Treatment Name: Palbociclib (Ibrance®) + Letrozole (Femara®)
Palbociclib (Ibrance®) + Letrozole (Femara®) is a Chemotherapy Regimen for Breast Cancer - metastatic
How does palbociclib + letrozole work?
Palbociclib is designed to inhibit (block) a specific protein that is responsible for turning off tumor suppressor genes and allowing the breast cancer cell to grow and divide. In other words, by inhibiting (blocking) this protein, palbociclib causes the breast cancer cell to stop actively growing and dividing.
Letrozole is designed to block an enzyme (a type of protein) in your body called aromatase. Aromatase is responsible for helping produce a female hormone known as estradiol (a type of estrogen).
When letrozole inhibits aromatase, there is less estrogen produced. When estrogen is not able to bind to the receptors on breast cancer cells, the breast cancer cells are not able to grow or divide. Patients with breast cancer that are not estrogen-receptor positive may not respond to treatment with letrozole.
Goals of therapy:
Palbociclib + letrozole are taken together to slow the growth of breast cancer and prevent it from spreading further, not for cure.
- Palbociclib usual starting dose: 125 mg oral capsule by mouth daily with food for 21 consecutive days, followed by a 7-day no palbociclib rest period. This “21-Day on, 7-Day off” treatment period is known as one Cycle
- Letrozole usual starting dose: 2.5 mg oral tablet by mouth once Daily, continuously (no days off)
Palbociclib + letrozole is usually taken at home and is taken until the regimen no longer works or until unacceptable side effects occur. Each cycle is repeated every 28 days.
Note: Letrozole is only indicated for use in post-menopausal women and should not be used by pre-menopausal women.
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 + letrozole are shown here:
Roughly, 7% of patients discontinue palbociclib and 2% of patients discontinue letrozole due to unacceptable side effects. Most symptoms reported above were mild (Grade 1 - 2).
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), triglycerides, and blood cholesterol levels, 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 + letrozole as planned, reduce the dose, delay therapy, or switch therapy.
- Palbociclib in combination with letrozole may increase your risk of developing blood clots more than with letrozole alone. Go to the emergency room if you experience signs of a pulmonary embolism such as shortness of breath, chest pain, or heart palpitations (rapid, fluttering, or pounding feeling)
- Do not take estrogen replacement therapy or other medications that contain estrogen as they may decrease the effectiveness of letrozole
- 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 clinicaltrials.gov 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®) + Letrozole (Femara®), 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®) + Letrozole (Femara®). Depending upon your income, they may be able to help cover the cost of:
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®) + Letrozole (Femara®) 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.
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®) + Letrozole (Femara®)