Palbociclib to ribociclib

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I’ve been on letrozole/goserelin and palbociclib for about 17 months. In that time my palbociclib dosage has been lowered from 125mg to 100mg to 75mg. Had my blood test last Friday and neutrophiles were 0.7, which means my palbo treatment has been delayed by 8 days and just got a sore throat today. Some unknown seasonal infection (not Covid) which id get around this time of year even before cancer

My substitute Consultant suggested in the long term switching palbo to ribociclib or a third drug which causes diarrhoea if my neutrophiles dropped again as the alternatives are easier on the immune system. I countered this and she conditionally accepted. As apart from this recent bout, the neutrophiles have not dropped and I’ve not missed treatment since the reductions.

However the conversation has caused me to panic. I want to remain on palbociclib as long as I can.

What have others done in this situation?

Did you accept the change in drugs and how is it working out? Want to be an informed patient.

thanks Greenery

FormerMember over 3 years ago

Hi Greenery, I know quite a bit about these drugs so I thought I'd share what I know. Palbociclib, Ribociclb and Abemaciclib are all CDK4/6 targeted drugs for ER+ metastatic breast cancer. They all cause low white blood count and treatment is often delayed until bloods improve which is frustrating or the dose is adjusted. They are all very similar with the key difference being Abemaciclib which has an adverse side of Diarrhoea but interestingly there are trials for this drug as it may cross the blood brain barrier. It's positive that your oncologist is prepared to swap you over to try another CDK4/6 as the NHS guidelines say that patients cannot swap over when they've been on one CDK unless they have an adverse side effect within approx 12 weeks of starting the drug. I hope this helps and you are very right to say you want to be an informed patient, it's the only way to be with secondary BC. I hope the treatment works well for you, Pretty Gardener

Greenery over 3 years ago in reply to FormerMember

Hi thank you for your helpful reply. It’s helped me look at it from a different perspective and feel maybe it’s not so bad , which I don’t think I would have considered without your advice. I also hadn’t realised ribociclib had the same impact on bloods as palbociclib.

Out of interest what is the blood brain barrier, I’ve not come across that yet.
thanks again Greenery

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