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Treatment Name: Palbociclib (Ibrance®) + Fulvestrant (Faslodex®)

Palbociclib (Ibrance®) + Fulvestrant (Faslodex®) is a Chemotherapy Regimen for Breast Cancer - metastatic

How does palbociclib + fulvestrant work?
Palbociclib is designed to inhibit a specific protein that is responsible for turning off tumor suppressor genes and allowing the cancer cell to grow and divide. By inhibiting this protein, palbociclib causes the cell to stop actively dividing (growing).

Fulvestrant is designed to block estrogen receptors on the surface of breast cancer cells. In patients with Estrogen Receptor positive (ER+) disease, estrogen binds to these receptors and tells the breast cancer cells to grow and divide. Fulvestrant blocks this signal and helps stop the breast cancer cells from growing.

Goals of therapy:
Palbociclib + fulvestrant are taken together to slow the growth of breast cancer and prevent it from spreading further. This therapy is not usually given with the goal of cure.


  • Palbociclib usual starting dose: 125 mg oral capsule by mouth Once Daily for 21 consecutive days, followed by no drug during a 7-day rest period
  • Fulvestrant intramuscular (I.M.) injection once weekly for 3 weeks, then once monthly thereafter

Palbociclib is usually taken at home while fulvestrant is given in an outpatient infusion center or doctor’s office. Palbociclib + fulvestrant is taken until the regimen no longer works or until unacceptable side effects occur.

Click here for common starting doses of Ibrance + Faslodex.

Side Effects

In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported side effects with palbociclib + fulvestrant are shown here:

On average, 3% of patients discontinue palbociclib + fulvestrant due to unacceptable side effects.

Side effect videos Side Effect Videos
Fatigue Fatigue Nausea and VomitingNausea and VomitingAnemiaAnemiaDiarrheaDiarrheaConstipationConstipationHair LossHair LossPainPain


How often is monitoring needed?
Labs (blood tests) may be checked before starting treatment, then every 2 weeks during the first two cycles, then monthly thereafter. Labs often include: complete blood count (CBC), comprehensive metabolic panel (CMP), plus any others your doctor may order.

How often is imaging needed?
Imaging may be checked before treatment and every two to six months during treatment. Imaging may include: bone scans, magnetic resonance imaging (MRI), and computerized tomography (CT) scans. DEXA (dual energy x-ray absorptiometry) scans may be performed to monitor your bone mineral density.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue palbociclib + fulvestrant as planned, or delay or switch therapy.

ChemoExperts Tips

  • Of the patients that experienced any hair loss, it was usually not obvious from a distance and could be seen only on close inspection. For a few patients, a different hair style may help cover up hair loss. A wig or hair piece to camouflage hair loss is almost never required for patients receiving this regimen
  • Only a certain amount of fluid can be given by intramuscular (I.M.) injection at one time. Because of this, the total dose of fulvestrant must be given as two separate injections on the same day. Each injection will be given slowly over 1-2 minutes, one in each buttock
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for breast cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to to search for other centers offering study medications

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Palbociclib (Ibrance®) + Fulvestrant (Faslodex®), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Palbociclib (Ibrance®) + Fulvestrant (Faslodex®). Depending upon your income, they may be able to help cover the cost of:

  • Palbociclib
  • Fulvestrant

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Palbociclib (Ibrance®) + Fulvestrant (Faslodex®) and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with Palbociclib (Ibrance®) + Fulvestrant (Faslodex®)

Individual Drug Label Information

Palbociclib (Ibrance®)

  • Palbociclib is an oral capsule that comes in strengths of: 125 mg, 100 mg, or 75 mg 
  • Take with food at the same time each day. Do not crush or open capsules. 
  • If you miss a dose, take it as soon as you remember if it’s the same day. If it is the next day, take your regular dose as scheduled. Do not double the dose to make up for the missed dose 
  • If you vomit up a dose, an additional dose should not be taken that day. Take the next dose at the next regular scheduled time 
  • Store at room temperature in a cool, dry place 
  • Dosage adjustments may be required for low white blood cells or other severe side effects 
  • May interact with certain antifungal and seizure medications. Ask your doctor or pharmacist to review your medications for any possible interactions  
  • May interact with grapefruit and grapefruit juice causing increased blood levels of palbociclib. This could increase your risk of experiencing side effects. Avoid eating grapefruit and drinking anything containing grapefruit juice during treatment 
  • Avoid therapy with St. Johns Wort as it will decrease blood levels of palbociclib. This could decrease it’s effectiveness 
  • Avoid during pregnancy. Contact your doctor immediately if you think you may have become pregnant. 
  • Females who are of child bearing age should use contraception during treatment and for at least 2 weeks after stopping palbociclib 
General Palbociclib (Ibrance) Side Effects 
  • Low white blood cells, red blood cells, and platelets are common 
  • Can increase risk for infections such as upper respiratory tract infections 
  • Spontaneous nose bleeds may occur 
  • Nausea and vomiting may occur 
  • May cause diarrhea 
  • May cause mouth sores 
  • Hair loss can occur 
  • May cause tingling or numbness in fingers and toes 
  • Click on the palbociclib (Ibrance) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaHair LossHair LossFatigue Fatigue BleedingBleedingAnemiaAnemiaBlood ClotsBlood Clots

See DailyMed package insert.

Fulvestrant (Faslodex®)

  • Fulvestrant is a intramuscular (I.M.) injection 
  • Dosage adjustments may be required for decreased liver function
  • Should only be given to post-menopausal women
  • Can cause fetal harm when given to pregnant women.  Women of childbearing age should be advised not to become pregnant
General Fulvestrant (Faslodex) Side Effects
  • One of the most common side effects reported are hot flashes. Talk to your doctor about ways to minimize and treat hot flashes. Do not take any medicines, herbs, or natural supplements without speaking with your doctor or pharmacist first
  • Injection site pain
  • Headache
  • Bone and join pain
  • Weakness
  • Nausea/Vomiting
  • Constipation or diarrhea
  • Fatigue
  • Shortness of breath
  • Click on the fulvestrant (Faslodex) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaFatigue Fatigue ConstipationConstipationPainPain

See DailyMed package insert.

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Turner NC, Ro J, André F, et al. Palbociclib in Hormone-Receptor–Positive Advanced Breast Cancer. N Engl J Med. 2015;373:209-219.

Created: February 14, 2016 Updated: January 5, 2017

What is Breast Cancer - metastatic?

What is Metastatic Breast Cancer?
A disease of the milk-producing glands known as lobules, milk ducts, or other cells found in the breast. Metastatic breast cancer is one that has moved from the breast to other areas of the body, which may include the brain, liver, or bone. Breast cancer is one of the most common types of cancers in women, but may rarely affect men as well. Known causes of breast cancer include genetic causes, such as the BRCA mutation, or obesity. The effectiveness of the treatment may depend upon the stage at diagnosis.

Types of metastatic breast cancer:
1. Hormone-receptor positive or negative (60 - 65% of patients)

  • Estrogen Receptor positive (ER)+ or negative (ER)-
  • Progestin Receptor positive (PR)+ or negative (PR)-

2. Hormone Epidermal growth factor Receptor-2 (HER-2) positive or negative (20 - 25% of patients)

  • HER-2 +
  • HER-2 -

3. Triple Negative (15 - 18% of patients)

  • ER- and PR- and (HER-2)-
NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

Common Starting Doses

  • Palbociclib (Ibrance) usual starting dose: 125 mg oral capsule by mouth Once Daily for 21 consecutive days, followed by no drug for a 7-day rest period (21 days on, then 7 days off)
  • Fulvestrant (Faslodex) 500 mg intramuscular (I.M.) injection once weekly for 3 weeks, then once monthly thereafter

Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability.

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

14) Serum calcium