[MUSIC PLAYING] JANE MEISEL: Hello! How are you?

CHRISTEN CHANDLER: Good? How are you?

JANE MEISEL: I haven't seen you in a while.

CHRISTEN CHANDLER: I know. It's been a while.

JANE MEISEL: Yeah. How are things going?

CHRISTEN CHANDLER: Really good.

JANE MEISEL: Yeah?

CHRISTEN CHANDLER: I can't complain.

JANE MEISEL: Awesome. Still taking the pills, and everything's going well with that?

CHRISTEN CHANDLER: I mentioned last time I sometimes get some sores on my nose, and I've been noticing a little bit of hair loss, but that's-- I mean, I really can't complain if that's all I've got going on.

JANE MEISEL: I mean, the hair looks good, but--

CHRISTEN CHANDLER: Thanks.

JANE MEISEL: Yeah.

CHRISTEN CHANDLER: It's a lot of powder.

JANE MEISEL: Some people use-- well, some people use thickening shampoos that are biotin supplements I think we may have talked about that before, which helps with hair and nail growth because sometimes the medicines can actually cause a little bit of hair thinning. So that could be what you're noticing. And then with the sores, are you using anything like Vaseline? Or how are you--

CHRISTEN CHANDLER: So if they get really bad, I'll use a pain relief, Neosporin, on a Q tip, and that will help. But, I mean, they usually are just more annoying than anything else.

JANE MEISEL: OK.

CHRISTEN CHANDLER: Quick question.

JANE MEISEL: Yes.

CHRISTEN CHANDLER: Since April will be four years, so moving into five years, what does that survival rate kind of look like if once I hit five years?

JANE MEISEL: It's such a hard question, and I think such a moving target. And we talked about this a little bit at the beginning when you started that the average patient will stay on those two drugs for about two years before progressing. And then some people, of course, progress earlier than that. Some people, and you are falling into this category, do really, really well beyond that. And I think what we don't know enough about yet is these patients who do really, really well for a long time, what does that mean? If the scans show no evidence of any progression, is there some point in the future where we can back off on treatment and do less and watch you carefully? Or do we just continue you on it since you're tolerating it really well?

CHRISTEN CHANDLER: Right.

JANE MEISEL: And I think at this point since we know not that much about what would happen if we backed off, and because when you did present initially with your cancer having come back, it was pretty dramatic with the pleural infusions, and you were feeling pretty sick and had the liver involvement all this stuff, my preference would be probably to keep you on it even at the five-year mark.

CHRISTEN CHANDLER: Mine, too.

JANE MEISEL: Yeah. But I think we can-- I think we can continue to talk about that as we get there. And the other thing that's nice is that having-- if you get to that five-year mark, or even where you are right now, the fact you've been so sensitive to these drugs and they've worked so well for so long also bodes well for you doing really, really well on the next thing, if at any point you progressively need a next thing.

CHRISTEN CHANDLER: I know that it can suppress my immune system a little bit. Are there things that I should avoid while I'm on that? Or can I just live life like normal?

JANE MEISEL: It suppresses your white blood cell count a bit. And that's one of the very, very common side effects. What we don't see with this class of drugs, in contrast to chemotherapy, is that we really don't see a lot of infections related to that. And so your immune system is very mildly suppressed. But I wouldn't say that there are things you should actively avoid.

CHRISTEN CHANDLER: My mom will constantly say, oh, you're immunocompromised. You've got to really be careful. Can you explain to me the difference? Because when I ask you that, you'll say, when I look at my labs, my white blood cell count will be critically low. But my total ANC is on the lower end of normal, but it's still in normal.

JANE MEISEL: Well, I think because the neutropenia that you have, the low white blood cell count that you have and that slightly low neutrophil count, is really a direct byproduct and side effect.

CHRISTEN CHANDLER: OK.

JANE MEISEL: And we now have studies in so many patients on these CDK4/6 inhibitors showing that even though people have routinely low white blood cell counts and live like that, they don't tend to be-- they don't tend to get infections, and especially life-threatening infections at a higher rate.

CHRISTEN CHANDLER: OK.

JANE MEISEL: And so that leads us to think that it's a different kind of suppression, that those neutrophils, those white cells that you have are probably still functioning just as well, whereas with chemo, they probably don't function as well. That's why people are more likely to get infections.

CHRISTEN CHANDLER: And what is the future of my treatment look like? I was on every three-month scans, now I'm on every four months. What does that look like scan-wise?

JANE MEISEL: There's no absolute, we must scan you every three months or every four months. I think some of that--

CHRISTEN CHANDLER: I like it.

JANE MEISEL: I know. Well, I was going to say, some of it, I think, is also based on patient and physician comfort, like, how comfortable do you feel? Some people hate scans, some people prefer to just get that little check a little more often. I think it's arbitrary, but I would suggest to you, just to plant the seed, that potentially when you get to five years, we could space it out to every six months and see how things are going. And, of course, they'll see you probably every three months just because we want to make sure that you're still feeling well and there's not anything we're missing. But yeah, I mean, I think at some point if the cancer progresses on what you're on, I would suspect that at that point we would switch you to an estrogen receptor down regulator regimen or trials that are open, if you're amenable to that. And then I think after that, there's still so many options. And those options probably will look different, too, at the time that you need them because I suspect that will still be several years from now, if not longer. So I think in the future to me looks very, very bright in terms of both you having lots of options and options that are going to allow you to live your life really, really fully.

CHRISTEN CHANDLER: Thank you so much.

JANE MEISEL: Oh, of course. I'm so glad you're able to come in today. It's great to see you.

CHRISTEN CHANDLER: Awesome. You, too, as always.