As all my test results were optimal and perfect, I was placed in Treatment Arm A where the main focus is killing off hormone production. The plan is that I get Zoladex, Tamoxifen, and if those two don’t give the expected results Ibrance will be added. Deep biopsies and blood work will be done at regular intervals to check that the meds are working.

It’s all very medical and I am learning (reading) loads of new words. I’m glad I have a solid background in microbiology and chemistry, because I do sometimes find words I recognise and can relate to!

Due to my tumour being estrophile the treatment regime targets both my hormone production and the tumour’s ability to feed off existing hormones. Zoladex is a long-acting depot injection that I will receive every 28 days and it’s in charge of reducing hormone production. Tamoxifen is a pill that I take once daily and it targets the tumour cells’ ability to utilize estrogen. After two weeks I am scheduled to have a new deep biopsy, to check the effects (if any) on the tumour cells. One of the results that will decide future treatment is the KI-67 antigen. If the current meds are sufficient, my KI-67 levels should have halved – but as mine are at 7.5% (“normal” level for estrophile breast cancer patients is 30%) it is highly doubtful this has happened, in which case I will also start taking Ibrance, which is a CDK-inhibitor, and its role is “preventing overproliferation of cancer cells”.

I like Wikipedia because it explains difficult medical stuff as simply as possible, which basically means I know most of the words and recognize some biological pathways from biochemistry! But as the authors formulate descriptions much better than I ever will, here’s their explanation of the drugs involved:

Ibrance/palbociclib is a selective inhibitor of the cyclin-dependent kinasesCDK4 and CDK6 (enzyme inhibitor).

Zoladex/goserelin acetate, is a drug used to suppress production of the sex hormones (testosterone and estrogen), particularly in the treatment of breast and prostate cancer.

Tamoxifen itself is a prodrug, having relatively little affinity for its target protein, the estrogen receptor (ER).

Unlike Ibrance, Tamoxifen and Zoladex have been used for many years and there are comprehensive lists of potential side effects of both.

The most commonly reported adverse reactions with ZOLADEX in breast cancer clinical trials were hot flashes (70%), decreased libido (47.7%), tumor flare (23%), nausea (11%), edema (5%), and malaise/fatigue/lethargy (5%). Injection site reactions were reported in less than 1% of patients.

Commonly reported side effects of tamoxifen include: amenorrhea, fluid retention, hot flash, nausea, vaginal discharge, vaginal hemorrhage, weight loss, and skin changes. Other side effects include: infection, sepsis, alopecia, constipation, cough, diarrhea, edema, increased serum aspartate aminotransferase, menstrual disease, oligomenorrhea, ostealgia, vomiting, and weight gain (these may or may not appear until years after treatment)

Ibrance, on the other hand, got an accelerated approval by the FDA on February 2nd, 2015. According to TV2, “In 2015, a study of cancer drug palbociclib (Ibrance) was stopped because the results were so good that it was not prudent to continue and give some of the study participants placebo medicine”. Ibrance was approved by Norwegian health authorities on November 9th, 2016.

Common side effects of Ibrance include: decreased neutrophils. Other side effects include: infection and pulmonary embolism.

Looks a bit too good to be true – the complete list is slightly longer.

Today is day 5 and I am still awaiting the onset of side effects. I was actually hoping the hot flashes would appear instantaneously, as it’s been pretty cold the last week. Not that I’m complaining, not the slightest bit! But with my oh-so-weird body, a thought that sometimes circulates is are the meds actually working since I’m not experiencing side effects? And I know that they most probably are, and I should count myself lucky that there are no side effects yet and that they will set in at some point and I will be cursing old-me who wanted them… weird mind, I know.

And in case you’re wondering about the financial pros of this study:
I get the drugs and tests for free (I just have to pay for getting the stitches removed). I don’t get paid to participate. I am doing this of my own free will because I want to contribute.