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All TopicsForum: Clinical Trials, Research Studies, News, and Study Results → Topic: PALLAS Trial: Palbociclib (Ibrance) - Stage II & III, ER+, HER2-

Topic: PALLAS Trial: Palbociclib (Ibrance) - Stage II & III, ER+, HER2-

Forum: Clinical Trials, Research Studies, News, and Study Results —

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Posted on: Aug 16, 2015 05:26PM - edited Jul 29, 2016 05:36PM by JohnSmith

JohnSmith wrote:

The success with Palbociclib (Ibrance) in the PALOMA-1 trial for advanced staged patients, has led to the Feb 2015 drug approval by the FDA (See PR here). Now investigators are wondering if this drug will help "early stage" patients, so a new clinical trial called PALLAS has launched.
The purpose of the PALLAS study is to determine whether the addition of Palbociclib (Ibrance) to adjuvant endocrine therapy will improve outcomes over endocrine therapy alone for HR+ / HER2- Stage 2 and Stage 3 breast cancer.
Official title: "PALbociclib CoLlaborative Adjuvant Study: A Randomized Phase III Trial of Palbociclib With Standard Adjuvant Endocrine Therapy Versus Standard Adjuvant Endocrine Therapy Alone for Hormone Receptor Positive (HR+) / Human Epidermal Growth Factor Receptor 2 (HER2)-Negative Early Breast Cancer"

Estimated Enrollment: 4600 (this is a large trial)
Study Start Date: August 2015
Estimated Study Completion Date: September 2025
Estimated Primary Completion Date: September 2020 (Final data collection date for primary outcome measure)
Locations: Worldwide

Palbociclib (Ibrance) targets the CDK4 & CDK6 pathways.

Here's a 8 minute video with Dr. Erica Mayer of Dana Farber discussing these trials.

There's a very extensive thread discussing this drug (Ibrance) in the Stage IV section, here.

LOCATIONS: As of JULY 2016, the following locations are enrolling patients:

Alabama
- Southern Cancer Center

Alaska
- Katmai Oncology Group

California
- Marin Cancer Center
- Palo Alto Medical Foundation (PAMF)
- UCSF Mount Zion

Delaware
- Christiana Care Health Services

District of Columbia
- MedStar Georgetown University Hospital

Florida
- Morton Plant Mease
- Mount Sinai Comprehensive Cancer Center

Georgia
- Phoebe Putney Memorial Hospital

Illinois
- University of Chicago Medical Center
- OSF Saint Anthony Medical Center

Iowa
- Physicians' Clinic of Iowa PC-Hematology and Oncology

Maine
- Eastern Maine Medical Center
- New England Cancer Specialists

Massachusetts
- Massachusetts General Hospital
- Dana Farber Cancer Institute
- Lowell General Hospital

Minnesota
- Mayo Clinic
- Coborn Cancer Center
- Metro Minnesota Oncology Research Consortium

Missouri
- St. Luke's Hospital
- Cancer Research for the Ozarks
- Washington University School of Medicine
- Missouri Baptist Cancer Center
- Mercy Hospital

New Hampshire
- New Hampshire Oncology-Hematology PA - Concord
- New Hampshire Oncology-Hematology PA - Hooksett
- Dartmouth Hitchcock Medical Center

New Jersey
- Englewood Hospital and Medical Center

New Mexico
- University of New Mexico Comprehensive Cancer Center

New York
- Monter Cancer Center
- Oneonta FoxCare Center
- SUNY Upstate Medical University

North Carolina
- Cone Health Cancer Center
- Kinston Medical Specialists
- First Health of the Carolinas

Oklahoma
- Cancer Centers of Southwest Oklahoma
- Stephenson Cancer Center

Rhode Island
- Rhode Island Hospital

South Carolina
- Lexington Medical Center

South Dakota
- Rapid City Regional Hospital

Utah
- Huntsman Cancer Institute

Virginia
- Medical Oncology and Hematology of Northern Virginia

Wisconsin
- Gunderson Health System

Outside of US:
Australia, New South Wales
Australia, Queensland
Australia, South Australia
Australia, Tasmania
Australia, Victoria
Australia, Western Australia
Israel
Switzerland

Wife was Age 45 at Dx 4/2014. BMX Surgery 6/2014 revealed: ILC, Stage 2 (Multifocal ILC, largest lesion 2.2 cm), Grade 2, ER+/PR+ (95%), HER2-, Ki-67 5-10%, Oncotype 11; Variant in the ATM gene Dx 4/8/2014, ILC, Left, 2cm, Stage IIA, Grade 2, 0/3 nodes, ER+/PR+, HER2- (IHC) Surgery 6/26/2014 Mastectomy; Reconstruction (left); Reconstruction (right)
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Aug 16, 2015 11:14PM Annette_U wrote:

Thanks, I plan to look into this. I am having a total hysterectomy on September 1- then moving to letrazole. I will ask my Onc about this.


Dx 4/13/2013, ILC, 5cm, Stage IIIA, Grade 1, 0/5 nodes, ER+/PR+, HER2- Chemotherapy 4/18/2013 Cytoxan (cyclophosphamide), Ellence (epirubicin), Fluorouracil (5-fluorouracil, 5-FU, Adrucil), Taxol (paclitaxel) Surgery 10/29/2013 Lymph node removal: Left, Underarm/Axillary; Mastectomy: Left, Right; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy 12/15/2013 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy 1/7/2014 Breast, Lymph nodes Surgery 8/6/2014 Reconstruction (left); Reconstruction (right) Surgery 11/25/2014 Reconstruction (left): Nipple reconstruction; Reconstruction (right): Nipple reconstruction Surgery 9/1/2015 Prophylactic ovary removal Surgery
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Aug 17, 2015 10:11PM mary625 wrote:

When do you think they'll be announcing the locations conducting this trial?
Dx 8/29/2011, ILC, 1cm, Stage IIIC, Grade 2, 10/16 nodes, ER+/PR+, HER2- Chemotherapy 9/26/2011 AC + T (Taxol) Surgery 2/6/2012 Lymph node removal: Left, Underarm/Axillary; Mastectomy: Left, Right Hormonal Therapy 3/12/2012 Femara (letrozole) Radiation Therapy 3/13/2012 Surgery 9/24/2014 Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap
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Dec 8, 2015 06:17PM - edited Dec 8, 2015 06:18PM by JohnSmith

New info on Palbociclib (Brand name: Ibrance), a CDK4 and CDK6 inhibitor for ER+, HER2-.

Public Release: 8-Dec-2015

One-two punch of palbociclib and paclitaxel shows promise against advanced breast cancer

Philadelphia, Pennsylvania, USA - Combining the new breast cancer drug palbociclib with paclitaxel (Taxol) shrank tumors in nearly half of ER+ patients, according to new research from the Perelman School of Medicine at the University of Pennsylvania.

The results will be presented Saturday at the 2015 San Antonio Breast Cancer Symposium (Abstract P6-13-08).
A second study (Abstract P4-13-04), to be presented Friday provides new clues to how breast cancer develops resistance to the palbociclib, a common occurrence among many patients who take the drug.

"Results of the first study found that palbociclib and paclitaxel can be safely combined on an alternating dosing schedule," said Angela DeMichele, senior author on the study. "The high response rate we saw suggests this combination may hold benefits for patients over paclitaxel alone. Based on these results, a larger clinical trial to determine the benefits is warranted."

A Complementary Therapy

Palbociclib targets the rapid division of tumor cells by inhibiting the activity of the enzymes CDK4 and CDK6, which help drive cell division and are upregulated in most cancers. The researchers suspected that palbociclib's unique mechanism of action may make it a good partner for other breast cancer drugs such as paclitaxel, which kills dividing cells at a certain point in the cell division process (also known as the "cell cycle"). Palbociclib effectively halts the cell cycle before that point, and thus in principle can synchronize cancer cells in a way that makes them more vulnerable to a closely following dose of paclitaxel.

To begin to test this concept in the clinic, DeMichele and colleagues, including lead author Amy S. Clark, MD, treated 27 breast cancer patients with alternating doses of palbociclib - administered daily for several days at a time - and paclitaxel administered once per week. The researchers ultimately settled on an optimal palbociclib dose of 75 mg per day, combined with a standard dose of paclitaxel.

The chief aim of the study was to determine if this alternating dosing of the two drugs is safe enough to use in larger-scale trials. The results suggest this appeared to be the case. Though most participants developed the low-white-blood-cell count condition known as neutropenia, a common side-effect of palbociclib and other chemo drugs, DeMichele says in general it was not dangerous. Some participants had their palbociclib doses lowered as a result of the condition.

Although the trial wasn't designed to test whether the combination is more effective against breast tumors than paclitaxel, the patients' responses were promising. Nearly half showed long term shrinkage or disappearance of detectable tumors. "The partial or complete response rate among the entire population was 12 out of 27, or 44 percent, and four additional patients achieved stable disease for six months or longer," Clark said.

"That seemed better than what we would have expected from paclitaxel alone, but the only way to know the difference for certain is with a randomized clinical trial of the combination versus the single drug," DeMichele said.

The team now hopes to set up such a trial. They also plan a similar trial using a newly developed CDK4/6 inhibitor, Novartis's ribociclib.

Clues to Resistance

In a related study, DeMichele and her colleagues, collaborating with a team at palbociclib's maker Pfizer, looked for molecular clues to how breast cancer develops resistance to the drug. By examining samples taken from a patient through the course of her treatment with palbociclib, the team found that as the tumors became resistant, the cells more than doubled their expression of several cell-cycle-driving genes, including PLK1, TOP2A, CDK1, and BUB1. Lab dish studies of tumor cells that develop resistance to palbociclib revealed similar changes.

The study focused on a Penn Medicine patient who was first diagnosed with breast cancer in 1999. After more than a decade of standard therapies, the patient's cancer was found to have progressed in 2010. As part of an earlier clinical trial, she began treatment with palbociclib. The drug caused the woman's tumor to shrink, and her cancer remained progression-free for nearly three years, until a metastatic skin lesion was detected in 2013.

Notably, the resistant cancer cells did not appear to have lost the activity of the tumor suppressor RB1--a potential mechanism of resistance since the CDK4 and CDK6 enzymes drive cell division in part by suppressing RB1. The analysis also ruled out several other suspected mechanisms including alterations to CDK4/6 genes and estrogen receptor genes.

"It appears that while the drug blocks two important cell-cycle drivers, CDK4 and CDK6, other cell cycle genes can compensate with increased expression levels to enable tumor cells to start dividing again," DeMichele said. "That suggests that we might be able to prevent this resistance by adding a drug that blocks these other cell-cycle drivers."

Wife was Age 45 at Dx 4/2014. BMX Surgery 6/2014 revealed: ILC, Stage 2 (Multifocal ILC, largest lesion 2.2 cm), Grade 2, ER+/PR+ (95%), HER2-, Ki-67 5-10%, Oncotype 11; Variant in the ATM gene Dx 4/8/2014, ILC, Left, 2cm, Stage IIA, Grade 2, 0/3 nodes, ER+/PR+, HER2- (IHC) Surgery 6/26/2014 Mastectomy; Reconstruction (left); Reconstruction (right)
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Jul 29, 2016 11:14AM ALH49 wrote:

JohnSmith -- is your wife participating in the PALLAS trial? I'm thinking of doing it and I'm wondering if anyone else with Stage 2 or 3 breast cancer has started the trial and what they've experienced so far.

Dx 8/31/2015, ILC, Left, 2cm, Stage IIA, 0/2 nodes, ER+, HER2- Chemotherapy 9/16/2015 AC + T (Taxol) Surgery 2/15/2016 Lumpectomy: Left Hormonal Therapy 4/22/2016 Arimidex (anastrozole), Zoladex (goserelin) Surgery 5/9/2016 Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 5/31/2016 Lumpectomy: Left
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Dec 8, 2016 06:42PM - edited Dec 8, 2016 06:43PM by JohnSmith

@ALH49. Sorry for the slow response. No, she's not participating in the PALLAS clinical trial.


Here's some news about the trial and CDK 4/6 inhibitors from San Antonio Breast Cancer Symposium (SABCS)
Dec 8, 2016.

Next Big Thing in ER+ Breast Cancer: For Early-Stage Too?
SAN ANTONIO, TEXAS - Two agents that inhibit cyclin-dependent kinases 4 and 6 (CDK4/6) have yielded unprecedented results in progression-free survival in clinical trials involving postmenopausal women with ER+, HER2- metastatic breast cancer.
One drug, palbociclib (Ibrance, Pfizer), is approved by the US Food and Drug Administration in this metastatic setting, and the other agent, ribociclib (Novartis), is under priority review by regulators for use in the same setting.
Now, new data on the third agent in this class, the still experimental abemaciclib (Eli Lilly), show that the strategy of inhibiting CDK4/6 has effectiveness in even more patients – those with early-stage disease.
In the first randomized neoadjuvant trial of a CDK4/6 inhibitor in early-stage patients, twice-daily abemaciclib, either alone or in combination with anastrozole (Arimidex, AstraZeneca), significantly reduced Ki67 expression after 2 weeks of presurgery treatment in comparison with anastrozole alone. Thus, the three-arm, 161-patient study met its primary endpoint.
"Ki67 is a well-validated surrogate endpoint for disease-free survival," said lead study author Sara Hurvitz, MD, of the Jonsson Comprehensive Cancer Center at the University of California, Los Angeles. She spoke at a press conference here at the San Antonio Breast Cancer Symposium (SABCS) 2016.
These new findings are akin to results from two earlier, single-arm neoadjuvant trials with palbociclib and ribociclib that also showed reductions Ki67 levels among patients with early-stage disease. Together, these results raise the question:
Is CDK4/6 inhibition well suited to be a curative therapy for early-stage disease?
Dr Hurwitz wants to find out: "We need to push this into early-stage disease," she told Medscape Medical News concerning adjuvant and neodadjuvant studies.
Echoing other experts, she said the results in metastatic disease are important and represent a new standard.
"It's the biggest thing that's happened in the last decade [in metastatic ER-positive disease]," said Dr Hurvitz, referring to the success of CDK4/6 inhibitors. "It's a very important class of drugs."
Tufia Haddad, MD, a medical oncologist at Mayo Clinic, in Rochester, Minnesota, who is not involved in these clinical trials, is looking forward to more results in early-stage disease.
"We are all very hopeful about this class of drugs in this setting," said Dr Haddad, adding that any improvement in overall survival and progression-free survival will be challenging because results with standard endocrine therapies are already good in these patients with early-stage disease.
The large international PALLAS study addresses this question, said Dr Haddad. Now enrolling patients, the adjuvant trial examines standard endocrine therapy alone or in combination with palbociclib for the treatment of pre- and postmenopausal women with stage II and stage III disease that is HR positive and HER2 negative.
Aditya Bardia, MBBS, MPH, a medical oncologist at the Massachusetts General Cancer Center in Boston, believes that CDK4/6 inhibitors will eventually be used in patients with early-stage disease.
"This is a bit speculative, but I think CDK4/6 inhibition would be effective in the right setting of early-stage disease," said Dr Bardia, who was not involved in this new study.
The right setting for curative use would "probably" be in higher-risk patients in whom endocrine therapy alone is unlikely to be sufficient, he told Medscape Medical News.
However, adverse events are a concern, because the adjuvant setting would involve longer-term use than the metastatic setting, Dr Bardia pointed out.
In the current study of abemaciclib, 55% of patients experienced some grade of diarrhea – and that occurred while the patients were receiving a prophylactic agent, per study design. Also, 37% experienced nausea (all grades). Notably, patients in the study were receiving twice-daily therapy only for up to 4 months. "Now imagine for 5 years, or even 1 year of daily therapy," said Dr Bardia. "This does impact the quality of life," he said.
"These are patients with early breast cancer ― the safety profile is very important," concluded Dr Bardia.
One of the selling points of abemaciclib is that it is associated with much less neutropenia than the other two CDK4 inhibitors, as reported in the literature.
In the current study, grade ≥3 neutropenia was reported in only 8.2% of patients, stated Dr Hurvitz. However, Dr Bardia pointed out that 66% of patients still experienced a decrease in neutrophil count.
At the SABCS press conference, Carlos Arteaga, MD, of the Ingram Cancer Center at Vanderbilt University in Nashville, Tennessee, said that abemaciclib was not just an imitation of the more extensively investigated palbociclib. "This is not like Pepsi-Cola and Coca-Cola," he said.
Dr Hurvitz explained that "this is a fairly unique drug in that it can be given continuously."
She said: "We do not need to take a 1-week or more break every month in order to allow neutrophil recovery," she added, referring to the higher rates of neutropenia seen with the other two agents, with their 3-week-off and 1-week-on regimens.
"During that 1 week off...there is this concern that there will be a rebound in [cancer] cell cycling that may actually promote resistance to this therapy," said Dr Hurvitz. "This is a theoretical benefit of abemaciclib."

- San Antonio Breast Cancer Symposium (SABCS) 2016. Abstract 24-06. Presented December 8, 2016.

Wife was Age 45 at Dx 4/2014. BMX Surgery 6/2014 revealed: ILC, Stage 2 (Multifocal ILC, largest lesion 2.2 cm), Grade 2, ER+/PR+ (95%), HER2-, Ki-67 5-10%, Oncotype 11; Variant in the ATM gene Dx 4/8/2014, ILC, Left, 2cm, Stage IIA, Grade 2, 0/3 nodes, ER+/PR+, HER2- (IHC) Surgery 6/26/2014 Mastectomy; Reconstruction (left); Reconstruction (right)
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Jan 9, 2017 06:57PM Melgirl wrote:

I am on day 10 of this study. Anyone else?

Melissa

Age 48 at Dx, married, 13yo daughter and 9yo son Dx 1/29/2016, DCIS, Left, 6cm+, Stage 0 Dx 1/29/2016, IDC, Left, 2cm, Stage IIB Dx 1/29/2016, IDC, Left, 4cm, Stage IIB, Grade 3, 1/10 nodes, ER+/PR+, HER2- Surgery 1/29/2016 Mastectomy: Left, Right Chemotherapy 3/4/2016 AC + T (Taxol) Hormonal Therapy 9/5/2016 Arimidex (anastrozole) Surgery 9/7/2016 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Radiation Therapy 10/5/2016 Whole-breast: Breast, Lymph nodes, Chest wall Surgery 11/17/2016 Prophylactic ovary removal Targeted Therapy Ibrance (palbociclib)
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Feb 8, 2017 05:37PM Akaamy2003 wrote:

I was just assigned to the PALLAS trial today. I landed in Arm A (palbociclib/Ibrance), which is both a relief and scary at the same time. I am supposed to start next Tuesday the 14th.

I did not have chemotherapy, even though I had three positive nodes, because of a low oncotype score. I'm currently on tamoxifen but recently started Lupron shots and once we know those are doing their job, I'll switch to anastrozole.

I'm interested to hear from others in this trial and would like to keep in touch and compare notes.

Dx 6/20/2016, IDC, Right, 3cm, Stage IIB, Grade 1, 3/12 nodes, ER+/PR+, HER2- Surgery 7/12/2016 Mastectomy: Right Surgery 7/27/2016 Lymph node removal: Underarm/Axillary
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Feb 15, 2017 11:21PM Licata519 wrote:

My tissue is being sent in to see if I qualify.

Dx 8/26/2016, ILC, Left, 1cm, Stage IIA, Grade 2, 1/2 nodes, ER+/PR+, HER2- Surgery 9/18/2016 Lumpectomy: Left, Right; Lymph node removal: Left, Sentinel Radiation Therapy 11/9/2016 Whole-breast: Breast, Lymph nodes Hormonal Therapy Femara (letrozole)
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Feb 20, 2017 07:08PM Licata519 wrote:

I am on the control arm, meaning I don't get the Ibrance. 😢

Dx 8/26/2016, ILC, Left, 1cm, Stage IIA, Grade 2, 1/2 nodes, ER+/PR+, HER2- Surgery 9/18/2016 Lumpectomy: Left, Right; Lymph node removal: Left, Sentinel Radiation Therapy 11/9/2016 Whole-breast: Breast, Lymph nodes Hormonal Therapy Femara (letrozole)
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Feb 20, 2017 07:22PM Hopeful82014 wrote:

Bummer about being on the control arm, Licata :( I hope the knowledge that you're helping others is some small consolation.

I would have liked to do the trial but had done neoadjuvant Femara so didn't qualify. Otherwise, I would have volunteered in a heartbeat. I did get into another trial however but don't know which arm I'm in.

Stage IIA. One known positive node at dx. Six months neoadjuvant Femara. Participating in Herceptin/Neuvax E-75 trial post-treatment. PALB2 mutation. Dx 9/2014, IDC, Left, 1cm, Stage IIA, Grade 2, ER+/PR-, HER2- Hormonal Therapy 10/13/2014 Femara (letrozole) Radiation Therapy 6/17/2015 Whole-breast: Breast, Lymph nodes Targeted Therapy 11/2/2015 Herceptin (trastuzumab) Surgery Lumpectomy: Left; Lymph node removal: Sentinel
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Feb 21, 2017 04:49AM SSInUK wrote:

what is the trial Hopefour? I wanted to do PALLAS too but ineligible

Dx 11/2014, IDC, Left, 5cm, Stage IIIA, Grade 2, 5/17 nodes, ER+/PR+, HER2+ Dx 3/30/2016, Left, Stage IIIC Surgery Reconstruction (left): DIEP flap Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone), Zoladex (goserelin) Targeted Therapy Herceptin (trastuzumab) Radiation Therapy Whole-breast: Breast, Lymph nodes, Chest wall Surgery Lymph node removal: Underarm/Axillary Surgery Lymph node removal: Underarm/Axillary; Mastectomy: Left Chemotherapy AC + T (Taxol)
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Mar 4, 2017 05:32PM Akaamy2003 wrote:

An update from me: After two weeks on palbo my blood work showed my white blood cells (mainly neutrophils) had gone down too low and I had to stop taking it. The plan is to check again in a week or two and then start me back on a lower dose. The only side effects I noticed during those two weeks was the giant bruise where they took blood, and when I blow my nose, it's bloody. But otherwise I have not noticed any unusual bruising, and I have had no fatigue, nausea, hair loss, or anything like that. I felt pretty much totally normal while on palbo. Fingers crossed my WBC bounce back and I can start again soon.

Dx 6/20/2016, IDC, Right, 3cm, Stage IIB, Grade 1, 3/12 nodes, ER+/PR+, HER2- Surgery 7/12/2016 Mastectomy: Right Surgery 7/27/2016 Lymph node removal: Underarm/Axillary
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Mar 7, 2017 05:43PM ArtyMom wrote:

I signed the paperwork to join this study today. They took some blood and will take a sample of my tumor. Then I'll be randomized. I'm also joining the B Well study about fitness after treatment. Glad to feel like I'm helping the cause

Dx 10/18/2016, IDC, Right, 1cm, Stage IA, Grade 2, 2/3 nodes, ER+/PR+, HER2- Surgery 11/7/2016 Lumpectomy: Right; Lymph node removal Radiation Therapy 12/26/2016 Whole-breast: Breast, Lymph nodes
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Mar 13, 2017 04:35PM cwaechte wrote:

I am also participating in this clinical trial too. After ten days I was told to stop taking the drug because my neutrophils count was too low. Like akaAmy2003, I will have my blood work evaluated again this week to see if I can go back on. I'm hoping they are able to do that, maybe with a lower dosage. Unfortunately, I am feeling extremely exhausted, just can't seem to shake it. Good luck to everyone.

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Mar 20, 2017 06:25PM ArtyMom wrote:

I was randomized into the 'taking the drug' arm of the study. Taking more blood and getting the drug on Thursday. Also joining the Bwell study, hoping to get the Fitbit and personal fitness training branch

Dx 10/18/2016, IDC, Right, 1cm, Stage IA, Grade 2, 2/3 nodes, ER+/PR+, HER2- Surgery 11/7/2016 Lumpectomy: Right; Lymph node removal Radiation Therapy 12/26/2016 Whole-breast: Breast, Lymph nodes
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Mar 20, 2017 09:49PM Akaamy2003 wrote:

Welcome Artymom! I hope we can compare notes. I am on round 2 of palbo now. I had to take a break when my neutrophils went too low, but am back on the 125 dose for now. So far I don't have side effects but my understanding is that they may not really kick in until week 3. I have not made it that far yet! I did notice today that I could not taste my lunch at all, so that could be the palbo. Weird.

I have not heard of the Bwell study. I will ask about it. I'd need to be in the couch potato arm, if there is one :)

Dx 6/20/2016, IDC, Right, 3cm, Stage IIB, Grade 1, 3/12 nodes, ER+/PR+, HER2- Surgery 7/12/2016 Mastectomy: Right Surgery 7/27/2016 Lymph node removal: Underarm/Axillary

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