Tumors shrinking on ibrance and letrozole

[Mcap]

I've just finished my second cycle of ibrance with letrozole. Diagnosed de novo stage 4 with mets to the left lung in February. I'm am very anxious about the treatment working. How soon should I see shrinkage in my breast tumor. Mary

[darlenejulien]

So, I was diagnosed in Aug. 2017 with bone cancer to the spine. Started Ibrance in Sept. & I'm on cycle # 6. The first scan, which was Jan. 2018 showed the the cancer was "controlled".

I would like for it to be gone! But I guess where I have it, this is the best I will get. I'm scared, it's cancer but the results from this medication has become the miracle drug! I might just live to hear my granddaughter say, "Nonna"!

[Mcap in reply to darlenejulien]

Darlenejulien, I am scared too, but controlled sounds like a good place to be.

[neosha in reply to Mcap]

My onc calls it "stable" instead of "controlled" but the meaning is the same. I am scared too and very depressed. I think part of it is chemical. I am already on meds for depression and have been for years. But this situation has really heightened it.

[lashinator]

I'm kind of in the same boat. Still in my first cycle, but I know my first scan isn't until 3 months. I would think that would be the first way to detect if it's working. ?? You would have one more cycle to go to see, if your scan is also at 3 months. Don't hold your breath that long- but I know it's hard not to.

[Mcap in reply to lashinator]

Lashinator, like you, I believe I'm going to be scheduled for a scan after the third cycle. I was just hoping to see some effect to the tumor in my breast. The waiting is hard. Mary

[Joan37]

Hello, Mary. If you have limited disease in the lung you may want to consider using a local procedure along with Ibrance after your first scan, regardless of getting a good scan result.

Local procedures would include radiation to the tumors and/or radiofrequency ablation (RFA). Often times, oncologists never mention this to patients because there is no evidence from prospective clinical trials about whether they are effective. However, Dr. Stephen Chmura of U Chicago is now running such a trial for those living with MBC. His idea is based on that of Dr. Samuel Hellman who several decades ago felt that people who had limited metastatic spread could be helped. This is called oligometastatic disease.

The trial: clinicaltrials.gov/ct2/show...

Ludwig Institute: ludwigcenter.uchicago.edu/p...

I wrote a piece about it on this site. My piece was based on a presentation about MBC at the San Antonio Breast Cancer symposium in Dec. 2017. Dr. Seema Kahn of Northwestern U spoke about these procedures. Dr. Kahn feels that these procedures are being used more and more, despite the lack of evidence.

Dr. Kahn is a surgeon. But I didn't have much luck with surgery for my single lung met in 2007. A year later, it recurred. The surgery was the first thing I did, along with taking Perception. I then did RFA, which burned the tumor with radiofrequency waves (not radiation). There's also microwave ablation and a host of other interventional radiology procedures. My tumor has never come back to my lung, and I continue to take Herceptin. At the time, I had considerable difficulty in getting these procedures and switched to an oncologist who was open to them.

I also had a brain met in 2008, which was removed with a craniotomy followed by 5 dosages of radiation targeted to the tumor bed. That was standard treatment. I had stage II breast cancer in 2003.

[blms in reply to Joan37]

Joan37, thanks for more info. I read several of the reports from the San Antonio conference and found those helpful and reassuring for future treatments as well as what is currently going on. But, I did not look at these and am excited to see what they write. I was first diagnosed with and aggressive stage 3 in 1998, then a return of metastatic BC December 2017. My cancer turned up as nodes, not tumor, attached to my left lower lung lobe with the pleural fluid being the alarm sound. So, at this point, no cancer elsewhere and most of the fluid was gone, indicating that my immune system was working at doing its job. So, I am on letrozole and Ibrance, 100mgs. only right now. As my pleural fluid is my cancer tumor, I need to have some of that to be further tested, I believe. But, possibly with some of these procedures you mention, that is not the case. If my fluid builds back up again and enough to draw through thoreoscentisis, I want to consider tumor sequencing Have any of you done that?

[Joan37 in reply to blms]

blms, thanks for your reply. I'm glad that most of the fluid is gone. I'm not sure whether local procedures can be used for pleural fluid, with the exception of "talcum" powder. I believe that treatment can help to keep the fluid away, but I'm not certain. I did tumor sequencing a little over a year ago. It was a liquid biopsy through GuardantHealth, and I have a few cancer-related mutations.

[blms in reply to Joan37]

where do you live?

[Joan37 in reply to blms]

In the Northeast.

[Mcap in reply to Joan37]

Joan37, thank you for the information about local treatments. I will be talking to my oncologists about my options. My ct scan showed 10 to 20 nodes in the left lung. The largest at 9 mm was biopsied. So im not sure if local treatment would work for me. Mary

[blms]

How much did they charge? I was told by NIH that with sequencing, that their are some treatments that could be done to target the particular tumors DNA. At least when that treatment is available. But, also that the new immunitherapy drugs, etc. are getting closer.

[Joan37 in reply to blms]

I did the test only once. So, I don't have a comparison as of yet. Right now, there are not drugs, but I feel some how comforted in knowing what they are anyway.

(You may already know this, but the assay is not a genetic test but rather a genomic test, meaning that the mutations are not passed from generation to generation. That has nothing to do with how many times the test is done, but sometimes patients are not clear about what a genomics test is.)

I'm hopeful that immunotherapy treatments will improve for breast cancer. Right now, it seems that triple negative breast cancer may be the best candidate, but scientists are working on turning "cold" tumors into "hot" ones, to help increase response rate and duration of response for hormone positive and HER2 positive tumors.

[blms]

Are ;you HER2+ or -?

[Joan37 in reply to blms]

I'm HER2+/ER-/PR-. Always. Since first being diagnosed with stage II breast cancer in 2003.

[lashinator]

I dont know when you see a shrinkage. I would need a scan to tell. Seeing Onc next Tues. Will def ask! I want to know too!

[MaryJ-S]

My oncologist gives me 3 to 4 months to see if a treatment is working. With Ibrance and Letrozole he gave it 3 months as my tumor markers made a 300 point jump. Now I am on Ibrance and Faslodex and hoping this combination will work.

[HopeinNJ in reply to MaryJ-S]

Hi Mary, my name is Cindy. I have lung Metz dx in Nov 2017. (Was originally Stage one in 2012) I now have diffuse nodules through out both lungs. A persistent cough led to a scan. Blood tests found my 27/29 marker was 450. Four months on IBRANCE and Letrozole my nodules are decreased by 50 percent and my oncologist anticipates 100 percent and NED by the summer. My markers are currently down to 85 as of last week.

[Mcap]

Cindy, that's great news. I have an appointment with my oncologists today. I'm going to ask about tumor markers. I'm not sure if they use them. Hope to hear your NED soon.

[blms]

Okay end of my first week off lower Ibrance dosage and neutrophils even lower than last week. That is surprise. I thought I’d be on the rebound! Any similar?

[blms in reply to blms]

At hospital now waiting for my car and just surprised

[Mcap]

Just left my oncologists office. Cannot start my 3rd cycle of ibrance. After a week off my neutrophils are lower than they were at the end of my second cycle. I was told almost considered severe neutropenia. So I get another week off and if they don't come up I'll be getting a lower dose. I've been assured that it will not change the way the medication works. That my body may not be able to tolerate the higher dose. But I'm so disappointed.

[Bobbie86]

My mum Had her first results from the first 3 month scan today. She was diagnosed in April with bc, a broken neck and bone/lung mets all in the same day! She started on Letrozole that day. Started on the palbociclib/Ibrance 125mg few weeks later. She has had low blood counts so has had a few weeks off through each cycle and has had the foes lowered to 100mg but things seem to be settled. She seems well in herself. She has lost some weight and her hair is falling out quite a bit but she seems good. Results were There is no further activity and some nodules on her lungs have shrunk. She also knows that the lump in the breast has shrunk as she can feel it and says it’s more than half the size smaller now. Such positive news today. We didn’t know what to expect. Now it’s 3 monthly scans and to continue this treatment plan. Also told today to enjoy a good quality of life x