"Ask Me Anything" on HealthUnlocked with Dr. Eleonora Teplinsky
Monday, February 11th
3-4pm ET
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2. Join us at 3 pm ET, Today February 11th, on HealthUnlocked. A new post will be created titled "Ask Me Anything with Teplinsky, Join Now" where you can post any questions you have about Metastatic cancer and Dr. Teplinsky will answer as many of them as she can.
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My oncologist told me about an upcoming CDK 4/6 inhibitor called Alpelisib, specifically for those who have the PIK3CA mutation. Do you know anything about this....when it may be available, if it is now available in clinical trials, what the side effects may be? Thanks!
Alpelisib is not a CDK 4/6 inhibitor but actually is a PI3K inhibitor that is being studied in breast cancer. There was a fantastic study presented at the ESMO conference this past fall. Alpelisib was studied with fulvestrant in patients with PIK3CA-mutated breast cancer and it doubled progression free survival (11 months versus 5.7 months). I highly recommend that people whose cancer has progressed on CDK 4/6 inhibitors be tested for the PIK3CA mutation. Most common side effects are high blood sugar, nausea, diarrhea, vomiting, decreased appetite and fatigue. It is not yet FDA approved but is in clinical trials.
Thank you for clarifying and for the additional info! I have not yet taken a CDK 4/6 inhibitor so my cancer has not progressed on Ibrance or another one. Are you suggesting to try one of those before Alpelisib, even with the mutation? (of course I'll discuss with my oncologist too!) Thanks again!
That depends on whether a clinical trial is available and what population it is looking at as alpelisib is not yet FDA approved.
Good evening Dr Teplinsky,
I posted my question in another thread, so this is just a repeat of my question on there. I am interested in finding out if the following therapies are effective in treating metastatic breast cancer:
-Cryotherapy
-Cryoablation
-Vascular embolisation
-Vitamin C infusions
-Mistletoe therapy
-Infrared saunas (near or far?)
Also, the question I think a lot of us are thinking: does it look like we are any closer to a cure for this disease?
Thanks,
Sophie
THanks for your question! Unfortunately, there is no evidence based data that I am aware of for treating metastatic breast cancer with any of those modalities. I think it's hard to say whether we are closer to a cure but we are certainly closer to overcoming mechanisms of resistance, developing new cancer treatments and hopefully this translates into improved survival!!
Thank you for your answer, Doctor. That's what I was thinking too, but thought I would run it by you to see what your thoughts are. It is encouraging to know that we are getting closer to dealing with resistance, and developing new treatments. That can only be good news for us all as it makes it easier to deal with this disease as a chronic illness rather than thinking that death may be imminent! Thank you!
Sophie
Is there any information that determines if length of time from first cancer diagnosis to onset of MBC
has any significane?
It depends on the initial breast cancer diagnosis and what type of cancer that it was - whether ER positive, HER2-positive or triple negative. It also depends on the extent of metastatic disease that someone has.
From @mariootsi Thank you so much for making Dr. Tepinski available to us. I believe I would ask the question s already outlined plus help for low platelets while on Ibrance. My palliative care doc gave me wheatgrass powder which I use in a smoothie. I made it through my 3 wk. Ibrance cycle. I will have bloodwork on Monday. So far so good. Is it safe? How safe is cbd oil in combo with Ibrance and Faslodex? Have you done any research with the oil? And dosage. Thank you, Marianne
I personally have not done any research on CBD oil but I do have patients who use CBD oil. I am not aware of any interactions with CBD oil and low platelets but this use of CBD oil is fairly new and we may just not be aware of anything yet.
Sorry I replied to this and it deleted my post!
Basically, right now, we know that new drugs for ER+/HER2- MBC (such as CDK 4/6 inhibitors) have not yet significantly improved overall survival but have improved progression free survival and we hope that with longer term follow-up, this will translate into overall survival benefit. With that said, ER+/HER2- MBC to bone only has an excellent prognosis. I can't give a number without knowing the exact situation BUT these patients do quite well in the spectrum of metastatic disease.
From: barbarac76 Hi Maem. Thanks so much for doing this. I have three questions:
1. Repeating therapies - Can you ever return to a treatment (hormone or chemo) after it has run its course?
2. Diet - There is a lot of discussion about diet and living with metastatic breast cancer. Do have strong feelings about specific foods to avoid and specific foods that can help?
3. New drugs - Are there any promising new treatments on the horizon? I have ER+, HER2- MBC.
Thanks again.
Barbara
Thanks for your questions. Sometimes, you can return to prior therapies- depends how long you were on them and when, what side effects you experienced and so forth.
In terms of diet, there's data for the Mediterranean diet in lowering breast cancer risk/recurrence. We don't know how that affects metastatic breasts cancer. Overall, I recommend a healthy lifestyle- core of fruits, vegetables, legumes, whole grains, healthy fats (avocado, olive oil), fish, some poultry-- limiting red meats and processed foods!
There are new treatments on horizon -- immunotherapy for triple negative, PI3K inhibitors for ER+/HER2- breast cancer. Sacituzumab govitecan is a new antibody drug conjugate for ER+/HER2- MBC with promising data in early clinical trials!
Is it true that drug companies choose names for new drugs by pulling random letters from a pile of Scrabble tiles and arranging them in the least-pronounceable order? "Sacituzumab govitecan"....sheesh! 
Agree--- it's so hard to pronounce some of these names!!
From: @kduck Are there any New treatments for er/hr positive bone mets only!
Yup! We are seeing new studies with PI3K inhibitors (alpelisib), sacituzumab govitecan- antibody drug conjugate for ER+/HER2- breast cancer
From: @lemur2015 Hello Maem! I have mbc to the lymphe nodes and a large pleural effusion. I am currenly on Ibrance (5th cylce) and letrazole. Does the pleural effusion ever dissipate? Are there other drugs out their besides Faslodex and Letrazole?
There are many other drugs besides faslodex and letrozole. Sometimes, the pleural effusion resolves with treatment and other times, it needs to be drained if causing symptoms.
From: @Becca65 Will try to be here for the live but gonna post questions here
ER + Her - original breast cancer 2008 infiltrative ductal carcinoma, staged 2b, lumpectomy, had to go back in for clean borders, removed 16 nodes 2 were positive, this was followed by 4x A &C and then 4x T with nulasta given with appropriate drug, then 6-1/2 weeks radiation and because I always had abnormal Pap smears they showed pre cancerous cells a total hysterectomy. Then I was on Femara/letrozole for 6 years. Was no sign of disease for a few years post Femara. Mets were diagnosed July 2017. My only met is to the fluid/lining of my peritoneal cavity and looks very small there in one small area and some tiny flecks of light in the fluid itself. Have had 7-8 pet scans, the only way they can see/find my cancer, since diagnosis. I am looking into Hipec and the scraping cleaning removing of any affected flesh ,would like any info you might have, drs where this procedure might be done for breast cancer mets to peritoneal cavity/ peritoneal carcinamatosis. Where I might get done, best Dr for, may have to be done as palliative care, are there trials going on that I might fit into. My local Dr doesn’t seem to be encouraging me to think out of the box. I found a study online done in Italy I believe. It was very small as it is so rare to have mets to only the peritoneal cavity. But these woman were actually considered cured with the longest patient living 10 years later considered cured not just no sign of disease. Not having to be on chemo drugs. Love my local dr but she encourages me to stay with the known until they stop working. Assuming at that point I would be in worse physical condition and less able to withstand this 6-18 hour surgical procedure and that I would have to go through months of suffering through ascites and it happening multiple times. I would rather try now when I am strong not a deaths door last ditch effort. It could mean a cure for me. Thank you for taking the time to read this. Any and all information, help would be greatly appreciated and might lead to me being cured!
Thank you so very much,
Rebecca
HIPEC is not routinely done in this instance but I would encourage you to speak with a surgical oncologist who performs HIPEC to obtain more information.
In response to your response re: length of time from initial diagnosis to MBC -
Can you share any specifics or generalizations?
I was diagnosed with BC ,ESTROGEN +, with 2 tumors approx 2 cm., inright breast.Total mastectomy,chemo,
no radiation, 5+ years on Tamo then Arimadex(sp?)
18 years later MBC found in pleural effusion.
Just wonder if reoccurance time affects anything?
Thank you
We know that ER+/HER2- breast cancers can recur much later - even 20 years later. Unfortunately, this can occur with early stage breast cancers
New drugs - Are there any promising new treatments on the horizon? I have ER+, HER2- MBC.
Scroll up to see of some my earlier comments but definitely lots of new treatments on the horizon - We are seeing new studies with PI3K inhibitors (alpelisib), sacituzumab govitecan- antibody drug conjugate for ER+/HER2- breast cancer, immunotherapy for triple negative breast cancer.
From: New drugs - Are there any promising new treatments on the horizon? I have ER+, HER2- MBC.
Scroll up to see of some my earlier comments but definitely lots of new treatments on the horizon - We are seeing new studies with PI3K inhibitors (alpelisib), sacituzumab govitecan- antibody drug conjugate for ER+/HER2- breast cancer, immunotherapy for triple negative breast cancer.
From: @danniele2 Besides BRACA! and BRACA2, are there other DNA combinations that are known to be dangerous?
Aside from the BRCA1 and BRCA2 mutations that increase your risk of breast cancer, there are other mutations such as CHEK2, ATM, and PALB2 that also incraese your risk of breast cancer. If you are referred for genetic testing, the genetic counselor will go through with you about which panels you should be tested for which include testing for a number of genes (not just the BRCA 1 and BRCA 2)
from: How important is food and how important are vitamins?
That's a difficult question to answer. Overall, the recommendation is for people to follow a healthy diet! However, if you are getting chemotherapy and are nauseous, it is much more important to keep up caloric intake and so it's okay if you are not eating as healthy as you could be. It depends on which vitamin and where you are in your treatment!
Any studies comparing the effectiveness of Verzenio vs Ibrance on liver mets? How about the difference in side effects? Thanks again!
There are no studies that are specifically looking at abemaciclib versus palbociclib on effectiveness in the liver. However, all three available CDK 4/6 inhibitors (abemaciclib, palbociclib and ribociclib) are pretty equally efficacious. Abemaciclib may be more efffective in the brain. Abemaciclib has more GI side effects (diarrhea) while palbociclib results in more cytopenias (low blood counts).
If one stops working is it common to try a different one, or do they all work in pretty much the same way?
For the most part, it is not common to try a different one. However, there are clinical trials looking at this exact scenario---switching to a different one after progressing on a CDK 4/6 inhibitor- will be interesting to see the results!
From@Polly Are any of the newer medicines crossing the blood-brain barrier?
yes! Abemaciclib is one of the CDK 4/6 inhibitors approved in ER+/HER2- MBC and it crosses the blood brain barrier!
BIg thanks to Dr. Teplinsky and Share, this has been very informative and encouraging!
Yes that is correct. It went to FDA for review for triple negative breast cancer and in 1/2019, was not approved - there were issues in chemistry, manufacturing and control matters...hopefully this will be addressed and brought back to the FDA.
Thank you everyone for joining us today for our Ask Me Anything. And special thanks to Dr. Teplinsky for participating. See you guys next time. Please fill out the evaluation sheet docs.google.com/forms/d/e/1...
Thank you!!! Great answering everyone's questions!
Thank you for your time, Doctor!
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