Fulvestrant and Palbociclib (The James)

Fulvestrant and Palbociclib

What is Fulvestrant (fool-VES-trant) and how does it work?

Fulvestrant is a cancer medicine known as an “estrogen receptor antagonist”. Another name for this medicine is Faslodex. It is made in a laboratory. This medicine fights cancer by keeping the hormone estrogen from “feeding” cancer cells, which stops the cancer cells from growing. This type of treatment is different from chemotherapy and is also known as “endocrine” or “hormone blocking therapy”.

What is Palbociclib (PALB-o-si-clib) and how does it work?

Palbociclib is a type of oral, targeted cancer therapy called a “cyclin D kinase inhibitor.” Another name for this medicine is Ibrance. It is made in a laboratory. This medicine dissolves in your digestive system and gets absorbed into your blood. Once inside cancer cells, Palbociclib can prevent cells from dividing and making new cancer cells.

What should I tell my doctor before starting this treatment?

Talk to your doctor about the following:

  • If you have ever had chemotherapy or anti-cancer treatment and the names of the medicines you were given.
  • If you are pregnant or think you may be pregnant. Your doctor will talk with you about birth control when you take these medicines.
  • If you are breastfeeding.
  • If you have been told that you need to start a new medicine.
  • The medicines/pills you are taking, including:
    • Medicines prescribed by any of your doctors
    • Herbs
    • Vitamins
    • Over-the-counter medicines

How do I handle, store and dispose of Palbociclib?

  • There are special safe handling instructions for this Palbociclib. Talk to your doctor, pharmacist or nurse about the precautions you need to follow when taking this medicine at home.
  • Store this medicine at room temperature, away from heat, moisture, and direct light.
  • Do not store in your bathroom or in your refrigerator.
  • Palbociclib comes from the pharmacy in individually wrapped containers.
  • Keep this medicine away from children and do not share it with anyone.
  • Disposal:
    • Talk with your pharmacist about how to get rid of (dispose) this medicine safely.

How does my doctor decide my treatment dose?

The dose of Fulvestrant (500 mg) is often the same for all patients. During the first 4 weeks of treatment, this medicine is given 3 times (1 dose every 2 weeks). After your third dose, this medicine is given once every 28 days. 

To determine your Palbociclib treatment dose, your doctor will review the following: your white blood cell counts, your medicines, how well your liver and kidneys work and any other health problems you have.

You will see your doctor or nurse practitioner every 1 to 3 months during treatment.

How will my Fulvestrant treatment be given?

Fulvestrant comes in a 250 mg syringe and is very thick and oily. The total dose you will be given is 500 mg. You will be given 2 injections into your buttock muscle (bottom). You can have 1 injection at a time, or have both injections given at the same time, one injection on each side of your bottom. Your entire visit, including your doctor’s appointment and your treatment will take 1 to 2 hours.

    How do I take Palbociclib?

    • Do not crush, break, chew or open the capsule.
    • See your prescription label for how many capsules to take each day and how often
    • There is a check next to your dose of Palbociclib:
      • ____ 125 mg
      • ____ 100 mg
      • ____ 75 mg
    • One “cycle” is 4 weeks:
      • On days 1 to 21 (first 3 weeks of the cycle), take 1 capsule each day. Take this medicine around the same time each day.
      • On days 22 to 28 (the last week of the cycle), do not take any Palbociclib.
    • Swallow the capsule whole with a full glass of water, with or without food.
    • If you miss a dose by more than 6 hours, wait until it is time for your next dose, and skip the missed dose. Do not double up on doses.
    • Do not take another dose if you vomit.
    • Your doctor may change your dose in the future to find out what works best for you. Taking a lower dose of Palbociclib does not mean the medicine will not work.

    What are the side effects of this treatment?

    Every person responds differently to treatment. Some of the more common side effects of Palbociclib are:

    Most common side effects:

    • Nausea and/or vomiting
    • Fatigue or weakness
    • Diarrhea
    • Mouth sores
    • Infection
    • Low white blood cell counts (can increase risk of infection)
    • Low red blood cell counts (can lead to tiredness and weakness)
    • Thinning of your hair
    • Rash

    Less common side effects:

    • Low platelet counts (can lead to easy bruising and bleeding)
    • Decreased appetite
    • Nosebleeds

    Some of the more common side effects of Fulvestrant are:

    • Hot flashes or flushing
    • Stomach pain
    • Back pain
    • Headache
    • Sore throat or cough
    • Nausea
    • Pain or soreness at the injection site

    When should I call my doctor?

    You should call your doctor right away if you have any of the following signs or symptoms:

    • Fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher
    A fever can be life-threatening if not treated. Your doctor may ask you to go to the hospital.
    • Open sores on your tongue or in your mouth
    • Nausea that keeps you from eating or drinking
    • Diarrhea (4 or more loose stools in 24 hours) or diarrhea at night
    • Shortness of breath or difficulty breathing
    • Swelling of your face, lips or throat
    • Severe pain, blistering, redness or swelling at the injection site
    • Depressed mood or sadness

    Is there anything else I should know about this treatment?

    • Palbociclib may cause changes in your blood counts. Your doctor will want to check your blood counts at the start of this treatment, every 2 weeks for the first 2 months and then every 1 to 3 months.
    • Do not eat grapefruit or drink grapefruit juice, Seville oranges or star fruit. This can increase your risk of side effects.
    • This treatment may make it harder for your body to fight infections. Wash your hands often and stay away from people who are sick.
    • It is important to keep hydrated during treatment. Unless told otherwise by your doctor, drink 8 to 10 cups of non-caffeinated fluid each day.
    Go to this video link: http://cancer.osu.edu/patientedvideos to learn more about your cancer diagnosis, treatment and care.



    © April 14, 2020. The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.

    This handout is for informational purposes only. Talk with your doctor or health care team if you have any questions about your care.

    For more health information, call the Patient and Family Resource Center at 614-366-0602 or visit cancer.osu.edu/PFRC