I’ve been on Ibrance with Letrozole for 8 months now. My metastasis is to chest cavity modes and my liver. Chest cavity nodes are stable but The size of my lesion and tumour markers in my liver fluctuate and now a little one has grown 30%. It fluctuates with every CT scan. My latest CT scan was last Friday. My oncologist gave me this news and said he wants a PET scan immediately and thinks we should go back to conventional chemo. I don’t see why he won’t try another pill treatment. Maybe because he thinks it’s too aggressive and the chair of horror is the only option left.
Has this happened to any of you? And what was the course of action as well as the results you got from it?
Thank you so much and God bless you all 🙏💕
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Annadm
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I will be interested to find out what you do. I am in the same boat. After 6 months Ibrance/Faslodex has stopped working. I am meeting with new oncologist Tues to set date for new scans and treatment plan. God bless and hope you find the solution best for you!
Hi Annadm -
To be honest, I'd have the exact same question.
Needless to say, your doc is the one who went to med school, but from what you describe it does seem like another "pill" option - or injections of Fulvestrant(sp?)/Faslodex - is what's typical (based on what we see here on the board...), unless the progression is pretty worrisome?
I would def discuss with your doc and/or get a second opinion. Re: discussing with your doc, simply expressing this as your preference while maybe conveying that you're okay assuming a bit of risk (if this is what s/he's concerned about....), would help?
Re: second opinion, if you don't want to see someone in person, I'm pretty sure they're all doing teledoc these days. I'd keep in mind that the process of setting that up can take some time, e.g. if you have to obtain / mail CD's of the scans and medical records, this can (in my experience) take about a week.
One potential shortcut is if you can find a doc who's on the same "share site", in which case the secondary doc can just access your scans/info online. (My experience is US-based...not sure where you live but things might be different). E.g. I've learned that Duke and MSK are on the same share site...my local provider is not. So if you want to move extra quickly, I'd either ask about which hospitals are on the same share site or, if they can't provide that, get the name of the share site and ask about it when you're selecting a secondary doc?
Good luck with it! And I admire your self-advocacy (I just read Radical Remission and they listed this trait as key! ).
I am sorry to hear you are requiring a new treatment, but the good news is that you have many options for second-line therapy that do not include IV chemo. Typically, chemo will not be offered until at least 2 prior endocrine therapies have failed (or the patient is experiencing visceral crisis), and then the first chemo that's prescribed is tyoically an oral form called Xeloda.
Below from my book, "The Insider's Guide to Metastatic Breast Cancer" which is also offered as a complimentary .pdf is a list of therapies for hormone receptor positive, HER2 negative postmenopausal patients. For more info pls visit insidersguidembc.com/about
I would strongly suggest that you consider seeking a second professional opinion.
FDA-Approved First Line Hormonal and Targeted Treatment Options for Postmenopausal Patients in the US (depending upon what, if any, recent treatments the patient may have had in the adjuvant setting):
•The combination of a CDK4/6 inhibitor such as Ibrance, Kisqali or Verzenio with either an Aromatase Inhibitor (Letrozole, Arimidex, or Aromasin) or with Faslodex (Fulvestrant) is the current standard-of-care as initial treatment.
•An Aromatase Inhibitor alone
•Faslodex (Fulvestrant) with either Letrozole or Arimidex
•Faslodex (Fulvestrant) alone
•Tamoxifen (Nolvadex) or Fareston (Toremifene) alone (rarely used as a first-line therapy).
FDA-Approved Second Line Hormonal and Targeted Treatment Options for Postmenopausal Patients in the US (depending upon prior treatment):
•Possibly any of the above therapies.
•Afinitor with either Aromasin, Faslodex, or Tamoxifen.
•Verzenio alone (after disease progression on endocrine therapy and prior chemotherapy for MBC).
•Piqray in combination with Faslodex if the cancer has a PI3K mutation
FDA-Approved Third Line and Above Hormonal and Targeted Treatment Options for Postmenopausal Patients in the US (depending upon prior treatment):
•Possibly any of the above therapies (although not all options are widely used in a third or later line setting).
•Either Ethinyl Estradiol, Megace (Megestrol Acetate), or Halotestin (Fluoxymesterone).
Chemotherapy is usually prescribed after 2 to 3 lines of endocrine therapy have stopped working. A clinical trial may also be a consideration. Once the cancer has regressed or stabilized, it may be possible to go back on endocrine therapy if sufficient time has elapsed and if the initial response to endocrine therapy had been favorable.
Annadm, there are some great post lots of information.
I'm in the process of changing from 40 cycles of Ibrance/Let then Flav.... to Afintor/EV.
I went from 15 Months NED on Ibrance to liver issues. I currently have several Liver Tumors...the largest being 4.9cm. It was biopsied at 1cm, keep Ibrance but changed Letrozone to Flav. Waited 5 months. Kept growing. 4.9cm seems really large to me. But, Mayo docs still want to try more oral therapy, so Afinitor it is.
I agree with the great information provided by all these wonderful Peeps. Go into your next appointment informed, ask all the questions about all the other therapies and trials available. I keep a list on my desk and mark off the ones I'd had and make a note on the ones I'm not eligible for.
My first Onc....started my on IV Chemo....Adriamycin/cytoxan (3 cyclesof the RED DEVIL). With a Aortic Thoracic Aneurism - Today, I think that was the wrong move, Ibrance had already been release and that should have been my 1st line of treatment.
My 2nd opinion was 2 months into the process. I changed docs and started Ibrance. I'd like to think I had a successful run for 3yrs. on Ibrance.
Stay Strong be informed. I know it took me a few months to get upto speed. It did not help that I was diag. and started IV chemo the next day. It was such a whirlwind. I try to read a little everyday so that I keep a balance with life.
I started chemo, Abraxane, in May and after the first month I am actually feeling better then I did while taking Ibrance and Letrozole. I have more energy and less side effects then I did before. I don’t have Mets to my liver so your chemo drug could be different. I was scared when I had to switch but it’s ended up being better all round for me.
That is so reassuring. Thank you so much for answering. 💕... anything showing that the chemo is working over the Ibrance and Letrozole? Did you lose all your hair again? God bless you 🙏
My first ct scan showed numerous of my bone mets were healing. ❤️. The first time I have received that kind of need. I did lose my hair but being summer and hating the heat it’s not bad. I don’t like my look without hair but I don’t let it bother me.
Glad to hear you are feeling better. Chemo had a bad sound to it for me, but I am trying to retrain my thinking that there are many kinds of chemo and it is helpful. It is just a matter of getting the right one for our body. Everyone reacts so differently with these meds. I have heard some women say their chemo is easier on them then some of the hormonal meds they were on. One just never knows! Thanks for sharing with us Sarcie!
I’ve been on same treatment plan (also monthly injections of Zoladex) for 7 months for exactly the same Mets. My last scan showed an improvement but was told that women typically have 2 years before it stops working and then it’s chemo but a very mild version. It’s such a rollercoaster as although we may get a great scan we’re told it’ll never go away and we will always be on treatment. It’s hard to feel happy when we know what’s still to come. Trying to stay positive though as I know we are all getting more years than we used to plus there’s so many treatments out there. 👍
Ask your oncologist why he is suggesting IV over pills. You can't feel confident with the choice if you don't know why. If you disagree with his answer then please get a second opinion. Some practices seem to be more comfortable with the same way they have always done things. Hopefully, if you talk to him about the treatment something will feel right to you. I wish you the very best and lots of peace with your decision 🙏. Blessings Hannah
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