Second line treatment after Ibrance, letrozole and monthly zoladex.

[TE53_67]

I live in the south east of the U.K. previously someone posted the U.K. second line treatment from NICE after Ibrance / letrozle. I can not seem to find it, Would anyone have that article again, as the NICE website does not seem up to date. They removed pathways yesterday !

Thanks and hugs all

[Bestbird]

You may be referring to the excerpt below which I occasionally post from my book, "The Insider's Guide to Metastatic Breast Cancer." The Guide is continually updated as new therapies are approved and cutting-edge research unfolds. To obtain the book (or a complimentary .pdf) visit insidersguidembc.com/order

SEQUENCE OF THERAPIES FOR HORMONE RECEPTOR POSITIVE, HER2 NEGATIVE MBC PATIENTS GOVERNED BY NICE GUIDELINES

(Although the author has endeavored to procure and provide treatment information for European MBC patients governed by NICE guidelines, the list below may nevertheless be incomplete, and patients are urged to fully review and discuss treatment options with their medical teams).

FOR PREMENOPAUSAL MBC PATIENTS GOVERNED BY NICE GUIDELINES:

• Tamoxifen and ovarian suppression should be used as first-line treatment if the premenopausal patient was not previously treated with tamoxifen.

• For patients who had been pre-treated with tamoxifen, ovarian suppression should be used as first-line treatment.

Premenopausal patients should consult with their doctors about the NICE guidelines below for postmenopausal patients, as they may likely apply to premenopausal patients with ovarian suppression.

FOR POSTMENOPAUSAL MBC PATIENTS GOVERNED BY NICE GUIDELINES:

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

• An Aromatase Inhibitor (Letrozole, Arimidex, or Aromasin) alone, or with a CDK4/6 inhibitor (Ibrance, Kisqali, or Verzenio)

• Tamoxifen (for men with MBC)

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-...

For MBC patients in Scotland: The Scottish Medicines Consortium (SMC) indicated that Ibrance or Kisqali in combination with an Aromatase Inhibitor is acceptable as first-line treatment of hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) locally advanced or metastatic breast cancer.

[Rubyjude]

I am in Scotland and have just started monthly Faslodex injections after having been on Ibrance, Letrozole and Zometa for a year. I have found virtually no side effects from Faslodex whereas Ibrance made me very tired and sometimes breathless. I am still on the 3 monthly infusions of Zometa as well. I guess your second line treatment depends on your age (pre/post menopausal), your hormone receptor status etc.

[TE53_67 in reply to Rubyjude]

Thanks yes. I am post menopausal- per se as still receiving monthly zoladex injections.