But I thought you were on chemo….

Ibrance indications
One of the biggest questions I am asked when people find out I have breast cancer is about my chemotherapy. I take oral chemotherapy medications and a monthly injection, rather than one that is through an IV or a port. I take Ibrance along with a second medication called letrozole.

Before I go any further I want to comment on just how funny marketing departments are. Some days I wonder whether or not they even think about what they are saying in their advertisements. Today I received an email from the company that makes my medicine. As you can see, one of the indications is for women who have gone through menopause. Pretty simple, right?Before you take Ibrance

Then a little further down, it tells you to tell your doctor if you are able to become pregnant and if you are to use birth control. WHHHAATT? Please explain to me how a post-menopausal woman can become pregnant? Did I miss something in sex ed class?

Well in all fairness, I went to a Catholic high school in the early 90’s. I am not lying when I say that when we learned about AIDS it said something like ‘AIDS can be prevented by using {black marker}.’ Yes, anytime the word condom was used in the text, they marked over it with a black marker. No wonder I had three kids by 23. I thought if I had a black Sharpie in the bed with me, I wouldn’t get pregnant! 😂

But still. I can’t help but scratch my head as I try to wrap my head around ‘able to become pregnant’ and ‘post-menopausal.’ Feel free to comment if you can explain to me how these two things are compatible.

Anyway, back to my original point. I’m a nurse yet I was always led to believe that the only way chemotherapy was administered was through an IV. Breast cancer has opened my mind about how little I really knew about cancer treatments. Chemo can be given in lots of different ways. Through the traditional IV form, oral forms, shots just under the skin or into muscles, among many, many other ways.

Since my diagnosis I have had two chemotherapy agents that are administered through a shot into muscle. The first one is an antineoplastic agent called Lupron Depot (leuprolide acetate). Lupron is used for many things including treating prostate cancer, endometriosis and breast cancer.

In my case, I have a hormone positive cancer and the tumors were literally being fed by estrogen and progesterone. In order to bring that to an abrupt halt, I was given Lupron to block the hormones. Oh my goodness. My doctor warned me that it would send me into immediate menopause, but I was not prepared for what that would actually mean. Holy macaroni. I was no where near menopause. In fact, I was about as regular as someone could be. Periods literally every 27-29 days like clockwork. Menopause within days? Hot flash on top of hot flash. I am the most cold blooded person alive. I could literally be happy with the temperature being 80 degrees. Now I couldn’t find clothing light enough to not be cooking. Ugh.

The second medication I get through a monthly injection is Xgeva (denosumab) which is a targeted therapy to prevent further breakdown of my bones that had already been invaded by my breast cancer. My calcium levels need to be monitored closely to ensure they don’t go too low and I need to take calcium with vitamin D supplements. Calcium is such a horse pill. My goodness. Thank the heavens for gummies. Now that I have found them, I could seriously eat an entire bottle in one sitting. Thank you CVS!

Prior to my hysterectomy, I took a hormonal therapy medication in pill-form called tamoxifen. Yes, also a chemotherapy medication given for hormone positive breast cancer. It’s given to both women AND men. I still struggle to remember the guys. (Doesn’t everyone?) It is given to both early stage as well as metastatic breast cancer. Long story short, it prevents estrogen from binding from cells, preventing further growth and spread of cancer cells.

Step back to Lupron for a minute. There are some unpleasant side effects to that bad boy and my doctor recommended a hysterectomy and removal of my ovaries so I didn’t need to have further doses. Considering my baby boy (yes Sterling, you will always be my baby) is a 20-year-old sophomore in college, I am way past my baby birthing years. I am 43 years old. I am still young enough to enjoy life. The last thing I want is to be a mom all over again. So when he recommended the hysterectomy I was like cool, can I do it tomorrow?

So hysterectomy done, onto the next set of medications. Bye bye Lupron and tamoxifen, hello letrozole and Ibrance.

Femara (letrozole) is an oral hormone therapy in a drug class called aromatase inhibitors. Apparently, even though my ovaries have been removed, the body still produces some levels of estrogen. (I didn’t know this either!) Letrozole blocks enzyme aromatase (that can be found in the body’s muscle, skin, breast and fat), which is used to convert hormones produced by the adrenal glands into estrogen. I seriously never knew any of this! I swear I am learning more through cancer than I ever did in nursing school!

Ibrance (palbociclib) is an oral targeted therapy that is used in combination with aromatase inhibitors. It’s purpose is to block proteins and stop cells from dividing to make more cancer cells, thereby slowing cancer growth.

I am often also asked, so if you aren’t having regular chemotherapy that means none of the side effects, right? I would love to say that isn’t the case. Unfortunately I still do have side effects, although through experimentation I have found ways to reduce them.

I have dealt with terrible nausea at times. I have eaten only to find myself throwing up soon after. I have lost 40 pounds since my cancer journey began in September. My cancer has metastasized to my bones so bone pain was already an issue for me, and now I am taking medications that have a side effect of bone and joint pain. Fun combination. Unfortunately the medications cause fatigue and I feel like I am always tired no matter how much I sleep. And although I have always shed like a dog, I feel like lately that has become worse. Hair thinning is very common and I am researching ways to prevent it from becoming a serious issue.

Thank goodness I have learned some tricks to improve the side effects. Claritin. Seriously, Claritin? How does that help? The antihistamine helps reduce the increased histamines in the body and helps reduce the pain and lethargy caused by letrozole and Ibrance. A cheap little pill that has been a game changer for me. My doctor also recommended taking them before bed that way I slept through most of the nausea and fatigue. That also has helped immensely.

Metastatic breast cancer really is a journey without an end. So far, I have been incredibly blessed to only have to deal with blood draws, a few shots and more pills each day. My life could be so much worse. So far the cancer cells are responding very well and I feel better every day. My only real fear at this point is whether these medications continue to be effective for years to come. I see some women talk about them working well for them for years while others say it was only a few months before their cancer came back with a vengeance.

I suppose that is what metastatic breast cancer is. A lifetime of looking over your shoulder. A lifetime of that nagging fear. My life could be a year or it could be fifty years. My biggest prayer is that I live long enough for scientists to discover a cure for me and my sisters and brothers.

In the end, my goal is to be around long enough to drive my kids completely insane for decades to come. 🤣

Jennifer – Extensive mets to bones. Diagnosed de novo at 43 of ‘unknown cancer’ on 9/25/2018, official diagnosis of metastatic breast cancer with bone metastasis on 10/9/2018. Cancer won’t win. I won’t let it. Life’s too short not to fight for every minute.
Dx 10/9/2018, invasive ductal carcinoma (IDC), left breast, 1.5cm, Nottingham Grade 2, hormone receptor positive, ER+ (estrogen receptor)/PR+ (progesterone receptor), HER2- (human epidermal growth factor), BRACA- (genetic mutation), Stage IV, metastasized to bones
First CA 27.29 10/9/2018 83 (goal <38)
Hormonal Therapy 10/12/2018 Tamoxifen (Nolvadex, Apo-Tamox, Tamofen, Tamone) pills
Targeted Therapy 10/12/2018 Xgeva (Denosumab) injection
Hormonal Therapy 10/19/2018 Lupron Depot (Leuprolide Acetate) injection
Surgery 11/29/2018 Vaginal hysterectomy with bilateral salpingo-oophorectomy
First CA 27.29 post hysterectomy 12/10/2018 73 (goal <38)
Hormonal Therapy 12/11/2018 Femara (letrozole) pills
Targeted Therapy 12/23/2018 Ibrance (palbociclib) capsules
First CA 27.29 post medication change 1/10/2019 60 (goal <38)