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Deciding whether to go on abemaciclib (brand name Verzenio)

Breast Cancer | Last Active: Jan 28 5:33pm | Replies (69)
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@slapshotmary

I got some info from my doctor. However, what the drug and research is saying doesn't really support me going on abemaciclib, but I'm not a medical doctor. I just want some feedback. So my Ki-67 is low at 2%, I have invasive lobular carcinoma with 4+nodes out of ten that were removed. I'm stage IIIA. I was not given a oncotype DX test. However, my doctor said they used a different test and my prognostic is 1B. He based his recommendation on being ER+ and HER2- and 4+ nodes. However, what I've read is that the Ki-67 is the big determiner of recurrence. Does anyone have an opinion or guidance? Or what questions I should be following up with? I am currently taking anastrozole and do not want to add another medication with so many side effects. I also did 20 cycles of chemo and 6 weeks of radiation after my lumpectomy. Thank you, Thank you so much. Oh yea, is IIIA with 4+ nodes considered early or advanced breast cancer? I'm so glad for this forum. It is helping with my sanity.

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Replies to "I got some info from my doctor. However, what the drug and research is saying doesn't..."
pharmonc88 | @pharmonc88 | Jul 20, 2022

Advanced breast cancer is metastatic (Stage IV); meaning it has spread at least to bone, or liver, or brain, or lungs, or a combination. Stage IIIA is still considered early stage; and technically IIIB and IIIC is known as locally advanced.

Ki-67 is not the bigger predicter of breast cancer recurrence, but it is one of many factors. Size of tumor, nodal involvement, and even tumor Grade have much more influence on the risk of recurrence. Stage III are by definition larger tumors; 4-positive nodes is what's contributing to stage III over II (stage II nodal involvement is <4).

If you take a look at figure 1 (Hazard of recurrence among women after primary breast cancer treatment–a 10-year follow-up using data from SEER-Medicare by Cheng published in 2012)

What this is showing you is that Stage III disease (which is larger tumor and more nodal involvement) has a higher risk of recurrence, particularly in the first 2-3 years. The peak is higher comparatively to Stage I and stage II. What your doctor is suggesting is to lower that peak…lower the risk of cancer coming back when that risk is the highest. Technically Verzenio/abemaciclib is not FDA approved for patients with Ki-67 <20%, like you. However the major guidelines for practice (NCCN, ASCO) all endorse adding abemaciclib based on the available data published data shown to reduce recurrence, even in patients with a low ki-67 score but stage III disease like yourself.

Hope this helps.
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