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Nothing is more frightening than when you or a woman you love has been diagnosed with Stage IV, Metastatic Breast Cancer. Stage IV cancer means the cells have spread beyond the breast and are now present in lymph nodes and other parts of the body. Most commonly, cancer will spread to the liver, bones, or lungs, but it can also spread to the brain or other organs.
Thanks to innovative research in the field of curing cancer, women now have more treatment options than ever. Treatment methods are continuing to improve. Women with Metastatic Breast Cancer should explore all the possible options and select the one she feels most comfortable pursuing.
The good news is that with advanced care, many women are living longer with metastatic breast cancer than in the past. Research is continuing and progress is happening. Once the form of the metastatic breast cancer has been determined, the best treatment options can be explored.
Breast cancer patients will need to determine if their tumors are positive or negative for growth receptors. This signals the presence or absence of the known drivers for cancer. The cancer may or may not be driven by HER2 (human epidermal growth factor receptor 2) receptors.
Once this has been determined, a more tailored treatment approached based on the patient’s specific needs can be determined.
Inhibitors for Treating Breast Cancer
Inhibitors are drugs that block proteins called cyclin-dependent kinasis (CDK’s). By blocking the proteins in the hormone receptor-positive breast cancer cells, the cells can be deterred from dividing. This helps slow down the growth of the cancer. There are many types of inhibitors now available, but here are a few examples.
Now approved for women with advanced hormone receptor-positive, HER2-negative breast cancer, this treatment only involves taking pills once or twice daily. Three approved inhibitors are palbociclib (Ibrance), ribociclib (Kisqali), and abemaciclib (Verzenio). There are other medications that may be used in conjunction with the inhibitors.
Women who have already gone through menopause and have advanced hormone receptor-positive HER2-negative breast cancer have the option of using Everolimus. Everolimus is commonly used with the aromatase inhibitor exemestane Aromasin. This combination is used for women whose cancer cells are still increasing while being treated with letrozole or anastrozole. It can also be used if the cancer started growing after the treatment with these drugs was stopped.
This treatment is targeted therapy. The drugs block mTOR which is a protein in cells that helps them grow and divide. Everolimus is used to help stop the tumors from developing new blood vessels. The results can often limit their growth. This drug has been known to help hormone therapy drugs work better when treating breast cancer. The pill is only taken once-a-day.
PARP inhibitors are used in metastatic breast cancer treatment to help repair damaged DNA inside cells. The two main drugs used as PARP inhibitors are olaparib (Lynparza) and talazoparib (Talzenna). Women who have BRCA gene mutations need help with cell DNA repair. BRCA normally helps repair DNA but mutations in those genes stop that from happening. That is when the PARP inhibitors come into play. PARP inhibitors help by locking the PARP proteins. Tumor cells with the mutated BCRA gene have difficulty repairing damaged DNA. Blocking the PARP proteins can lead to the death of the tumor cells.
In cases where women have already gotten chemotherapy and have a BRCA mutation, olaparib and talazoparib can be used to treat metastic HER2-negative breast cancer. Not all women with breast cancer have the mutated BRCA gene. It’s important to know if you have the mutation and you should be tested by your doctor before starting this treatment. The pills are taken once daily.
Special antibody drugs have been designed to target certain cancer cells. The drug trastuzumab (Herceptin) is an antibody that specializes in targeting HER2-positive cancer cells. The combination of an antibody targeted therapy drug and chemotherapy drug is called an antibody-drug conjugate. This combination makes a targeted delivery of chemotherapy drugs to the cancer cells.
There are other antibody-drug conjugates being studies. They are being used for the treatment of metastatic breast cancer. Breast cancer with a higher level of the protein Trop-2 is called triple negative breast cancer. Sacituzumab govitecan is an antibody-drug conjugate combining a Trop-2 and chemotherapy drug for a targeted delivery.
Not every breast cancer patient will need chemotherapy (chemo). Chemo drugs are commonly injected into veins or taken by mouth. They travel through the bloodstream to reach the cancer cells. Situations where chemo is recommended include the following:
Surgery is the most common treatment for breast cancer. There are different types of surgery, done for different reasons. Each situation is unique and based on what is best for the patient.
Mastectomies are simply removing as much of the cancer as possible. Biopsies are performed to determine if the cancer has spread to the lymph nodes under the arm. Often women have breast reconstruction surgery to restore the shape of the breast once the cancer is removed.
The choices for having a mastectomy are a complete mastectomy where the breast is removed completely or breast-conserving surgery. This again depends on the type of breast cancer, the size of the tumor, previous treatment history, or other factors.
Studies have shown that having a total mastectomy does not mean you have a better chance of long-term survival or a better overall outcome. Many women are choosing breast-conserving surgery.
Advanced breast cancer means the cancer has spread to other parts of the body. Surgery can be used to slow the spread of cancer or relieve painful symptoms.
Surgery might be used in the following situations:
Whether or not you need radiation for metastatic breast cancer will depend on if you have had surgery, if the cancer has spread to other parts of the body or age of the patient. Radiation therapy comes in many different types and combinations.
External beam radiation is given by a machine outside the body. Internal radiation (brachytherapy) is a radioactive source that is put inside the body for short periods of time.
Most commonly, radiation therapy is used after breast-conserving surgery to lessen the chance the cancer will come back in the breasts. It can be used after a mastectomy if the tumor was large or if it was found in the lymph nodes. It might also be used if the cancer has spread to organs, bones, or the brain.
Doctors are gaining a better understanding of how to use the many options now available for treating metastatic breast cancer. There is a focus on balancing symptom control with quality of life and allowing patients to make appropriate selections of treatments any given time. With this being said, there is every reason for breast cancer patients with metastatic breast cancer to stay hopeful and optimistic.
This article represents the opinions, thoughts, and experiences of the author. This content has not been paid for by any advertiser nor does WhipCancer.org recommend or endorse any products or treatments discussed herein. WhipCancer.org does not provide medical advice, diagnosis or treatment and information contained on this site is intended for informational purposes only. Please seek the advice of your physician or other professional healthcare provider with any questions you may have.