Hi everyone,
My mom's tumor markers came back higher, and her doctor wants her to switch from letrozole (which she's been on for 2 years) to either faslodex or exemestane. Just wanted to ask if any of you have used either and if there is a preference for one over the other.
Thank you
Hi Jac-genova -
I'm sorry to read about your mom's situation, and I'm really questioning the wisdom of making a change based on tumor markers. Has she had a scan recently? Tumor markers can be inaccurate for some women and even when they're accurate (e.g. for me) they can increase for months before any progression is detected on a scan. *And*, even if a bit of progression shows up when, e.g. the cancer seems to be slow-growing, etc., I'm an advocate of trying to wait it out before making a change and my docs have gone along with me on this...
Again, from what I think I've learned, we should (almost?) never change based only on markers...
Take care,
Lynn
That is true Lynn! Last scan showed slight increase in activity in one of her tumors but other than that nothing. I'm thinking maybe her markets couldve been elevated from stress/too many carbs on thanksgiving?
Hi Jac-genova -
When you say "increased activity", are you saying this was a PET and the tumor "heated up" a bit? I'll mention that on my first treatment my PETs showed things cooling off for 2.5 years (to where they barely registered), then they gradually heated up for another 1.5 years before I changed treatment due to a couple of small "new" mets (still bone, and I have lots and lots of small mets). So you can still ride things out for a long time with "increased activity" (i.e. heat) as long as you don't get new mets or, in many cases, growth of existing.
If they used a PET, even one with CT lite, to conclude that the tumor has grown, I'd be leery of that, too. Simply hotter can apparenty look "bigger" on a PET due to a halo effect. (*I'll mention that I'm only 98% certain of what I'm describing)
I'll also mention, in case your mom has a similar occurrence, I still question whether those two new mets I had were actually *new*. We used a PET (with CT-lite, i.e. not a fully diagnostic CT) to make the decision. A question remains in my mind re: whether those two were truly new or were they old but somewhat dormant, too cool to be detected for a period of time. The radiologists typically compare only to the prior scan. I wish I had asked them to compare to much earlier scans, too.
Since that time, I've been doing mostly CT's (fully diagnostic), specifically to avoid this issue. At my local provider, as at most providers, the machine they use is a PET with a CT that is used to do something like line up the images (don't quote me on that...I just call it "CT lite"). Some providers, like my secondary onc at Duke, have a machine that truly does both. *I think the key word to use when asking is if the CT is "diagnostic"?*.
Good luck with it...
Lynn
And, to your original question, my vote would be for Faslodex, if she does need to change. I've found it to be a very easy treatment, I'm 2.25 years in...
Hi Jac- Genova
My tumor markers went up the first few months I was on Exemestane/Ibrance. My Oncologist said tumor markers often go up at the beginning of treatments..... then after 7 months my markers went down. All stable now. Has your mother been stable up to this point? It is difficult not to want to leap to change— but scans may tell more if the story. Wishing you the best as you navigate the next steps.
Thank you! Her markers have been pretty stable the past 2 months - they'll jump from 56 to 66 then stay in the lower 60s, I think this past time they went up a few more points.
Good Morning - my experience has been 6 years on exemestane, which I tolerated pretty well. When MBC was diagnosed 2 1/2 years ago, I was switched to monthly faslodex injections. I will say that I seemed to feel achier (arthritis pain accentuated) on exemestane than I do on faslodex. My doctor tries to act quickly to make changes to head off increases rather than to wait for big changes, so I won't speak to doctors decisions about meds changes. But I like that everyone with experience has some good advice for you to consider. Prayers and our best to your mother!
Thank you so much! Praying for you as well. Yes her doctor wanted her to consider ibrance but we both are trying to be more conservative so she said she may just switch her from letrozole to faslodex
Exemestane is a "sister drug" to letrozole, so if letrozole fails (which is undetermined unless a scan shows progression) then faslodex (possibly with a CDK4/6 inhibitor) would be a viable choice.
Right, that's what I thought too but her Dr said she can do either exemestane of faslodex. What's the difference between exemestane & faslodex though?
Exemestane is an Aromatase Inhibitor (AI) like Letrozole. Faslodex (Fulvestrant) is a SERD (Selective Estrogen Receptor Degrader). They work differently to prevent estrogen from reaching the estrogen receptors on cancer cells.
If you do exemestane do you have to do afintor as well? Is this a good combo
Exemestane can be prescribed alone, although that is rare these days since it is usually prescribed in combination with a CDK4/6 inhibitor or Afinitor. Although some people do well on the Afinitor/Exemestane combination, Afinitor can cause significant side effects for some patients. It would be best to discuss options with your medical oncologist with regard to the pros and cons. Good wishes!
Could you tell me some of the side effects?
The most common adverse reactions (incidence ≥30%) were stomatitis (mouth sores) (67%), infections (50%), rash (39%), fatigue (36%), diarrhea (33%), and decreased appetite (30%). The most common grade 3/4 adverse reactions (incidence ≥2%) were stomatitis (8%), infections (6%), hyperglycemia (5%), fatigue (4%), dyspnea (difficulty breathing) (4%), pneumonitis (lung inflammation) (4%), asthenia (weakness) (2%), and diarrhea (2%).
*or
We’re all different.... I was on Ibrance and Letrozole successfully for about 46 months. I went on exemestane and everolimus for 6 months—it did nothing for me and my lungs reacted badly—don’t know which drug caused the SE. I seem to be doing ok on faslodex and Piqray. I had two injections of Faslodex before starting Piqray and other than a little butt soreness for a few days, had no SE.
Afinator and Exemestane
Exemestane and Afinitor
Faslodex 
Faslodex 
Faslodex
