Ibrance (Palbociclib)
Comments
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Brilliant Pat... perfectly balanced as always. You’re making light but we all know things must be hard right now. Roll on a good cyber knife result and a drug which doesn’t make you sick!
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A while back on this thread, it was brought up that Ibrance had changed over from capsule to tablet. I am must starting my third week of my first Ibrance cycle and my first round has been capsules. On the Pfizer Ibrance webssite, it said that the change to tablet was to allow the flexibility to take it with or without food. I noticed that some on here have been put on omeprazole because of Ibrance. Does the change to tablet mean that it could be easier on our digestive system and perhaps eliminate the need to have to take omeprazole if you only needed it to deal with the Ibrance or just used for occasional reflux?
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Cowgal, unfortunately I don't think the tablets are going to be any "gentler" on the digestive system. I think the stomach issues caused by Ibrance are due to a systemic effect that happens once it's absorbed in the blood stream, not to a local effect of the pills on the stomach, right after they are ingested. Could have something to do with the effect on cellular division - the lining of the mouth and stomach contain rapidly dividing cells, and Ibrance is meant to stop these types of cells from dividing. It's likely that both the gastric issues and the mouth sores some people experience are connected to this mechanism.
Pfizer recommended that Ibrance capsules should be taken with food because their clinical trials showed that 10-15% of the patients did not absorb enough Ibrance when it was given on an empty stomach, but everyone did when it was given with food. Rather than having to do blood tests to figure out which patients needed food and which patients would be just fine taking it on an empty stomach (which would be inconvenient for the patients), they just recommend that everyone take it with food.
So, for Ibrance, the "take with food" recommendation is not to avoid stomach upset or acid (like it would be for aspirin or some vitamins), it's just to make sure it's absorbed properly. The new tablets "fixed" whatever the absorption issue was (I'm not a formulations expert, so I can't comment on exactly how they did it) so the new clinical trials showed that everyone taking the tablets is absorbing Ibrance properly with or without food.
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I've been getting the little package insert about the coming tablets for three months. I still get capsules. Has anyone actually received the phantom tablets? Has anyone been given a choice between capsules and tablets? I don't mind taking it with food (I take all meds with food) but it is just curious that they keep talking about tablets but don't send them.
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Thanks for ther explanation Piggy99. I was so hoping I could get rid of a medication. 😕
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Magnesium - first paid attention years ago, long before cancer reared its ugly head. I was running a lot then. What worked was to find a Ca-Mg combo where the Mg was 100% daily need, no more cramps. Later, with Tamoxifen (not running then), sporadic, random, very painful craps. Took mg-citrate, seemed to help. Now taking MG glycinate after one woman blogged that it worked better for her. There are many formulations. Also tried mg-malate after reading that athletes often used. But I think the glycinate works better for me. Just do not take too much. Mg used in colon cleanout preps, also think Milk og Magnesia.......
2009 ER+ left breast. 52 yrs. Lumpectomy, Sentinel node removal, negative. Radiation 6 weeks, tamoxifen 5 years. Dense lumpy left breast, normal right. Acupuncture offered at facility as part of integrative medicine. It really helped with anxiety/stress during radiation treatment.
2016 ER+ left breast. Probably a new cancer, but unknown. 4 rounds TC Aug-Oct 2016, Bi-lateral (my choice) Nov 2016, no reconstruction. 2 sentinel nodes remove, negative. Cold Capping using Chemo Cold Caps (DIGNICAP not available). Anastrozole 1 mg starting May 2017. Joint issues noticed immediately. Stopped Anastrozole after 3-4 months due to joint stiffness in. After several months of no AIs, fingers were feeling better. Started tamoxifen March 2018, stopped tamoxifen 9/2019.
6/2019m-9/2019 Swelling in R-arm, opposite side from where lymph nodes removed. Scans, biopsies from then unti Sept showed tumkor in R-axilla. Ibrance and Arimidex.
1/2020 -CT showed tumor shrunk - Hooray!
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I read somewhere that the tablets would be available in April... if I find it, I'll come back and post the link.
Here it is:
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Fatigue was my nemesis since I started Ibrance and letrozolealmost.two years ago..Recently my guy read in AARP article about taking BPmeds at bed time...I know some of friend's Drs told them to take them then.even before we read this. My prior arimidex and now letrozole raised my BP..plus I ate black licorice..check that and high BP out!!!!..Anyway without talking to GP or MO.I decided to take my three BP meds at bedtime..Sleep so well and not that tough fatigue during the day..and blood pressure normal..Course not as active in winter..but I did celebrate my 80th and some special events getting the 10 point buck I shot last season scored and entered into a contest..and hoping article I wrote for NBBC..Northeast Big Buck Club .gets published..Still enjoy naps and books..and quiet time!! Prayers for all of you..
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BevJen - so happy your scans show stable and no progression!
Rabbit - so happy that your scans also showed no progression!
SondraF - hope your leg cramps get better, doesn't sound fun.
Pat, thank your for sharing your post. I am somewhat new here but admire you greatly and you are in my prayers!
Fatigue.....so, I am finishing up my week off of cycle 3, start cycle 4 of Ibrance on Tuesday. I am TIRED. I am kind of surprised since it's my week off, but maybe my body needs to recharge. This is my only side effect this cycle, so not too bad.
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BevJen - so happy your scans show stable and no progression!
Rabbit - so happy that your scans also showed no progression!
SondraF - hope your leg cramps get better, doesn't sound fun.
Pat, thank your for sharing your post. I am somewhat new here but admire you greatly and you are in my prayers!
Fatigue.....so, I am finishing up my week off of cycle 3, start cycle 4 of Ibrance on Tuesday. I am TIRED. I am kind of surprised since it's my week off, but maybe my body needs to recharge. This is my only side effect this cycle, so not too bad.
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Hello everyone
1 year on Palbo/Fulv so far. Couple questions if that's ok...
If Palbo fails, what would be the next line of treatments? Is switching to Ribociclib common practice? Would greatly appreciate anecdotal info or studies if anyone know of any.
Palbo is still quite new in my country (I was actually one of the first), so I would love to hear how oncologists in the US and elsewhere currently approach Palbo failure. Thank you in advance for your responses.0 -
Good morning, all,
Just a public service announcement for those out there who take omeprazole or something similar along with Ibrance -- yesterday I decided to drill down on the Ibrance drug information available on the Pfizer website about the new tablet versus the capsule. After clicking a few links, I came across something that stopped me in my tracks, considering our discussions on this thread about when to take Ibrance. I take my Ibrance in the evening after dinner. I'm glad that I have been doing that. Why? One of the other drugs that I take is omeprazole (a PPI) because I have reflux.
The Pharma info talked about how the new tablet doesn't have the same prohibitions about taking the Ibrance tablet without food, and went on to talk about taking PPIs -- WHAT? Neither my MO nor the hospital pharmacist said ANYTHING about this when I started Ibrance, even though I disclosed all drugs plus supplements that I take. Thankfully, I take the omeprazole in the morning, which is when I need to take it.
I wish I had copied the info, but I did not. If you are on a PPI, please read through the info to see what it says. The PPI cuts the efficiency of the Ibrance by a huge amount if you take them together. I hope one of our knowledgeable science types will read through this stuff and comment further if for some reason I've misinterpreted this.
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BevJen, the Ibrance label says that under fed conditions there is no clinically relevant interaction between Ibrance and proton pump inhibitors (PPI's). Although they saw a substantial (41%) decrease in the peak concentration of drug in the blood (the Cmax), they only saw a small, non-clinically relevant decrease in the total exposure (the AUC). So, if you picture the amount we are exposed to as the earth in a mountain, the PPI makes the mountain 41% less tall, but a little "fatter" so the total amount of "earth" is only 13% less.
For most drugs, Ibrance included, the clinical efficacy is driven by the total concentration (the AUC), which is why they say the PPI's don't have a "clinically relevant" effect if Ibrance is taken with food. The PPI's do have a significant effect on the Ibrance concentration when the Ibrance is taken without food, likely another reason for the "take with food" recommendation.
As an aside, when they say "co-administered" I'm not sure they mean "at exactly the same time", since they "co-administer" multiple doses of PPI with a single dose of Ibrance. If a PPI is doing its job properly, it should lower stomach acidity for at least 24 hours, and if we take PPI's on a daily basis the stomach acidity should be lower for as long as we take them. As a result, I would expect the slightly lower concentration of Ibrance to happen regardless on whether we take the actual pills together or separately.
All in all, it seems like drug absorption from the old formulation (capsules) was sensitive to the amount of acid in the stomach. The new tablets seem to get rid of all these issues - so they will be fine taken with or without food, with or without PPI's.
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Thanks for that explanation, Piggy. Makes sense to me. I was a little bit freaked out when I was reading that stuff, being at the end of my 7th cycle on Ibrance and not really knowing anything about the PPI interaction.
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Thanks for bringing this up BevJen and Piggy to providing some more information. I was put on omeprazole in 2018 when I had a colonoscopy that showed I had all sorts of gastric problems. Eventually, I was diagnosed with Celiac disease and between going to a gluten free diet and the omeprazole all of the other gastric issues went away. I asked my gastroenterologist if I could stop taking the omeprazole and he said I needed to keep taking it. I was concerned at the time about the study that said that it can cause dementia but he told me that has since been debunked and I have found that to be true in my research. However, I would still like to quit daily omeprazole and just take it if I needed it and have been thinking about getting weaned off of it. I thought that I had found something that said omeprazole taken with Ibrance could cause memory loss in breast cancer patients but I have not been able to find that information so maybe I am in error on that but I did find this interesting link when I was looking for it: https://www.researchgate.net/publication/336967565... . Then I wonder if it is good to stay on it.
Lakewoman - I will have to see if I can find that article on the BP meds at bedtime. Congrats on your 80th and your 10 point deer!
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BevJen, I did the same thing you did. Read all of the link Ciaci posted. What? No one told me either that a PPI was a problem when taken with Ibrance. And it is in all my records. I just had to up my dose of omeprazole from 10 mg to 20. I don't take it all the time, only when the gastritis gets bad. The last two months right after starting a new cycle of Ibrance, it kicked up a notch. Probably related. I haven't taken one of my off cycles in a year so I may need to do that. I need to look for the full description on the Pfizer site but that site is so hard to find anything on. Piggy, love the mountain/earth analogy. Very enlightening.
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Before anyone freaks out about the omeprazole, I have been on I/L and omeprazole for 3 1/2 years and am doing fine. I always appreciate new insights, and am thankful I do take my Ibrance at night and omeprazole in the morning. I tried to wean myself off of omeprazole a couple of times but with horrible results, and my onc said to stay on it as the extreme GERD was more dangerous than the omeprazole. I am also on 125mg Ibrance so perhaps if I am not getting a full dose it is no different than being on a lower dose? I am clueless as to medications so I could be showing my ignorance with this statement. I just know to always be cautious when I hear something new. As always I am thankful everyone on this site is so kind and understanding of each other's posts.
On a side note, my onc and I realized last week I have not had a bone scan to check for osteoporosis since long before my cancer dx. We were discussing possibly moving my Zometa infusions out a bit so she wanted to check and see how well it is working first. So I am having one tomorrow. We shall see! I only have PET scans up to now...
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BevJen, found it. They tested it in healthy subjects. What about us? And they used a less commonly used PPI. Again, so hard to understand their website. Happy we have a pharmacy expert and a lawyer in training to help us.
Gastric pH Elevating Medications: In a drug interaction trial in healthy subjects, coadministration of a single 125 mg dose of IBRANCE with multiple doses of the proton pump inhibitor (PPI) rabeprazole under fed conditions decreased palbociclib Cmax by 41%, but had limited impact on AUCINF (13% decrease), when compared to a single dose of IBRANCE administered alone. Given the reduced effect on gastric pH of H2-receptor antagonists and local antacids compared to PPIs, the effect of these classes of acid-reducing agents on palbociclib exposure under fed conditions is expected to be minimal. Under fed conditions there is no clinically relevant effect of PPIs, H2-receptor antagonists, or local antacids on palbociclib exposure. In another healthy subject study, coadministration of a single dose of IBRANCE with multiple doses of the PPI rabeprazole under fasted conditions decreased palbociclib AUCINF and Cmax by 62% and 80%, respectively, when compared to a single dose of IBRANCE administered alone.
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This is from the link I posted earlier this morning:
Proton pump inhibitors enhance chemosensitivity, promote apoptosis, and suppress migration of breast cancer cells - July 2019:
Proton pump inhibitors enhance chemosensitivity, promote apoptosis, and suppress migration of breast cancer cells Breast cancer is the most common cancer and is the leading cause of cancer deaths among women worldwide. Despite the availability of numerous therapeutics for breast cancer management , cytotoxicity and emergence of drug resistance are major challenges that limit their benefits. The acidic microenvironment surrounding tumor cells is a common feature inducing cancer cell invasiveness and chemoresistance. Proton pump inhibitors (PPIs) are one of the most commonly prescribed drugs for the treatment of acid-related conditions. PPIs have been reported to exhibit antitumorigenic effects in many cancer types. In this study, the anti-proliferative and anti-migratory effects of PPIs in three breast cancer cell lines; MCF-7, T47D, and MDA-MB-231 cells, have been investigated. In addition, the combined effects of PPIs with anticancer drugs, as well as the mechanism of PPI-mediated anti-proliferative activity were evaluated. The anti-proliferative and combined effects of PPIs were evaluated by MTT assay. Cell migration was assessed using the wound-healing assay. The mechanism of cell death was assessed using an-nexin V-FITC/ propidium iodide staining flow cytometry method. Our results indicated that PPIs treatment significantly inhibited the growth of breast cancer cells in a dose-dependent manner. The antiproliferative activity of PPIs was significantly induced by apoptosis in all tested cell lines. The combined treatment of PPIs with doxorubicin resulted in a synergistic effect in all cell lines, whereas the combined treatment with raloxifene exhibited synergistic effect in T47D cells only and additive effects in MDA-MB-231 and MCF-7 cells. In addition, PPIs treatment significantly reduced cell migration in MDA-MB-231 cells. In conclusion , the addition of PPIs to the treatment regimen of breast cancer appears to be a promising strategy to potentiate the efficacy of chemotherapy and may suppress cancer metastasis.
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I use famotidine (Pepcid) for my GERD. I know it works a little differently from PPI's, though I don't know the actual mechanism of action. No one has told me (doc or pharmacy) that Pepcid and Ibrance could interact. I do take both in the mornings, but I take Ibrance with breakfast and then wait an hour or so to take my BP pill, daily aspirin, and the Pepcid. I am still stable 2.5 years out on Ibrance and on the 75mg dose so it must not be making the Ibrance too ineffective.
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Dear roseo,
Welcome to the BCO community. We are so glad that you reached out to our members and hope that you will benefit from the support and information readily shared here. We hope that others on this topic of Ibrance will share some of their experiences with you and help you with some of your concerns. Here is a link to topics on our main site that also may be a help. Let us know if we can be of assistance.
The Mods
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Roseo - I do not know as I am just on my first cycle of Ibrance (Plabo) but others on here are very knowledgeable. I do know that my MO said that if this didn't work that there were still options. Bestbird has a link to a book that she keeps updated on metastic cancer on this site. If you can't find it, I will try to link to it later when I have a chance.
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Jaycee,
Yes, that's exactly what I read. And yes, what the hell? What about us -- I doubt we are the healthy subjects that they are referring to. But I did read what you posted, Cowgal, and that is probably a consideration for all of us as well.
Who the heck knows? I just was pretty amazed that neither the pharmacist nor the MO even thought to mention this to me. I mean, so far, so good, but I would guess that if this is mentioned in the Ibrance literature, there's a reason.
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Cowgal.TY for your comments on my post..and for compliments ..SO appreciated!
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Thanks Piggy99, for your input.
Jaycee49 , What do you mean '' I haven't taken one of my off cycles in a year''? How many days/ weeks do you stop? I feel I could do with a holiday, so am interested in what you do.
I often ask my oncologist about articles I have read on this thread. She said recently that drug trials are for efficacy and the highest level of medication that won't kill you!! There are not tests to study the lowest effective dosage, duh!!
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Cowgal thank you I found it, "The Insider's Guide to MBC".
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Hi, everyone. I finished my first cycle of Ibrance almost 2 weeks ago. My next cycle is delayed because of low blood counts. I'm wondering whether the drug has caused tingling and skin sensitivity, mostly on my legs. Have others had this?
I worry a bit because I've had spinal canal compression from a lesion at T10. Hoping this weird sensation has nothing to do with that!
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My MO agreed that my horrible nasal cold during my recent week off Ibrance impacted my ANC recovery. Oddly, I feel comforted with that info. It had decreased to .7, usually it is 2.1 around Day 1. So I took 9 days off. All okay now.
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denny10, I have a long history with UTI's. When I was taking Tamoxifen for six months, I had a UTI the entire time. When I started I/L, I had periods of multiple consecutive UTI's often. My MO and I decided to stop I/L for an entire cycle each time. I've done that about every 4-6 months my whole time on I/L. I've been doing a lot of experimenting with non-estrogen moisturizers lately and have avoided the multiple UTI's (still get a few singles). When I had to up my dose of Prilosec from 10 to 20 mg, I noticed that I hadn't taken a cycle off in a year. Yup, taking a cycle off right now. I'm also experimenting with topical vaginal estrogen (see SandiBeach's thread on this topic). I am doing a clinical trial with one subject, me.
Jody, I would think about neuropathy and blaming letrozole, although the skin sensitivity is an Ibrance thing, too.
Sandi, so glad that was the conclusion.
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Lakewoman congrats on that 10 point buck and becoming an octogenarian!
Tanya
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