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Verzenio/Letrozole to Xeloda?

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Curious whether anyone else has had Xeloda as second line monotherapy after the Verzenio/Letrozole combo? 18 months on that but suddenly many more bone mets/lesions grown bigger so switch has been recommended by onc.

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  • emiliamarty
    emiliamarty Member Posts: 39
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    I don’t think I have many unaffected vertebrae left

  • cure-ious
    cure-ious Member Posts: 2,756
    edited January 21
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    If the goal is to enhance overall survival, most regimens try to delay the time to chemotherapy (TTC) in order to get the most benefit out of endocrine therapy for ER-positive MBC. Have you had genomic testing to learn why the cancer is not responding to Verzenio-Letrozole? For example, if the cancer has developed an ESR1 mutation, that can be readily reversed with an oral SERD such as Elascestrant or lasofoxifene, oral SERDs or PROTACS currently in clinical trials.

  • emiliamarty
    emiliamarty Member Posts: 39
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    Thank you. I will take these questions to her. I understood her to be recommending a break from hormonal treatments before a return to a different combination, with Xeloda as a temporary fix. It responded superbly to Verzenio-Letrozole in the first 9-12 months - at one point complete metabolic response - and then tapered and, most recently, an accelerated decline. Various alternatives were raised should I have DPD deficiency, including Piqray and Afinitor in combo with fulvestrant or exemastane but Xeloda was her first choice.

  • cure-ious
    cure-ious Member Posts: 2,756
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    Always worth the time to get all the data and go for a second opinion, especially right at the start, and with so many new drugs out there. Another issue is how many bone mets are heating up, when I first had bone mets start to light up they decided to radiate three areas ( two on spine plus a smouldering mass of hip mets that were getting hotter with each scan), which got me another 1.5 year on the same therapy. Just suggesting to look at all the options

  • emiliamarty
    emiliamarty Member Posts: 39
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    Thanks. Spine like a chain of Christmas tree lights, 11 new ones since October, the old ones also glowing brightly now.

  • kikiclam
    kikiclam Member Posts: 1
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    did you start the xeloda? How is it going?

  • amel_83
    amel_83 Member Posts: 166
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    I had xeloda after ribociclib +letrozole, my very first line of therapy

    I also had a clear PET with no cancer metabolism at 11 months, than the PET scan that I did after 14 months of this combo show recurrence in liver...

    So they put me on Xeloda. I think it was kind of a "they didn't know what to do", at first they even siggested docetaxel!

    I didn't had any mutations, but a 90% ER. I think Faslodex would be a better choice...or Everonimus+Exemertane.

    But I'm in Italy and we are centuries behind in oncology.

    I asked a second opinion in USA, to doc Hope Rugo, SF, she is a researcher as well. She say that she would never suggest me Docetaxel or Xeloda as a second line of therapy, with ER at 90%. She say is better to exaust ER before going to any chemo.

    Too late for me now...

    I would definitely ask a second opinion if I were you. Than if they really think it should be Xeloda, it's ok! Is not too hard, I actually prefere it than my previous line of therapy, and I'm on it since September.

    I wish you good luck anyways on your next med! Update us please when you switch!

  • emiliamarty
    emiliamarty Member Posts: 39
    edited May 13
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    Hi kikiclam, I’m just nearing the end of the fifth cycle of Xeloda. I’d echo what Amel said, in that I have found it relatively easy to tolerate, but maybe that means it isn’t working? First scan was not encouraging. Had another one today. Results on Friday. We shall see. It was put to me as a break from hormonal treatment, in that I can try another version of that when this stops working.

  • emiliamarty
    emiliamarty Member Posts: 39
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    Update: scan showed decent response to Xeloda, uptake reduced except for one site (iliac wing). So I’m pleased with this. I did find the fatigue pretty bad in the last few days of the fifth round of 14/7. I’m doing one more at full dose 14/7, then I have the option of switching to 7/7 (my preference, not least because it’ll make it easier to schedule work commitments without impacting on colleagues) or reducing the dose.

  • AJ
    AJ Member Posts: 219
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    I think I’m handling the Xeloda pretty well considering. I’ll be going along feeling ok then some evil side effect comes in out of the blue. In the second cycle I had a couple days where I was so tired and weepy. This time it’s fatigue cramping and diarrhea for two days then I magically felt much better. It’s not at all predictable!

  • emiliamarty
    emiliamarty Member Posts: 39
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    Unpredictable is definitely the accurate (polite) description!

  • AJ
    AJ Member Posts: 219
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    @emiliamarty , when I did IV chemo 10 years ago, I could predict which days would be worse and plan accordingly. But not with this! But I am grateful that there are treatments that allow me to live a somewhat normal life?

  • emiliamarty
    emiliamarty Member Posts: 39
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    I’m lucky that I haven’t had IV chemo yet but yes. It’s still unpredictable but there’s a limit to the unpredictability, if you see what I mean. My work colleagues are all much younger than me and I hate letting them down.