Advice

[yevgeniakoretskaya]

I have metastatic breast cancer. I am taking Ibrance and fulvestrant. After a gastroscopy, I was diagnosed with an esophageal ulcer. The gastroenterologist prescribed me pantaprozole. After many studies and a call to Fizer, I discovered that Ibrance does not work fully with ppi. I do not know how to take both medications for these problems. Has anyone encountered this problem, please help me with advice

[kiwi67]

I have the same issue, I am on Ibrance 125mg and Omeprazole. I take the Ibrance in the morning and the Omeprazole an hour before my evening meal, so that sort of splits them up. I also worried about the studies I found about Omeprazole causing less Ibrance to be absorbed but then I found one that said the evidence wasn't good enough to say one way or the other so I stopped worrying, plus I had to have both drugs so I did the best I could. One thing I have found is that I had to start drinking 1500mls water a day because I only have 1 kidney and with the drugs he is struggling a bit, so therefore was told to drink more and that seems to have had a good effect on my stomach issues and I am now down to 10mg Omeprazole alternate days. A year ago I was on 40mg daily. I hope this was some help but totally understand the mental dilemma you are feeling.

[yevgeniakoretskaya in reply to kiwi67]

Thank you for help.I will try to drink more water. I have metastasis in liver and after citiscan them mildly growing. I am worry about medications interaction.

[Likes in reply to kiwi67]

Try juicing celery for the ulcer. I’m on dexilant . I’m going to try the celery juice. Good luck to you .. feel better soon, Susie

[yevgeniakoretskaya in reply to Likes]

Thanks

[NPmary]

I suggest you call the pharmacist at Pfizer and ask their advice. I did recently read a study that concluded no problem with taking a ppi, it's pretty commonly prescribed. My guess is take the pain in the morning, take lbrance late afternoon or evening. I trust you will do very well.

[yevgeniakoretskaya in reply to NPmary]

Thank you for good advice.

[awesome4ever]

Welcome to the board, although I am truly sorry you have the need to be here.

Recent studies have shown that the link between taking a PPI and Ibrance or any other Kinase 4/6 Inhibitor does not reduce efficacy has been previously recorded. Personally I was on Rabeprazole (another PPI) for the whole duration of my time that I was on Ibrance and Femara. I was on that combination for 5 years so far greater than many people who id not take a PPI.

Medically you have to look at a risk versus benefit for your situation. You have been diagnosed with an esophageal ulcer which can be very serious if left untreated. For me this would be a no brainer and I would start the pantoprazole immediately. Pfizer has not continued studies on this so they will not change their statement. The recent evidence is from studies from independent studies. Here are some supporting studies below.

ncbi.nlm.nih.gov/pmc/articl...

academic.oup.com/oncolo/adv...

Good luck in making your decision. Take care.

[yevgeniakoretskaya in reply to awesome4ever]

Thank you for such a detailed answer. I called Fizer and they provided a link to previous studies. I read the study that you sent and really doubted which of them was correct. But your experience is the most important thing. Thank you very much. I have a question for you, after 5 years, what treatment do you take? The doctor says that Ibrance only works for one or a year and a half. I’ve been here for 5 years with one change, instead of fimara, injections of fulvestran. Sorry if my question is tactless.

[awesome4ever in reply to yevgeniakoretskaya]

No worries. I started Everolimus and Exemestane as my 2nd line in May 2023 and get scans every 3 months. I am bone only mets.

Yes Pfizer's drug interaction information if you read it closely is related more to whether or not you take Ibrance with or without food. I always took mine with food and the other key is to drink lots of water. This is my opinion only. I am a long time medical professional but not a physician.

pfizermedicalinformation.ca....

[TammyCross in reply to yevgeniakoretskaya]

The average time that Ibrance works is a year and a half. There are many people with mbc who have been on it 5-7 years, and some even longer. Some get less than a year. An average is not an absolute.

It is disconcerting and...just wrong that our oncologists are not aware of interactions, nor are the docs prescribing the meds for other problems. I found out that two over-the-counter meds one doc insisted I use (for allergies) interacted with the two cancer meds I am on (exemestane and Kisqali). It was a couple of months before I realized I needed to check. Then no one could help with the problem. Finally, one doc referred me to another specialist just to see what I can safely take. This is ridiculous. It should be someone's job.

For prescription meds, at least here in the US, one of my docs showed me how the interactions come up on their screen for the cancer meds. But they have to look.

[yevgeniakoretskaya]

Thank you so much for such a detailed explanation. I was first diagnosed with breast cancer in 1997. I had stage 2. More than 20 years passed and the cancer returned and it was already stage 4. They found cells in my lung. After treatment with Ibrance and Fimara everything went away. I stopped Ibrance 125 mg due to side effects. Almost 4 years later the mts were in the liver and I received treatment 75 mg Ibrance and fulvestran. Every city scan for 3 months and my nerves are at a breakdown level. You probably know this feeling. Sorry for such details, but I wanted to talk to a person who would understand me. Sometimes I want to share. I have nothing to do with medicine (I am a pianist and teacher), but I read a lot. I really want to understand what is happening, sometimes I am confused. Therefore, I am very grateful for your detailed explanations. Thank you, it helps me and makes me confident that I am doing the right thing.

[HelenWi in reply to yevgeniakoretskaya]

Yevgenia,

It sounds like your cancer is responding well to Ibrance, and there are so many new drug options after that. Of course I can understand how you’re feeling - we all can - especially after scans. But practice pushing away fear and worry … and do things to strengthen your immune system, like experiencing beauty such as your piano. You will do great. Maybe instead of researching on your own, just listen to experts talking about whats new in fighting MBC. UCSF and Dana Farber are among big cancer centers that have such presentations.

Wishing you peace and health,

Helen

[yevgeniakoretskaya in reply to HelenWi]

Thank you Helen for your support and advice. Unfortunately, my piano no longer makes me happy. Every 3 months the city scan brings me stress, especially waiting and receiving results. I am being treated in one of the best hospitals in Canada, I have a great doctor. After 4 years of treatment with fimara, in September I was diagnosed with a metastasis in the liver. After 3 months of treatment with Ibrance and fulvestran, the city showed an increase and the appearance of several new ones. I was in a panic. Now the new city has hardly changed. And it’s like that all the time, like on a volcano. And It's been 5 years now, my nerves can't stand it...

[awesome4ever in reply to yevgeniakoretskaya]

Hi Yevgeniakoretskaya. Thank you for your reply and sharing of some of your journey. It indeed can be a lonely path we walk and I understand your feelings around scan times....there is actually a term for it called 'scan anxiety' so please know you are not alone in those feelings. You know for my first year I felt the same way but a very wise person from the board mentioned a thinking process that has served me well....try to remember whatever is on that scan you are already living with and no amount of anxiety or fear is going to change the outcome. It has made a world of difference to me and I hope it can help you too.

Oh I am so envious of your ability to play a piano. It is the most soothing sound in the world to me. My cancer center has a pianist playing during the day so I enjoy it whenever I go for appointments.

As for researching, knowledge is always a good thing but just remember to use reputable sites only. I hope you have a good therapeutic relationship with your oncologist. Don't be afraid to write down and ask questions if there is something you don't understand. I am blessed to have a wonderful relationship with mine.

I'm glad you found this board my friend, it's a wealth of information and a safe place to ask questions or share your fears. We all understand and try to support as much as possible. Take care. You are not alone.

[yevgeniakoretskaya in reply to awesome4ever]

I deeply appreciate, thank you for supporting.

[Nocillo]

Did your oncologist have an opinion on this? I was taking Pantoprazole for tumors in my stomach and then was put on Ibrance as my second line of treatment. Once the Ibrance kicked in, then I no longer needed the Pantoprazole. I hope you have great success. It’s hard to treat so many things at once.

[wendle3007]

I've been on Ibrance for 2.5 years. Late last year I was referred to Gastro because a scan found I had a hiatus hernia. I've been prescribed Lansoprazole. I'm on the lowest dose possible and I take it early morning half an hour before breakfast and I take my Ibrance late evening about half a hour before bed so that splits them up. Both Gastro consultant and my oncologist are aware of each other and what I'm taking and so does the pharmacist at my GP surgery. None of them have made an comment about interaction. GP does like to check on my dosage of the PPI because taking them long term can cause other issues but no worries regarding my ibrance.

[Lennysmama]

I have taken both IBrance and pantoprazole for a year now, with Letrozole. I take the IBrance and Letrozole midday and the pantoprazole before bed. I had the same concerns as you, having read the same thing. So far, my chemo meds are working fine…mbc to lungs is stable. My doc says not to worry about it but I do!!???

[Elle713]

Hi

I was on Ibrance and Fulvestrant for 18 Most along with Omeprazole which I still take. I then got diagnosed with a primary lung cancer and had a right lobectomy. I was off the Ibrance before/during/after surgery for a bit. And then my PT Scan showed progression to the spine. So I am now on Oserdu. Sill on Omeprazole, many of us are.

As far as the fear and anxiety of living with this disease and the anticipation before and after every test, I hear YOU! For me it is the worst part of the process. I feel like a professional patient, as every scan brings you to another doctor of some kind who has their own specialized tests. It feels daunting and endless.......Look forward to the stable times in between. In other words, dance between the raindrops.

[yevgeniakoretskaya]

Thank you to share with me your story. Good luck!