Has somebody "steped back" to a former drug?

[deHans]

I asked some days ago for a drug that takes effect on liver.

Trovelvy seems to be a good possibility - THANKS for this information

On Friday my good friend(*) will have a talk with her Oncologist and she has the follwoing idea/question:

(*) MBC since Okt 21: HER2 +, mets in bones, lymph nodes and liver.

Liver gets worse so she switched to Enhertu -> without any effect.

1. She steps back from Enhertu to "Fulvestrant + Ibrance", because with that drugs everything else was " fine" (only the liver ist the problem).

2. She ist planning a TACE (isolated chemo only for the liver) again.

Last time it worked.

3. She starts an off label-Treatment with 150MHz.

....

5. Start Trodelvy. . . the wish/hope ist to find something with less side effects.

What do you think about this idea of "stepping back" to the former drugs?

Have somebody any experiences in such a way?

Thanks for your support!

[Silver126]

As for Trodelvy I’ve had two cycles without relevant side effects. No nausea or vomiting, just moderate constipation treatable with drugs and minimal tiredness. That’s for your info, I read in this site about side effects I’m not experiencing and I wanted to tell you.

[deHans in reply to Silver126]

Oh that is very kind of you

[Roarlion in reply to Silver126]

I have had 2 doses of Trodelvy. Interrupted by low white counts. I believe the premeds are more bothersome than the drug. I am trying to get those lowered. I take Benadryl, steroids, Zofran and Iv Emend . Constipation for 4 days after drug. Curious I’d you take all those meds, silver 126?

[Silver126 in reply to Roarlion]

I experienced low blood counts only with Abraxane. It was tougher on me than Trodelvy, but they decided a dose reduction at 75% At home I take Emend and desametasone for three days. Premeds are bothersome!

[Roarlion]

Thanks Silver 126…Hope Trodelvy work for you, deHans. For me , it has not be so bad!

[deHans in reply to Roarlion]

It is nice to get that positive reply

[Kerryd22]

Some places, like the UK and Australia, you can’t step back to a previous medication because there’s conditions on the subsidised drug list. And if you’ve had progression on a drug then possibly the cancer has mutated and it won’t be as effective the next time. Theres different opinions on drug use but there’s still lots of options so that’s a positive!

[awesome4ever in reply to Kerryd22]

Canada is included in this category too. Personally I think cancer is too smart to not recognize the genetic makeup of a previously used drug anyway. My references are if a previously used drug showed progression, not say if it was stopped for other reasons.

[Kerryd22 in reply to awesome4ever]

I had Abraxane and I was told I could have it again as it worked. But later I reported mild neuropathy and that immediately changed the doctor’s mind. So now I can’t have it although I would if I was allowed.

[awesome4ever in reply to Kerryd22]

If you needed to change medications(hopefully not for a long time) would your doctor not consider you taking any taxane or just Abraxane...meaning say he would give you Paclitaxel, Docetaxel or Cabazitaxel(taxoid for taxane resistant disease) though? Just curious.

[Kerryd22 in reply to awesome4ever]

I don’t know but I will definitely raise it with her when I have to change. I’m told the next drug is a chemotherapy but I won’t lose my hair so that tends to indicate it’s not a taxane.

In my mind I have it in the back pocket just in case. My neuropathy is very very mild but Abraxane was very effective for me.

[deHans in reply to Kerryd22]

Thanks for your feedback.I do not unterstand the action of the doctor.

Have you asked him why he changed his mind? If you explain the reason why it is important for you to take it, may be the human "inside" the doc will admit, I think/hope so.

Finally the one who take the risk of harm is you!

[deHans in reply to Kerryd22]

In generell the process you described makes sense but in our case the move to enhertu was initiated by the patient. I guess this is a very seldom situation, the feedbacks here showing this.

[Kerryd22 in reply to deHans]

We can reject a drug but we can’t initiate a drug we might prefer unless the conditions of its inclusion on the subsidised list allow it. If we want to pay the full cost ourselves we can, as long as it’s approved for use in Australia, choose the drug we want but most people don’t have thousands of dollars just laying around waiting to be spent on drugs.

And some drugs have conditions on the approval. Enhertu is approved and subsidised for a very limited number of patients. That can change though if there’s evidence that it’s effective for other patients. Much is about the cost to the government so the drug companies continue to make representations and the government continues to bargain the price down.