the snow tomorrow. I was surprised that my MO cleared me for skiing. The snow isn't great, but I'm not a great skier, so we're a match. This will be a test to see if I'm up for it, stamina- and lung-capacity-wise. I hate that my mind goes there, but of course am thinking this might be my last season (not on earth, just for skiing), so trying to make the most of it!
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I had 1st Faslodex injections Friday and have gone from growing discomfort to barely able to walk and bear weight in 6 days on left leg. Sitting and laying,g down fine, just walking. I think they hit sciatic nerve.
Dr office wanted to give me Tylenol codeine but I had allergic reaction to it after gall bladder surgery. Taking Alleve, Tylenol extra strength and heating pad with minimal relief.
I see oncologist tomorrow. Any ideas?
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Schoolmom: I just had my third set of Faslodex injections last Friday, Dec. 1st. The only thing I notice besides the soreness at the injection site is a slight aching in my left hip for about two days afterwards. It does go away and is mostly an annoyance. My injections are given high up on my hips where the fat pads are...LOL! Sorry to hear you are having a bad time with it.
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Thanks Amarantha. I have not ever taken Tramadol. I'll see what next month brings as I am changing oncos back to my original onco with a change in insurance. Maybe she will have some other ideas.
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I was on Tramadol when I had an infected tissue expander, and found it helpful. I tried it again when I had severe pain in my hip. It didn't help then. I went back to the gym, where they did myofacial releases and that relieved the pain after a few days, so the pain must have been muscular as myofacial releases would not help with bone pain. What I liked about Tramadol is that it didn't make my nauseous the way morphine and hydro morph do. Only people with certain genetic profiles respond to the pain relieving aspect of Tramadol so its hard to know if you will respond without trying it. It is not used such in British Columbia where I live as its not on the provincial formulary and therefore you pay for the full price of the drug.
Jo
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Here is an interesting article on Tramadol for a major national Canadian paper. It explains why only some people benefit from Tramadol Jo
Sorry for the gaps. I couldn't cut them out.
David Juurlink is the head of the Division of Clinical Pharmacology and Toxicology, Department of Medicine, at the University of Toronto.
The patient was a man in his early 60s. A year and a half before we met, he was in a surgeon's office seeking treatment for a painful shoulder. "We could try some Percocet," the surgeon said. Wary of opioids, the patient demurred. The surgeon understood his reservations and instead prescribed tramadol, a drug the patient had never heard of. It seemed to help.
The first sign of trouble arose three months later. His shoulder pain gone, the patient assumed he no longer needed tramadol. He was wrong. Shortly after stopping it, he developed debilitating insomnia, shakes and back pain – something he'd never experienced before. Irritable, exhausted and functioning poorly at work, he soon found the solution: All he needed to do was keep taking tramadol, and these problems went away.
In hindsight, what happened to my patient is clear. His body became accustomed to the presence of tramadol. Without it, he became sick; with it, he felt well again. Put bluntly, he no longer needed tramadol for pain; he needed it simply because he'd been taking it. This phenomenon is known as physical dependence and it's distinct from addiction, which includes behavioural elements and harm despite continued drug use.
In some ways, this man's story is unexceptional. Millions of North Americans are physically dependent on drugs prescribed for pain, anxiety and depression. When the drugs are tapered too quickly, withdrawal symptoms ensue, but they resolve with continued treatment. It's not hard to see how this can sometimes fuel the perception that a drug is effective or even essential, even when it's not really helping.
What led the surgeon to view tramadol as a safer option isn't clear, but there's a good chance that a decade-old misstep by Health Canada helped influence his thinking. To appreciate the misstep, it's necessary to first understand the drug.
Tramadol is a synthetic painkiller developed in the 1960s. In the body, it increases serotonin levels in much the same way antidepressants do. This contributes to its analgesic effect. In the liver, tramadol is converted to a different compound called M1, an opioid that relieves pain the same way morphine does. In a sense, tramadol is two drugs in one, and this "dual mechanism of action" has helped companies promote it to doctors wanting to help patients in pain.
But there's a catch: The conversion of tramadol (the antidepressant) to M1 (the opioid) varies tremendously from person to person. About 6 per cent to 7 per cent of Caucasians lack the enzyme completely, deriving none of the opioid effects, while in other patients the conversion is highly efficient. Roughly a third of people of East African or Middle Eastern descent, for example, convert tramadol to M1 readily.
The practical implication of this variability is that when a doctor prescribes tramadol, he or she rolls the dice, not knowing whether the patient will get a bit of opioid, a lot of opioid or none at all. In the patient-level experiment that is pain management, a key goal is to find a medication that works and is well-tolerated. Tramadol adds needless uncertainty to this experiment.
Fully aware of tramadol's pharmacology, in 2007 Health Canada announced it was considering "scheduling" tramadol as a controlled drug, like codeine, morphine and every other opioid in clinical use. It then sought input from stakeholders and, in doing so, was quickly lobbied by tramadol manufacturers and at least one patient advocacy group supported financially by these same companies. The lobbying seems to have worked: Ten years later, tramadol is nowhere to be found in the Controlled Drugs and Substances Act; in Canada, it enjoys more or less the same legal status as drugs for hypertension.
It's not hard to see why tramadol's preferential classification might lead a doctor to perceive it as safer than, say, Percocet.To its credit, Health Canada is now revisiting its 2007 decision. Placing tramadol where it belongs – in Schedule 1 of the Controlled Drugs and Substances Act – won't solve the opioid crisis. What the larger crisis demands is a massive federal and provincial investment in addiction treatment, more cautious opioid prescribing by doctors and a frank governmental rethink of whether it makes sense to put people in jail for something that is fundamentally a health issue. (It doesn't.) But classifying tramadol as its pharmacology demands will help dispel the perception that it's somehow safer than other opioids. This is Health Canada's opportunity to correct an old mistake and put the health of Canadians ahead of commercial interests.
My patient, I am pleased to report, is doing well. With the help of his pharmacy, we've tapered his daily tramadol dose from 150 milligrams down to 60, dropping by five milligrams every week. Going slowly has meant no insomnia, no back pain and no irritability. He'll take his last dose of tramadol in 2018
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great news cure-ious!!!
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Tramadol mixed with Paracetamol is even more helpful. I took Tramadol 100mg with Paracetamol morning and night for a month following my pneumonia episode (extreme pain in ribs from violent coughing) - and when I went off it, absolutely nothing happened, no bad reaction at all. That actually surprised me. In France it is available by prescription and reimbursed by the sécurité sociale.
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Paracetamol is acetaminophen (generic Tylenol). Here in the US, Tramadol with acetaminophen is called Ultracet.
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Is paracetamol the same exactly as acetaminophen ? Oh yes indeed ! I see it is, just looked it up. I always thought it was a different molecule. Thanks for that !
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Amarantha, Hobbes12 and Ciaci: You all know waaaay more than I do about these drugs! I would think paracetamol would be out as my MO doesn't want me to take anything that will make my liver work harder, and, I do have to admit, since I have not been taking anything with acetaminophen I have much less tenderness there. The description of Tramadol working as an antidepressant prior to being converted to M1 is interesting. A double whammy for some people. I'll see what comes up when I change MOs in January. Thanks for all your insight. Cindy
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Thanks Hobbes for the tramadol article. I was prescribed it and only took one so far. It acted much the way Percocet does. The pain was relieved but I couldn’t sleep all night. Guess I’m an outlier. I am on antidepressants so maybe that exacerbated the tramadol. Trying to uses Aleve now. Advil not much help. I’ll have to talk to the NP who prescribed it. I need to ask more questions about meds. Maire
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I just read on a British website that Pfizer, who markets Ibrance and Novartis who markets kitsquali have jointly agreed to lower their price to $3000 US per 28 day cycle. The National Institute for Clinical Excellence (NICE) refused to fund it at the initial price in February 2017, but has accepted this lower price. That about 1/3 of the US price. However it will only be available as a first line treatment for Stage 4. Women who have had previous treatment for Stage 4 will not get the drug. No doubt, the pan Canadian Pharmacutical Alliance (pCPA) will use this as leverage in their negotiations for a Canadian price.
Jo
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That's very interesting about the deal on the price Hobbes12. Have you heard anything about abemaciclib and when it will be made available in Canada?
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I just checked the pCODR website. It doesn’t show up in the queue, suggesting that the manufacturer had not applied for a review. In Canada, the manufacturer must apply to Health Canada for “a notice of compliance”. An NOC is granted if HC agrees the drug is safe and effective. The manufacturer can apply for a cost effectiveness review by pCODR at the same time, but pCODR will not review the drug until the NOC. Is granted. However, the prep work can be done. Both processes can take 6 to 12 months. pCODR is generally quicker. If and when pCODR recommends funding the drug, the provinces begin negotiations withe the manufacturer for a Canadian price. This is what pCPA does. They have been in negotiations with Pfizer for a price for Ibrance for over a year. There is a blackout on these negotiations so no one knows where the process is now.
I don’t know how to find out if the manufacturer has applied for an NOC for ahemaciclib, which is the first step in this process. You could try asking the manufacturer.
Bottom line is that funding for abemaciclib is likely several years away, as it has to enter the pCODR queue, be reviewed, get a positive recommendation, and then enter funding negotiations. We like complexity in Canada!
Jo
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hobbes that is very frustrating when so many people are likely running out of time.
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Canada represents 2% of the global market for drugs. As a result, manufactures are slower to apply for regulatory and funding approval than in the bigger markets, like the US, the EU, and Japan.
Here is an interesting article of the money that Pfizer has made on Ibrance.
The breast cancer medication Ibrance has been the shooting star in Pfizer's universe, and it's expected to burn brightly enough to raise the entire company's fortunes.
That's despite Ibrance's competition from newcomer Kisqali, a Novartis drug, and the forthcoming Lilly med abemaciclib. Or so says Morgan Stanley analyst David Risinger, who put out a research note this week saying the Pfizer med has advantages over its new competitors, even beyond its first-to-market status.
"Ibrance is Pfizer's No. 1 growth driver," Risinger wrote in an investor note. "Now that the competing CDK4/6 profiles are clear, we expect Ibrance to maintain its first-to-market advantage."
That's partly because of safety checks and known side effects. Novartis' Kisqali launch has been slow so far, because of requirements that doctors monitor cardiac and liver function, Risinger wrote in an investor note. And new data from Eli Lilly showing abemaciclib's elevated diarrhea risk won't help that drug either, he said.
RELATED: The top 15 best-selling cancer drugs in 2022 - Ibrance
Side effects are an issue for all three drugs; Kisqali and Ibrance each carry warnings of neutropenia, requiring regular blood counts. Kisquali is also tagged with a heart rhythm risk and liver toxicity, though, and patients are advised to undergo testing for both ahead of treatment and during it, too. Abemaciclib has been associated with severe diarrhea—which Lilly says is treatable, and subsides as treatment continues—and Risinger expects the med's final label to flag a risk of blood clots. (Ibrance had one initially, but it was removed in March.)
And then there are Ibrance's other market prospects. Expectations of sales overseas should be higher, the analyst figures, given the history of breast cancer therapies and their success outside the U.S. Plus, results of a phase 3 Ibrance trial in patients undergoing surgery are due in 2020, and if that succeeds, Risinger figures the Pfizer drug can rule that category of treatment—and it's an $8 billion market.
RELATED: Pfizer bows first Ibrance TV spot as Novartis revs up with rival breast cancer med Kisqali
"Most importantly, we believe Ibrance's clean profile positions it to garner the most share in adjuvant breast cancer," he wrote.
Pfizer executives were feeling upbeat about Ibrance in the wake of Kisqali's launch earlier this year. While it's "a little bit early to comment" on the rollout, "so far we have seen a minimal uptake of this product," Pfizer's Innovative Health President Albert Bourla told investors in early August.
Ibrance is certainly expected to pump up Pfizer's top line for the rest of this year and beyond, particularly if it hits Morgan Stanley's optimistic benchmarks. The firm sees $939 million in sales for the third quarter and a touch over $1 billion in the fourth, leading to $3.5 billion for the full year. Next year? $4.85 billion, a full 15% above consensus estimates. Pfizer will be pleased if those predictions come true.
RELATED: New Novartis rival Kisqali hasn't slowed down Pfizer's Ibrance—at least not yet
But another Pfizer observation could bode well for all three meds in the class. The CDK 4/6 share in breast cancer is growing overall as Novartis rolls out its med, Bourla said, expanding to about 57% from 50% by the end of Q2. That's an sign "the Kisqali introduction could potentially grow the total market."
"As you know, only 50% of the patients that could receive benefits from CDK treatments are now under a CDK program," he reminded investors. So there could be room for all three to make a splash—even if Pfizer's ends up bigger than the rest.
- Dec 06, 2017
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Hi everyone! Nice to hear from you all. I haven't been much around, life's been busy and I'm still dealing with side effects, this time from radiotherapy it seems. My whole body itches (not just the exposed areas), we're not sure what's causing it but it's kept me awake a couple of nights. One of my doctors said to stop all my medication until monday and see what happens. I also have swollen feet which they assume is either from not having enough protein or because of damaged lymph nodes during radiotherapy.
I hope you're all doing better, much love.
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Hobbes - thanks for the information regarding the top 3 CDK4/6 inhibitors (Ibrance, Kisqali and Abemaciclib). What's interesting is that all three, although targeting CDK 4/6, work a little differently and have different side effects (as your post noted). So they really aren't interchangeable and using one does not preclude the use of others after progression. Ibrance may enjoy the "first to market advantage" and it certainly came out of the gate as the latest and greatest with high expectations for its long term efficacy, but for those of us for which it failed we are grateful that Kisqali and Abemaciclib came around the corner quickly. These drugs aren't like Coke, Pepsi and RC Cola. They really shouldn't be competing with each other. We can't afford for one to outsell the others at the risk of putting the others out of business. It is important to have as many options as possible in our arsenal.
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Hobbes- I think Ibrance should not become too cocky, because Abemaciclib has activity on its own, without femara/Faslodex, whereas Ibrance does not, and Abemacicblib crosses blood-brain barrier where it can hit brain mets, whereas Ibrance does not, and they are always talking up the side effect of Abemaciclib, but reports are that diarhhea goes away after a couple of cycles, as the body adjusts, and anyway can be easily treated with over-the-counter meds, so these drug analyst guys may not really be so well-informed from the perspective of the patient, who will have the final say in this
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the article that I posted was from a financial website. Investors don’t care about side effects or brain Mets. The article is purely about money, lots of money.
J
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Hobbes - correct and it is not the patients that win it is the pharma companies and the insurance companies.
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Can I please get some advice? I don't know who else to ask, without sounding ungrateful, but I figured you all would understand...
My sister-in-law is a wonderful woman, and she's like a sister to me. She and my husband are very close, and they've been dealing with some stuff with their mom lately, so they talk on the phone almost every day. Every time she calls, she asks how I'm feeling. Then she asks if it's an on or an off day (if I'm close to the week off of the Ibrance). Then it's "Are you still really tired? Any bone pain? When's your next Xgeva shot? How was the last blood work? When do you see the doctor?" and more. Then she gives me advice on eating or updates about the latest research, etc. I know that she loves me, and is concerned, and wants to be involved, but I just don't want to talk about cancer! The only side effect I have is some fatigue late in the afternoon, and I don't want the rest of my life to revolve around this stupid disease. I tried laughing and saying, "Nothing new, but if anything changes, I'll let you know!" but she thinks I'm being brave... and she still asks every day. So I asked my husband not to put her on speaker, and I either stay quiet or leave the room, but then I hear HIM answering all the questions! How do I tell her that my preferred way of dealing with this is ignoring it (at least as far as other people are concerned), without hurting her feelings?
Then I have another friend, that I only talk to every couple of weeks, who called last night and kept me on the phone for 40 minutes; 30 of those minutes were taken up by talking about cancer. Which other friends of hers have it, where they go for treatment, what they're feeling; who has had breast cancer for how long, who died from it (yeah, she goes there), who benefitted by a certain diet (kale smoothies, anyone?), etc. She's a lot older than me, and means well, so I can't just tell her to stop talking about it, but I hung up feeling completely exhausted by the conversation. My husband tells me to cut her off, and say, "Let's talk about something else", but again, I don't want to hurt her feelings - not that she would take the hint anyway.
Other friends and relatives I see in person always start conversations with "How are you feeling?" and when I say fine, they kind of sigh... then they tell me I look good, like they expected me to be wasting away by now. It's gotten to the point that I wish I had never told anyone!
If I had diabetes or something, I doubt they would be like this - why does cancer make them behave this way?
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I must say that I'm very grateful that the big pharma companies are making these new drugs. Yes, they're making bags of money, but if the manufacture and distribution were not highly profitable, they would cease development and production, and it is reasonable to surmise that many of us might be in a considerably worse place. I feel that as patients we ARE winning, too, not just the pharma companies, though their wins can be measured in big bucks and ours in extended life expectancy.
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I agree JoynerL. In fact, I've even said things like I choose to be selfish in this case scenario. I used to gripe about big pharma and I still don't like it. But, for me, for now, in my life or death situation, I choose to be selfish and even grateful. My personal need is outweighing my outrage by 100%.
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Cisco- I think you could say- “oh let’s not talk about that again.” And ask a question about her or her kids or mom. Or “I’m fine, thanks for asking” - I think a lot of people feel that it shows they are really caring. If she has an ache or pain you could always focus on that for awhile - she might get a clue. Or, just say “ i know you care deeply about me and I appreciate it, but, DH and I just can’t talk about cancer anymore.” Or use a more active voice and say “ we won’t be talking about cancer anymore” it might sting for a minute, but, should help.
It’s odd that people want to tell you about total strangers who have cancer and their (often bad) outcomes. Sort of like when you’repregnant and people tell you scary delivery room tales. My OB called them war stories and told me to stop the person before they got going. Same with cancer I think.
I didn’t tell a lot of people for that very reason and I am glad about that decision. Haven’t told a new person for 5 years. It’s nice to have that topic off the table. I have a bit of the opposite- it I talk much about it with the people that know and then say “oh enough about cancer” they seem relieved!
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