Xeloda next, why not fulvastrant with Palbo first?

[Tigg14]

Hi

I’ve recently had small liver progression on Letrozole/palbo and will now be starting Xeloda on Friday which is making me a bit anxious re the side effects. However, I’m also wondering why my onc didn’t try fulvastrant with palbo firstly. I forgot to ask her last time we spoke. Does anyone know if this is normally tried first, or indeed, if it’s something that can be used after Xeloda?

I’m hoping Xeloda works for me but can’t help trying to think two steps ahead.

Such a blooming nightmare trying to think positively and just enjoy life with this rumbling in the background all the time!!

Hope you all have a lovely day…it’s sunny in London today and makes me feel so much better xxx

[Bestbird]

It is unusual for an oncologist to recommend chemo (which Xeloda is, in oral form) after only one line of endocrine therapy.

Below is a list of NICE-approved treatments for HR+, HER2- postmenopausal patients in the UK from my book, "The Insider's Guide to Metastatic Breast Cancer" which is also available as a complimentary .pdf. For information about approved treatments in the US, Canada, Europe and Australia, and for material about clinical trials and cutting edge research, please visit insidersguidembc.com

Second Line Hormonal and Targeted Treatment Options as per NICE Guidelines for Postmenopausal Patients:

• An Aromatase Inhibitor (Letrozole, Arimidex, or Aromasin) alone if the patient had previously received tamoxifen or chemotherapy

• Afinitor and Aromasin (for women without symptomatic visceral disease that has progressed after a non-steroidal aromatase inhibitor [Letrozole or Arimidex])

• Verzenio and Faslodex (for women without symptomatic visceral disease that has progressed after a non-steroidal aromatase inhibitor [Letrozole or Arimidex])

• Ibrance and Faslodex after prior endocrine therapy

• Kisqali and Faslodex after prior endocrine therapy

The above NICE hormonal treatment information is From: pathways.nice.org.uk/pathwa... and medicalxpress.com/news/2019... and pharmaphorum.com/news/nice-...

[love2golfwell]

If it were me I would ask about trying Ibrance with Fulvestrant before going to Xeloda. On the commercial for Ibrance it always talks about Ibrance with an aromatase inhibitor as a first line of treatment or Ibrance with Fulvestrant if there is progression on the aromatase inhibitor. I think you have a right to question your treatment if you are feeling uncomfortable. Best wishes to you.

[Bestbird]

girlsptz, so very true! And when I tried to research approved therapies in Canada, my head began to spin...

The UK is governed by NICE guidelines; as far as I'm aware there are no additional province related restrictions such as exist in Canada. But then, I learn something new every day!

One can well imagine that it is frustrating to read about therapies approved in another country that are not available in one's own. I wish that best-in-class treatments were available to everyone!

[queeneee]

I went off fulvestrant and verzenio because of side effects, I find xeloda better/more flexible.. so there is one advantage!

[Tigg14 in reply to queeneee]

Thanks, hope that’s the same for me xx

[Tigg14]

Thanks all for your input. I’ll talk to her again on next appointment just to clarify re fulvastrant. I’ve now started Xeloda, only an hour ago! And now just sitting and waiting - don’t know what I’m expecting to happen today!!

Just hoping that it works for me and gives me lots of worry free months ahead - I can but dream!

Have a good weekend !

[RLN-overcomer]

Sister/warrior I hope/pray that what ever treatment you get it will work to beat back anything that is not good for your body/temple. Amen🙏😇

[Cureforever]

Hi. I just came across your posting. I also gad a small met in the liver in addition to wide spread bone Mets. I have been on fulvestrant and ibrance before but I still had some meds left before chemo. But my MO told me that she believes that Xeloda works well on liver. I am on my second round of Xeloda. Actually just finished it. After the first one the liver enzymes went up and she lowed the dose. I am on 1500 mg now. Besides the messed ip bloodwork and fatigue I am doing fine. How are you doing on Xeloda. What Mets do you have?Best

Marina

[Ntash01]

Hey Tigg14

I’ve just come across this (didn’t apply to me when I read this back then!).

How are you doing on Xeloda? I do hope you are tolerating it well and are able to function same as you did in previous meds.

I was in your position not so long ago and the answer to your question is because of progression. Once this is noted on your file the ibrance/palbociclib is withdrawn because of the rules of CDF! I’m on the NHS, as I assume you are.

I was so upset because I wanted more time on P/I so did lots of research to get to the bottom of it! My new treatment is Faslodex, just finished my ‘3 loading shots’, will be going monthly end of this month. It’s early days, and I’m feeling ok so far.

N x