Drugs

Xalkori is very successful in causing tumor shrinkage in most patients whose tumors have an ALK fusion. Efficacy is usually measured by tumor shrinkage, time to progression or survival.

Assuming you are talking about adjuvant therapy here, the answer is split into pre and post menopausal women. Most premenopausal women are asked to start on Tamoxifen but some may get an AI plus a zoladex shot (to make them postmenopausal). In that case, the advice is 5 years. If you are premenopausal and start on Tamoxifen but then become postmenopausal, you may be switched to an AI for 5 years after 5 years of tamoxifen.

For postmenopausal women, it is typically 5 years of an AI only OR it could be 5 years of an AI AFTER 5 years of tamoxifen.

No, I did not begin taking Tamoxifen until after my son was born. Tamoxifen is harmful to fetuses and should not be taken while pregnant.

The FDA’s approval in 2011 of Zelboraf (vemurafenib) is another important step in what is a rapidly changing landscape for melanoma and cancer therapy in general. Some cancers are formed when, inside a cell, a signal is passed from one molecule to another, like a game of telephone. Zelboraf stops that signal from being sent and, in doing so, stops the growth of the cancer. Data published in February of 2012 in the New England Journal of Medicine showed that Zelboraf extended average survival to about 16 months for stage IV melanoma patients whose tumors had BRAF mutations. The drug was generally well tolerated with minimal side effects. These results, while promising on their own, are a stepping stone to another exciting prospect in cancer research: combining drugs like vemurafenib with other therapies, where two treatments used together might be more effective than each one by itself.

In the United States there are two FDA approved forms of interferon. The first is standard, high-dose interferon, which is given over 12 months. The first month is given intravenously at 20 million units/m2, five consecutive days per week for 4 weeks. The remaining 11 months are given as subcutaneous injections at 10 million units/m2 three times per week. The second form is called pegylated interferon (Sylatron) and is given weekly at 6 mcg/kg/week subcutaneously for eight doses, followed by 3 mcg/kg/week subcutaneously for up to five years. There are several factors involved in choosing between the options, including convenience and length of therapy. If you are considering interferon, it’s also important to talk with your oncologist about clinical trials of medications designed to prevent melanoma from coming back after surgery.

Yervoy is FDA approved for stage IV melanoma and can be used in patients whose disease cannot be removed by surgery. The biggest benefit of Yervoy is that it improves the average survival of patients compared to other treatments, like chemotherapy. It’s important for patients to talk to their oncologists about the risks and benefits of Yervoy, which, because of the way it interacts with the immune system, can cause some serious side effects.

The most common side effects of crizotinib (Xalkori) are:
- Gastrointestinal side effects which include nausea, vomiting, decreased appetite, diarrhea, constipation
- Swelling of hands and feets (edema)

Less common side effects include:
- Mild dizziness
- Fatigue
- Insomnia
- Mild rash
- Numbness or tingling
- Cold symptoms
- Arthralgia and back pain


Side effects that are not as common but may present problems are:
- Pneumonitis
- Hepatic liver abnormalities (elevated ALT (alanine aminotransferase) and AST (aspartate aminotransferase) levels
- QT Prolongation which is an irregular heart rhythm

Crizotinib (Xalkori) side effects vary greatly from patient to patient depending on different issues including patient history, existing conditions, other prescribed medications the patient is taking, and stage of disease. Some people experience minimal side effects, while others may experience severe side effects.

If the side effects from Xalkori are severe, you may speak to your physician about medications to treat the side effects. It is important to notify your physician if and when you develop any side effects and to listen to your body and call your healthcare provider if something seems amiss.

Websites that may provide more information include:

http://www.drugs.com/xalkori.html
http://www.pfizerpro.com/hcp/xalkori_home??source=google&HBX_PK=s_+xalkori&HBX_OU=50&o=69985681|245244793|0&skwid=43700003139871797
http://www.rxlist.com/xalkori-drug/side-effects-interactions.htm

I've taken a number of aromatase inhibitors, starting with Arimidex, followed by Femera, and now Aromasin. About six months in, Arimidex starting giving me the most incredible joint pain in my feet. I tried managing the pain for another 8-12 months but feet were in so much pain and I wasn't getting any relief from anti-inflammatory meds (i.e. Aleve or Advil). I was then given Femera and felt a 100 times better physically but at the six-month mark I noticed my hair was thinning - a lot. Im honestly not sure if it was the Femera or menopause but my oncologist felt it wasn't necessary to have to deal with that issue. I just started taking Aromasin about two weeks ago and haven't noticed any uncomfortable side effects yet. My hair still seems to be thinning though.

My partner is also premenopausal, and has refused taking Tamoxifen, despite being ER+. Instead, she has opted for use of bio-identical hormones. 2-methoxyestradiol has been demonstrated to have the SERM like qualities of Tamoxifen, however, with no side effects. In addition, it has specific anti-cancer properties. We reference http://lib.bioinfo.pl/pmid:15156405 as one study among many. Good luck with your choice!

Be very conscious about your food choices, and compose a delicious yet low/moderate glycemic diet for yourself. (you can have organic dark chocolate over 65% cocoa, too. but not more than an ounce a day).Choose the cancer-protective foods while you're at it (listed earlier today). Plus, you'll need to exercise in some fashion that suits you--walking 1/2 hour a day or tai qi or Pilates or yoga. All you need is 1/2 hour a day of movement. More is even better. In addition, green/white tea is a bit stimulating to your metabolism and has anti-cancer activity. Make sure your thyroid is working well (TSH @ 2.5 or less is what I like to see), and your vitamin D-OH25 is over 55 (I like to see it between 55-80ng/ml). And you need to sleep well at night to maintain good sugar balance. All this helps. Dale

Hi,
I may have addressed this in your other question about taking Tamoxifen longer term/taking aromatase inhibitors, but I've been very lucky in that I really haven't noticed any side effects. My family doctor had me take a bunch of clotting tests before starting it since that can be an issue. When I read the pages and pages of side effects and warnings I almost scared myself out of even trying it, but I'm glad I did. The endometrial stuff seemed a bit scary but my oncologist told me that's so rare he's never seen it. But I am back to yearly pap smears just to make sure everything's normal; before my family doctor was going to back me off to every couple of years and then when I started Tamoxifen he said we should stick to annual check-ups.

We have not discussed taking Tamoxifen longer than 5 years or taking an aromatase inhibitor. I had asked him about aromatase inhibitors awhile ago and he said they don't have the clinical trial history that Tamoxifen has. I see him again next month so I may ask him whether an AI drug makes more sense now that I have officially hit menopause. I'm perfectly fine continuing on Tamoxifen though. I'm lucky to not have any side effects, and I read recently that the benefits can last up to 15 years. I just finished year three on Tamoxifen so I have another couple of years to go.

Your doctor and your pharmacist can both provide advice about avoiding interactions between drugs and supplements. Make sure to tell them both about everything you're taking, including supplements and over-the-counter medications. Prepared Patient has two feature articles that may be helpful to you, "Vitamins & Supplements: Before You Dive In" (http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue4.cfm) and "Side Effects: When Silence Isn't Golden" (http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue2.cfm).

It is almost impossible to identify liquid form drugs. However, you can identify solid dosage forms like tablets, capsules by imprints present on it, color, texture, shape, score type, etc.

I would always recommend you to use gloves if you are handling unknown drugs. Because certain drugs are carcinogenic.

Thanks

I am on Femara. I unfortunately have other pills as well. I have them all set up in a pill container for 2 weeks at a time, I take mine at night faithfully with my other meds. I sometimes still get nauseous from Femara so this way I sleep right through it. I would suggest taking it at a time of day that you WILL remember. I find having cancer you just do NOT forget to take it for the fear of cancer returning. Oh and definitely as JK Jones stated above, take calcium and Vitamins D as well.

I was on Tamoxifen before Femara. My biggest problems were nausea and joint aches and pains. I do not remember having any cough with it though. This is just my experience though.

When initiating treatment with Letrozole, here are some topics to be aware of and inform your physician:
- What allergies you have and if you've ever experienced an allergy to Letrozole.
- Your medical history including if you have any issues with cholesterol, liver disease, bone complications, history of stroke or blood clots, heart disease, high blood pressure, or kidney issues.
- Any other medications you are taking and this includes prescription medications, all over-the-counter products you are taking, vitamins, and herbal remedies as they might contain estrogenic components or promote estrogen activity.
- Any other medications that you are taking that contain estrogen such as hormone replacement drugs or hormonal contraceptives which includes all birth control products such as contraceptive pills, patches, rings, or injections.
- If you are taking tamoxifen or raloxifene.
- Women who are perimenopausal or recently menopausal should employ contraception methods until postmenopausal status is achieved. Letrozole is harmful to the fetus.
- If you are pregnant or breast feeding.

As the name implies, the action of Aromatase Inhibitors is to inhibit the production of estrogens by stopping the conversion of androgen into estrogen. Aromatase inhibitors operate by blocking the aromatase enzyme that converts androgen to estrogen. Post-menopausal women get estrogen from the conversion of androgen into estrogen in the tissues of the body. In contrast pre-menopausal women get estrogen from the ovaries. By inhibiting the production of the estrogen, the estrogen receptor [ER]-positive and/or progesterone receptor [PR]-positive tumors in the breast cannot grow.