Progression of BC Mets

[SpicyChick]

I have had a good run of my Ibrance, (in different dosages), and Letrozole combination since 2017 after 1st Mets diagnosis. (History ER+ Her2- BC)

Now I have progression and I'm not sure my doctor is going down the right road. She is suggesting Kisqali and Faslodex. From what I've read, Kisqali would be an equivalent of Ibrance and Faslodex an equivalent of Letrozole (or in the same family of estrogen blockers). These medications appear to be taken at first mets diagnosis?

Are any of you on this combo after mets progression? Kisqali & Faslodex

What are you all taking for your Her2- progressed mets?

[Aprilfoolz1]

Has your oncologist ordered a biopsy of the progression ? I've read it's important to have a biopsy on any progression to see if any new mutations have come up- like the ERS1 mutation which seems to be a common one to come up after taking hormone blocking meds .

I know someone who had progression on Ibrance and letrozole with a new bone met . The met was radiated and the onc put that patient on kisquali and Fulvestrant.

[SpicyChick in reply to Aprilfoolz1]

Yes, I had a liquid biopsy testing for all mutations. Negative. Thanks for suggesting.

My doctor didn't seem to think that was good because there isn't a target to aim at. (My research showed that those mutations have targeted therapies that have good response)

[NPmary]

Like you I was on Ibrance and Letrozole since 2017, had progression in July, 2022 and have been on faslodex since then. I have heard of others being on faslodex and kisquali for second line treatment.

[SpicyChick]

Ok. That's good to know. Thanks

Are you on Kisqali now as well? or did they just change your Aromatase Inhibitor? (Also curious if you had hysterectomy? If not too personal)

[Hazelgreen]

I think you are mistaken in thinking ribociclib (Kisqali) is the equivalent of palbociclib (Ibrance). The medical research studies I've read indicate that Kisqali is a more effective intervention for longer periods of time than Ibrance. I'm now in my second year of Kisqali and Letrozole treatment for my extensive (bones, lungs, liver, lymph nodes, scalp) metastatic breast cancer diagnosed in 2019. I initially did well on double tamoxifen but my oncologist refused to allow me to continue taking double, and my cancer markers quickly climbed out of the normal range when I was reduced to single tamoxifen. It took time for my cancer markers to return to the normal range on Kisqali but they've now been there since last December.

[Lindoky in reply to Hazelgreen]

hello I’m ++- recent stage 4 diagnoses bone meta all over , just started kisqali 400 mg and fulvestrant . How’s it going for you are you on the same treatment

[Hazelgreen in reply to Lindoky]

Hi Lindoky, I've been on Kisqali 400 mg with letrozole (week days only) for well over a year. Before my husband died last year, we used the lab information about ribociclib (which remains in the body for up to 8 days) to determine that 2000 (5X400) mg per week was sufficient to keep my cancer antigens in the normal range even with weekends off. I find that I feel more healthy when my body has a break from the meds every weekend. Cheers, Cindy

P.S. I am 79 years old. My age may mean that bodily reactions are slower...

[MettavivorDS]

Fulvestrant is a Selective Esteogen Receptor Degrader (SERD) while Letrozole is an aromatase inhibitor (AI). They are not in the same class of hormone therapies and fulvestrant is often used as a second line treatment after an AI fails.

I was changed to fulvestrant and Kisqali as a second line treatment after my six year run on Letrozole alone failed. The side effects from the fulvestrant are much lighter than the ones I experienced on letrozole. It’s also a monthly injection, so there are no pills to take and remember. The Kisqali side effects were so bad that I only did one round. My onc told me that taking fulvestrant alone is extremely effective and not to worry about dropping the Kisqali. You never take a kinase inhibitor by itself, so the fulvestrant is the most important of the two drugs. My met was in the bone, so I was also started on quarterly Zometa infusions to strengthen the bone. Zometa makes it more difficult for the cancer to grab on and also treats the osteoporosis caused by hormone therapy. After six months on the new treatment my scans showed a partial remission of the met on my bone in April, 2023. Another set of scans is scheduled in a couple of weeks. I like this second line of treatment better than my first line. I’m feeling better, have fewer aches and pains and am less debilitated by side effects.

[Gingerann1]

I’ve been on first line treatment of Ibrance and Faslodex for almost 3 years. My Onc has suggested next line would be Kisqali and Faslodex. When I questioned that Kisqali was another CDK 4/6 inhibitor he said he’d like to refer to it as “1-1/2” instead of 2nd line treatment. I’m thinking it will depend on where any Mets are found as I have been NED so not sure where it is lurking. Praying I won’t have to make a change for a while.

[JMPhD]

Hi Kisquali has better data for overall survival than Ibtance. So could be a good choice!