Letrozole and Fulvestrant

[Tanyateresa]

morning ladies !! After being diagnosed MBC last November in my pelvis and vertebra I was put on Verzenio and monthly injections of Fulvestrant. Before the diagnosis of the MBC I was on Letrozol for 8 months but my oncologist hasn't told me to discontinue the Letrozol now that I'm taking Fulvestrant. And it appears that both Fulvestrant and Letrozol are inhibitors and do the same function.😳 Just wanted to know if anyone else was on both these drugs. Thanks again and happy new year to all

[Kerryd22]

The drugs aren’t the same but they’re similar. Sort of. I’ve seen lots of posts where women are having both drugs at the same time.

‘Owing to its favourable tolerability profile versus cytotoxic chemotherapy, endocrine therapy is the treatment of choice for postmenopausal women with hormone receptor-positive advanced breast cancer (ABC). However, tolerability concerns associated with some endocrine treatments and the potential for cross-resistance has helped to drive the need for new, effective and better-tolerated agents. Fulvestrant is a new type of oestrogen receptor antagonist with no agonist effects. In phase III trials, fulvestrant has been shown to be at least as effective as the third-generation aromatase inhibitor (AI) anastrozole in the treatment of postmenopausal women with ABC progressing on prior tamoxifen therapy. Fulvestrant is administered as a once-monthly 250 mg intramuscular injection into the gluteus muscle. Here we review the tolerability of fulvestrant in the treatment of postmenopausal women with hormone-sensitive ABC and compare it with that of the four most frequently prescribed endocrine treatments for advanced disease (tamoxifen, anastrozole, letrozole and exemestane). Compared with these agents, fulvestrant is well tolerated and is associated with a lower incidence of joint disorders compared with the non-steroidal AIs and none of the potential androgenic side-effects that are sometimes seen with steroidal AIs. It is also associated with hot flushes compared with tamoxifen. Fulvestrant therefore provides clinicians and patients with a useful, well-tolerated option for the treatment of hormone-sensitive ABC. Integration of such agents into the endocrine treatment sequence may extend the opportunity for using well-tolerated therapies before chemotherapy needs to be considered and thus may improve quality of life for patients with ABC. The overall safety profiles of newer agents such as fulvestrant will become increasingly clear with their ongoing use.’

annalsofoncology.org/articl...

Interestingly Fulvestrant has an effect on the PR part of a positive HR diagnosis. And it has less of the side effects that the standard hormone inhibitors have such as joint pain, hot flushes etc .

I had Letrazole alone as the first line but it was an abject failure so after Abraxane I started Exemestane with Afinitor. I had to drop Afinitor due to side effects but almost 7 years later I’m still on Exemestane.

The longer we can get from the basic treatment the better and it appears that Fulvestrant does improve time spent on the hormone inhibiting drugs and that’s a good thing!

I hope it works well for you!

All the best

Kerry

[Tanyateresa in reply to Kerryd22]

Thank you so much for your in depth reply. I will check out the link you have sent. Thank you for your concern. I will let you know how I get on. This is the long haul and all the help you can get is much appreciated 😀

[Fiercefighter13]

Hi there! I was on Faslodex and Anastrozole at the same time for 4 months. I had a big jump in progression on this duo so off I went on to Xeloda. I didn’t have any side effects from that duo but it didn’t help either. Wishing you the best, take care!

[Tanyateresa in reply to Fiercefighter13]

Yeah I don't seem to have any side effects taking the two of them but if it is not effective or has lesser long term effects on my health I would rather take only one pill. I will let you know how I get on and thanks for your feedback. 😀

[TammyCross]

I had fulvestrant when first diagnosed and it worked wonderfully. I would save letrozole or other AIs for when fulvestrant fails, assuming it does (I got two years). When fulvestrant stopped working, onc put me on anastrozole. She said it was worth a try because it had never failed for me before. I was on it for five years after my initial bc and had no recurrence or spread until 7 years after I stopped it.

It sounds as though you progressed to mbc while on letrozole. I don't see why you would continue to take it, then.

[Tanyateresa in reply to TammyCross]

Yes absolutely right. Thanks so much

[Proudmetsmama]

I am not sure about that. I would reach out to her. How are you feeling? I was just diagnosed with a reoccurrence bone in my ribs and pelvis. I have been unresolved for six years. I am starting.Verzenio and flosadex . Have a good day.

[Tanyateresa in reply to Proudmetsmama]

Yes will talk to her this week and keep you posted

[MettavivorDS]

I went on fulvestrant after six years on Letrozole. I like it better, because the side effects are much milder. I asked my oncologist if I should continue taking the Letrozole and she said “no.” It’s possible that your oncologist may have forgotten to tell you to stop taking the Letrozole.

[Tanyateresa in reply to MettavivorDS]

Yes I think you are right. She just forgot. Fortunately I have realised after only 2 months of taking them both and thanks to the incredible support provided by this site 😀.

[Kahe]

Hi Tanya, my cancer reoccurred in Mar 2022, in my right lung, several tumours. I take both letrozole and fulvestrant plus ibrance (having failed on ribociclib).

I remember reading some comments here from , I think, US contributors that it is unusual for letroz and fulves to be given in combination these days. ...may have been used in the.past

I have read though some research (apologies I don't have it to.hand) where studies have shown that combining both slows progression.

Hope this helps. Wish you the v best of luck with your treatment and fo a healthy 2024

[Tanyateresa in reply to Kahe]

This is my doubt. But as one of the contributors pointed out, I was put on letrozole on its own for 8 months and then my cancer progressed to the bones this last november. Surely if it had been effective the letrozole,my cancer would not have progressed. Happy 2024 to you too.

[DianaTrapani]

I was diagnosed MBC in June 2023. Prior I had been on an AI, anastrozole. Once Dx’d she started me on Faslodex injections and Kisqali. (Although now I’m starting Verzenio, as my body didn’t tolerate Kisqali or Ibrance) . I continued to take the anastrozole.

Well today at mt first appointment for 2024, with new insurance, we reviewed all my prescriptions and she was surprised I was still taking anastrozole. She said I can stop it and be taking one less medication. Hurray for small victories. I think this was something she overlooked.

So, to answer your question, I’d ask my oncologist about it.

[Tanyateresa]

Thanks Diana for sharing your story I have my next appoitment in Feb with my oncologist so i will ask her then no doubt 👍

[Tanyateresa]

Finally spoke to my oncologist - although it wasn't my regular one - and she confirmed that I should only be on Fulvestrant. Thanks for all your contributions that made me alert to my oncologist who had obviously forgotten to tell me to discontinue Letrozole.