When making decisions between two options in cancer treatment, there are a lot of grey areas when black and white options would be much easier. You want to make sure that what you choose will work the best on your cancer but also impact your quality of life as little as possible. The base medicine which suppresses estrogen, exemestane/ Aromasin, was going to be the same in either possible option. The possible trial option was going to be an immunotherapy drug, entinostat, and the option that has been around for longer, everolimus, is actually an immunosuppressant drug originally used to prevent organ rejection but has been found to help breast cancer when paired with a drug such as exemestane.
Things to think about:
* Trials are not held at my cancer center so I would have to go to either the MLK or Brandon center adding about an hour total to each appointment & my on campus class times were built around the times that my dr is at my center; so, that could be more difficult.
*Trials sometimes have many more appointments b/c they are tracking everything
*I would not necessarily be seeing my doctor at all of those appointments
*Stage IV/ metastatic needs more research & that aspect is important to me
*Does the trial have a placebo arm for the 2nd drug? If so, oncologist won't let me on it because the progression free survival on the combo of drugs is twice that of the one drug alone
*The progression free survival median is about 1 month different based on research between the two combos - so not a huge factor either way
*Side effects are not substantially worse on either drug
BUT the big factor --
*If I don't take the trial drug now, I will lose it as an option in the future as it is only being tested with this one estrogen suppressing drug and only with those having never had the drug before. Unless trials start with another estrogen suppressing drug, it will not be in my arsenal to use.
So, I was weighing a lot of pros & cons, and once the decision is made, you have to just trust that it is the best one for you. You can't look back and wonder "what if" because that does no good. My gut kept saying go with the more tried & true exemestane & everolimus combo as it would be less disruptive on my life, but the "we need research" side of me felt pretty guilty about that. So, I was really kind of hoping that the decision would be made for me and that the trial would not actually be an option for me due to placebo, etc.
My doctor called yesterday afternoon, and my wish was granted. The trial wasn't an option b/c of the possibility of getting a placebo and it was not being administered even at the MLK and Brandon centers. The only location was 1 1/2 hours away which would not be feasible at this time. So, I'm able to go with my gut feeling without any concern that another option might have been a better choice which is such a relief! I should be getting the exemestane by tomorrow and will go ahead and start it. Once I get the other medicine from the specialty pharmacy I will add that in as well.
Sorry this was a much longer post than I expected when I began writing, but hopefully, it will help people to understand all the many aspects that go into deciding which treatment route to take.