Ibrance (Palbociclib)
Comments
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Gracie: please find enclosed the relevant section from the UK SmPC on Ibrance. In the fed state, even taking both together is not that bad (under the assumption that the AUC is the more relevant parameter) and 8-9 hours are certainly fine. In your position, there is no other option in any case. I hope that helps a bit.
Effect of acid reducing agents
Under fed conditions (intake of a moderate-fat meal), coadministration of multiple doses of the proton pump inhibitor (PPI) rabeprazole with a single dose of 125 mg IBRANCE decreased palbociclib Cmax by 41%, but had limited impact on AUCinf (13% decrease) compared with a single dose of 125 mg IBRANCE administered alone.
Under fasting conditions, the coadministration of multiple doses of the proton pump inhibitor (PPI) rabeprazole with a single dose of 125 mg IBRANCE decreased palbociclib AUCinf and Cmax by 62% and 80%, respectively. Therefore, IBRANCE should be taken with food, preferably a meal (see sections 4.2 and 5.2).
Given the reduced effect on gastric pH of H2-receptor antagonists and local antacids compared to PPIs, no clinically relevant effect of H2-receptor antagonists or local antacids on palbociclib exposure is expected when palbociclib is taken with food.
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Lena: greetings within Europe from Germany to Greece! Newly appearing liver lesions are not really a good sign and might lead to the neccessity to find a faster acting treatment option. My MO told me that they did not have good results with liver mets and Ibrance in their hospital yet, they are not sure if they are just having bad luck or if Ibrance and liver mets do not go together that well. However, even if Ibrance should fail on you, there are many very good other treatment options. It is rather unpredictable to know in advance which treatment will work well (there is a lot of research going on in this field), but I am optimistic that they will find the right one for you. Maybe you will even be able to go back to Ibrance after the liver lesions have been resolved.
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Thanks for that info NettaGER
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NettaGER, thank you so much for your kind reply. Not easy to accept such bad news. Trying hard the last days. Anyway thank you and wish you all the bes
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Going back to Claritin..Is that OTC like Claritin D.?? Should I ask Onc about it first are prolia and xgeva the same and is Claritin used with either.?.TY
My guy took me on two boat rides today. He had boat in before I awakened. .Little scary getting in..but felt safer second time.My guy ..yeh what a guy on liquids till supper tonite.. had implant prep after stub of tooth pulled yesterday afternoon..We are a team..
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Hi gang - I've been following along with all of your posts but have been a bit overwhelmed of late. I am finishing up round 3 of Ibrance 125mg and the fatigue has been fairly brutal. Like many of you, I have a demanding job (though I can work from home when my schedule allows) and my family obligations and I'm just barely able to do it all. I've had days where I had to reschedule meetings just to take a nap. Weekends are usually filled with hockey and baseball tournaments and I find I am sleeping in between games back at the hotel. My blood levels decrease with the cycle, as expected, but not such that I've had to take an extra week break.
I've got a bone and CT scan scheduled for tomorrow - my first since dx in Feb - to see if the radiation to my rib killed the met there and all else is at bay. (I only have the one met). Assuming the scan is good, I'm contemplating reducing my dose to 100mg for the next round but I keep going back and forth and I'm down to the wire on having to decide. So I'm looking for some input. My doctor is pretty much leaving it up to me (he has no issue with me going to 100mg but because my blood doesn't dip below 1.0, he is also fine with me staying at 125). I know the truth is no one really knows if it will make a difference.... but of course I don't want to have regrets on my own decisions. Have any of you reduced dose just due to fatigue Have any of you decided to power through and saw improvement over time at the 125 dose? Does the 100mg make a difference with the fatigue? Any thoughts to make this decision easier? My onc nurse said to think of MBC as a marathon.... and that a reduced dose could be analogous with "pacing yourself."
Thanks in advance for your wisdom and guidance. Hope all are enjoying some springtime weather (for those of you in the upper hemisphere)!
Lauren
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Lena, at my 3 month scan a spot appeared on my liver. My lymph tumors were better, and bone mets were stable. I was confused and terrified. How could the treatment work in some areas and not others? (It does happen, referred to as a 'mixed result'.) But my MO wasn't convinced it was progression. She said we'll give it two months and scan again. It could just be a fatty deposit, and she would have hated to pull out of a protocol that was working. I turned to my friends here and they supported me through those couple of months.
Fast forward to now, 10 cycles in, the whatever-it-was on my liver is still there, maybe a cyst, and everything else is stable. So it could very well be something other than progression. Sending you waves of support.
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Lauren - did you have a high dose of radiation as part of a trial or was it to potentially “kill” the net? I look forward to hearing, wishing you the best of results tomorrow 👍 I am finishing cycle 3 tomorrow...
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Lakewoman, the Claritin is OTC, generic name is Loratadine - I got a bottle of 365 for under $10 at Costco (their brand is called AllerClear). I'm not due to get my Prolia shot until July, but I'm taking it daily now for seasonal allergies - this pollen is killing me!
Xgeva and Prolia are both denosumab - the Xgeva is 120mg and the Prolia is 60mg. The reason the Claritin works is because it's an antihistamine, and the denosumab releases histamine in the body.
When I asked my onc about it last year after I had read suggestions here, she told me she wasn't familiar with the protocol, but if it worked for others, go ahead and try it. Now she recommends to to her other patients.
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Lauren, I'm on 125 mg, and my fatigue and blood levels have been bearable and within decent ranges, respectively, so I have no sage advice there. However, do try not to jump to conclusions if your scans don't show as much response this time as you had hoped. Ibrance frequently takes 6-8 months for response to be really visible. Do be prepared to give it time, at whatever level you and your onc decide. Good luck with your scans!! Today or tomorrow?
Lena, I, too, have spots show up on my liver on scan. The spots are stable and appear to be cysts. Yours probably are, too. Add my waves to Jaylea's!
Ciaci, thanks for the tip on the Costco brand of Claritin. I'll get that, as even Loratadine is fairly expensive at the drugstore. Neither of my oncology nurses had heard of the use of Claritin/Loratadine with Faslodex and Xgeva but made a note and said that they'd pass the suggestion on to other patients.
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Janky - Thanks for the well wishes. We are now on identical Ibrance schedules, taking our last of round 3 today! You are my Ibrance twin. :-) So my MO suggested high-dose radiation (I had 16 sessions) to kill the met in my rib since I am oligiometastatic, with just the 1 met to the rib. I had no pain in the rib before, during or after radiation, even though it measured 4.2cm.
Jaylea - Yes - scans are today (Thursday). So glad you find Ibrance tolerable. Did you notice that your fatigue improved over time or did it stay the same? I met a woman locally who is in cycle 17 and stable and she remembered that her fatigue improved after the first few cycles. Maybe I should give it more time at 125.... Like you, my blood levels stay in decent enough range at this dose. Thanks for the advice on Ibrance taking time.... I only have the one rib met, which was heavily radiated, so if anything new shows up, it will likely mean that Ibrance isn't working in my case.
Though, I do have one complication with the scan results now.... I had a Pet scan at dx and my doc ordered a Pet for the follow up today. However, my insurance denied it, since I just had one in Feb and I had no other tests that prompted a new Pet. Doc is annoyed but doesn't think it's worth an appeal. He said he intended to switch to CT + Bone Scan for ongoing surveillance but wanted a Pet to Pet comparison for this first follow up. SO now I'm worried that we will see new things on today's scans that were there all along but I was blissfully unaware of... As I understand it a bone scan can pick up smaller bone mets than the Pet. If that happens then I'll be all confused as to what to do next. Ahhhhhh - I just need to let that worry go.......... It is what it is.
Thank ladies - any other advice is welcome. I have until tomorrow to order the next dose.
Lauren
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Lauren, I'm on my 16th cycle of Ibrance/Faslodex. I would say that my fatigue is a bit better but has stayed relatively the same. On the other hand, I'm [a frisky] 72 and do lots of gardening and walking and go to the gym for an hour M-F at 6 AM, so my fatigue could also be at least partially age-related. It has to happen! My onc had been doing chest and abdomen CTs every 3-4 mo and did a couple of bone scans at the very first, but he said that the bone scans were more for a baseline. I've only had the one PET scan (last scan), and he said that he wanted one since we hadn't done one before. He has NOT scheduled my next scans but says that we'll meet in 3-4 mo and review where we are and decide when next to scan. I am excited that he felt optimistic enough not to plan my next scan. It's great that you had only the one met and that they identified and addressed it! Good luck with the scans, and let us know-
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Wow Joyner - You set the bar! 72 and at the gym 5 mornings a week for an hour! I'm 48 and I need to step it up big time. I wonder how much of my fatigue is just sort of inertia and even depression-related. I've not been moving much at all and if I'm honest, I think that lack of activity sort of builds on itself. I blame being fatigued from the meds, but I think part of it is really just mindset. I think sometimes I sleep because I'm depressed. I project a pretty positive outlook to the rest of the world, but on some level, I don't think I've yet processed this diagnosis much at all. Just thinking out loud........ Maybe I am blaming Ibrance and I really just need to work on me. Your post inspired me to look at this from a new angle. Thanks for that.
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Lauren, it's a depressing diagnosis, and most of us go through that at least initially. It's understandable and frankly, to be expected. Once you see that the medication is working and that things just might not be as bad as you thought, I'm hoping that you'll feel better and start "seeing the sunshine" again. By the way, I'm no star at the gym. I do 20 min of reasonably fast walking on the treadmill and then 40 min of weight-bearing and core exercises: light work-out three days and more intensive (all is relative) two days. This is all going to get better for you.
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Lauren - I too was reeling from mybstagec4 dx as I had only been do stage 2 a year prior😏 I present a very positive persona to to world, look great, but am sometimes sad inside. Stressed because my neutrophils go so low I have to delay ibrance by 3, then 2 weeks so my hp gave me a 10 mg if citalopram which I take on the morning. Not sure if it helps since abs ling as I amnesia on ibrance I am fine😄
Joyner - I have never, ever been an exercise person- busy running around chasing kids etc., then last October at a cancer information session, a group university researchers told us about a project to see if exercise post treatment had health implications. It is 2?days weekly for 1 hour of a multitude of things, each exercise having 3 ranges if difficulty so you don’t have to “kill” yourself and build to your own level! I, the queen of non exercise ‘ actually enjoy it and do random stuff at home between times! Hopefully it helps cancer stay away!! I am at week 4. I too Ann older, 64..
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Lauren, let me give you the flip side of the dose reduction issue. I've been on 75 mg for all but the first of 24 cycles. My scans are stable. I am actually NEAD. (I finally got out all the PET scan reports and read through carefully and found that description.) I don't accept words like tolerable or bearable or adequate to describe how I feel. I want to feel good. Granted, I don't have anyone dependent on me any more. My son is grown and doing wonderfully on his own. I went directly from 125 mg to 75 mg when the se of diarrhea started during round one. There is no data evidence that any dose works better or worse than any other. Look for Bestbird's post about the San Antonio conference and see what "experts" had to say. Trial designers choose doses and those doses end up being what we take. They choose the highest dose that will be "tolerable." I hate that word. Tolerable is not enough for me. It's like saying adequate is enough. I was a statistician. I sat in meetings with trial designers. It was fairly arbitrary what dose they chose. One time, I thought they were going to flip a coin to choose between two doses. They didn't.
Anyway, have your scans, talk to your MO, but consider lowering your dose carefully. There are many people here on 100 mg. PatMcG's MO starts all his patents on 100 mg. Several of us are on 75 mg, as well. I hate the idea of people losing quality time with, especially their kids, because of drug fatigue that could be avoided.
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Lauren, I was only on 125 mg for one cycle. I dropped to 100 mg due to very low blood counts. I did notice some fatigue during that first cycle, but I have had normal energy since. I have been on 100 mg for 20 months now. That dose has worked for me. I have seen marked improvement in my breast tumor and liver tumors and my bone mets have also shown a slight improvement followed by stability. It can take a while to see results with Ibrance, but 100 mg seems to be as effective as 125 mg. Exercise does help to keep my energy level since up, but it sound like you probably get quite a workout in your normal daily routine. Between your demanding job and running around with your children, you probably use lots of muscles and burn calories. Maybe some stretching, stress-relieving yoga would be beneficial. in addition to being good exercise, it can help us cope with everything happening to us. I am thinking of you today as you have your scans. I hope theresults are good.
Hugs and prayers from, Lynne.
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My RBC are always low, so last time I asked my MO to reduce the Ibrance to 75 mg. He did I and I defenitly feel almost normal. We'll see soon the results!
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I take 100 mg mainly due to fatigue I suggested it to my Oncbecause QOL was poor- always weary. I e been on 100 for four months I was on 125 for 8 months.
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Wow, I am trying to decide how to respond here. First of all, I am on cycle 23 of 125mg, and have been NEAD for 6 months now. I get a PET scan every 6 months now--started every 3 months. I am stage IV from the first scan and had extensive bone mets including at least 4 to the liver all which are now gone on Ibrance/Letrozole/Zometa; my only treatment from the start. My fatigue is low but fluctuates a bit. It has improved from the first 6 months. Some days I actually feel good. I have considered lowering my dosage but don't really have a reason to as my neutrophils have never dropped below 1.5 until yesterday which reveal 1.4. I am considering asking for a lower dose after my next scan in August which will be a year NEAD. My main complaint is lack of stamina. I try to get in a minimum 30 minutes of walking every day plus as much additional physical activity as I can, but I am not as diligent as some others here. I used to go to the gym every day before my last move and subsequent dx, but I live at the beach in San Diego now and prefer to walk since the weather is good most of the time. I am 65.
My suggestion is listen to your body and mind. We are all different and have different MO opinions. I have a PhD in education and believe in doing diligent research on treatments and care, which is one reason I love all of you who know medicine far better than I. I love Jaycee's attitude but I am more conservative. I struggle with my dx as everyone does. I was working my dream job and was planning on working past retirement age but ended up retiring early as I did not want to end every day so tired I couldn't enjoy life. I am fortunate enough that my DH is still working and the state of CA has great disability benefits so I could afford to. My DH and her 2-year-old daughter live with us so every day is a celebration of joy and laughter. That is how I want it to be.
This is too much information, but I hope it reveals enough of my side of the journey to help inform decisions. I am one who likes to look at all sides before making a decision.
Blessings on your day!
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Interesting article about a metastatic prostate cancer drug. One quarter of the full dose taken with food created similar results as the full dose with no food. The original trial was done with empty stomach so the label on the drug said empty stomach. Now, they are seeing that the "food effect" is in play with this drug. Trial designers don't think about the fact that however they set up the trial has long lasting effects on how the drug is taken. What's interesting here is that the new trial is to see if they can reduce cost of the drug with this lower dose change. As far as I know, at least with Ibrance, the lower doses cost the same. I'm not sure what that means about this drug. Do the trial people think the lower dose will be cheaper? Maybe but not with any drug I've ever taken.
Thank you, Chris, for loving my attitude. That's usually rare.
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Carci..ty so much for detailed info on Claritan..I copied it and emailed it to me lol!! for future reference like next week when I see my onc. and see if she has made any decisions on Prolia ..many thanks!
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Lauren-I am on cycle 34 of 125mg Ibrance and Faslodex and have been "stable" from the get go (bones only). Fatigue has most definitely gone away as time progressed. I work a full time job and then feverishly plant flowers, mow and everything else in between after work. My insurance has also starting denying PET scans, so I'm getting bone and CT scans every 4 months.
Just wanted to pipe in to say that things will get better....hope you have a blessed day!
MM
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I am not good at all putting in my BC history..wish there was a way just to type it and not have to answer questions. ..help!!
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Think of it as a multiple choice test instead of essay. My students always preferred multiple choice.
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Ladies - I can't thank you all enough for your inputs and perspective. You gave me a lot to think about while I lay in these scan machines today..... I am so grateful for your thoughts and experience. My husband is sitting with me today and he read them too and is equally as appreciative for your insights. I will let you know what I ultimately decide. Clearly, it's been eye-opening for me to recognize that I'm a bit depressed and that is likely contributing to some of the fatigue. Part of me knew that but I hadn't said it out loud.... or typed it. :-) Seriously - thank you all so much.
Lakewoman - you don't have to answer the questions for your BC history. What you typed in above the questions line works. You can just add additional text to that with your current meds, if you prefer. (Unless maybe it has a character limit?)
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Lauren, this is an amazing group, and we're all blessed to be part of it.
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Hi everyone!
Just quickly wondering how folks on Ibrance are doing with fatigue? I am on my 11th (?) month of Ibrance and man, these past three weeks I have been really low energy. My onco's fellow was inquiring about depression and I don't necessarily feel depressed. Just TIRED. Would love to hear others experiences.
Love to all,
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I'm in the middle of my 10th cycle, and while I certainly wouldn't say I feel tired all the time, I do fall asleep as soon as I sit for more than ten minutes on the couch... or in the car... or at the table. Where I DON'T sleep is in bed, at night. When it's dark and quiet, my mind just can't shut off. So I get up, get back on the couch, and turn the TV on. Within minutes, I'm out. It's really weird.
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Hi Love from Philly - if you scroll up and read the conversation just above your post, you will see responses to me similar question. In my case, I am only on round 3 but the fatigue is making me think about reducing the dose. I got a lot of insight from others on their experience with fatigue at different doses. Are you in the 125mg dose
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