The Future Of Metastatic Breast Cancer Treatment Is Bright
by Health Writer
Sometimes, despite treatment,breast cancer spreads and becomes metastatic, which doctors refer to as stage IV. According to the American Society of Clinical Oncology , the five-year survival rate for metastatic breast cancer is just 27%, leaving many women with this diagnosis fearful for their futures. But groundbreaking research into new treatment options for MBC is moving fast, instilling new hope in patients and doctors alike. Here, the experts share the latest on these advances to learn how they may soon help women with MBC live longer, better lives.
Adding Panitumumab To Chemotherapy Helps People With Ras Wild
Who does this study affect? People with RAS wild-type metastatic colorectal cancer.
What did this study find? This phase III PARADIGM clinical trial found that combining the targeted therapy drug panitumumab with standard chemotherapy as a first-line treatment helped people with metastatic RAS wild-type colorectal cancer live longer. Metastasis means that the cancer has spread to distant parts of the body. Wild-type means that there is not a mutation in the cancers RAS gene.
Colorectal cancer is the third most common cancer diagnosed in both men and women worldwide. When colorectal cancer has spread to distant parts of the body , the 5-year-survival rate is 15%, and about 22% of patients are diagnosed at this stage. It has been 10 years since a new drug has shown an improvement over the current standard of care for metastatic colorectal cancer that does not have a RAS mutation.
Copyright 2004 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.
To determine how well the treatments worked, researchers looked at several measures, including overall survival, progression-free survival, response rate.
The researchers main focus was on overall survival, which is how long people diagnosed with the disease are alive after treatment. Panitumumab improved overall survival for all study participants, and people with left-sided tumors had an 18% lower risk of death if they received panitumumab.
Living With Metastatic Breast Cancer
An advanced breast cancer diagnosis often elicits a flood of emotions: fear, confusion, sadness, anger and worry. You may wonder, Why me? You may think its unfair that this has happened to you. All of these emotions and feelings are normal, so take the time to process your thoughts, speak with your care team to understand your diagnosis, and connect with loved ones and close friends for support.
Over time, as the shock wears off, many patients find that they get on with their lives, adjusting to what some call their new normal. You may continue to work, enjoy life and spend time with family and friends, even if sometimes you have less energy than before.
Try to eat a nutritious diet to feel stronger and better tolerate treatments. Maintaining good nutrition may also help lower your risk of infection and provide you with more energy for enjoying life.
Light exercise may give your mind and body’s boost, helping you feel energized, especially if you spend time in the fresh air. Always seek medical advice before making any changes to your diet or exercise routines.
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Progression During Hormone Therapy
For hormone receptor-positive cancers that were being treated with hormone therapy, switching to another type of hormone therapy sometimes helps. For example, if either letrozole or anastrozole were given, using exemestane, possibly with everolimus , may be an option. Another option might be using fulvestrant or a different aromatase inhibitor, along with a CDK inhibitor. If the cancer has a PIK3CA mutation and has grown while being treated with an aromatase inhibitor, fulvestrant with alpelisib might be considered. If the cancer is no longer responding to any hormone drugs, chemotherapy immunotherapy, or PARP inhibitors might be options depending on specific features of the cancer or any gene changes that might be present.
Additional Tools For Diagnosing Advanced Breast Cancer
The additional tools below are often used specifically for diagnosing advanced cancer:
Sentinel lymph node biopsy: This procedure removes sentinel lymph node cells during surgery for examination. When breast cancer spreads, it often heads first to the lymph nodes.
Chest X-ray: This detailed image of the chest may help doctors see whether cancer has spread to the bones.
Computed tomography scan: Also known as a CAT scan, this procedure takes detailed pictures of internal areas of the body using a computer linked to an X-ray machine. A dye may be used to help the organs show up more clearly in the images.
Bone scan: This procedure looks for bone metastasis, or cancer cells that have spread to the bone. A small amount of radioactive material is injected into the blood, then detected with a scanner.
Positron emission tomography scan: A PET scan is a detailed imaging tool that uses a radioactive drug, known as a tracer, to search for cancer cells within your body.
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Treatment Advances In Metastatic Breast Cancer: Highlights From Asco 2022
At the 2022 American Society of Clinical Oncology Annual Meeting held in Chicago, Illinois, this years theme was Advancing Equitable Cancer Care Through Innovation. The program featured more than 200 sessions and 2500 poster presentations on a vast array of topics in cancer care.Adam M Brufsky, MD, PhD, FACP, is among the many clinician scientists who presented results of research on metastatic breast cancer. Dr Brufsky is a professor of medicine and associate chief for the division of hematology/oncology at the University of Pittsburgh School of Medicine, codirector of the Comprehensive Breast Cancer Center at the University of Pittsburgh Medical Center, and medical director of the Magee-Womens Cancer Program at the UPMC Hillman Cancer Center in Pittsburgh, Pennsylvania.
Among the wide range of research findings presented at the 2022 ASCO conference on the treatment of metastatic breast cancer, which stood out to you and why?
Your study examining the role of socioeconomic status in metastatic breast cancer survival reported worse survival among patients with low socioeconomic status.3 What are the implications of these findings and what is the significance of the observation that race was no longer a predictor of worse survival when socioeconomic status was considered?
What additional questions would you like to see investigated regarding the treatment of metastatic breast cancer?
Circulating Tumor Cells And Circulating Tumor Dna
Circulating tumor cell levels can help predict survival for people with metastatic breast cancer .
The more circulating tumor cells in the blood, the more advanced the metastatic breast cancer tends to be.
Having more circulating tumor cells may also predict a lack of response to treatment.
Circulating tumor DNA is also under study for use in monitoring metastatic breast cancer and predicting treatment response .
Circulating tumor cell and circulating tumor DNA tests are not used today to guide treatment. This is because they havenât been shown to offer benefit .
However, these methods are under study.
Integrative Therapies For Metastatic Breast Cancer
You may find it beneficial to add integrative therapies to your treatment plan. There are many evidence-informed integrative modalities to boost the mind and body. Practices like gentle yoga, meditation, massage and music therapy may feel enjoyable and reduce stress and anxiety levels.
To help our patients maintain quality of life after a metastatic breast cancer diagnosis, our team of breast cancer experts may offer supportive care services to help manage side effects of the disease and its treatments. These may include:
Before starting any integrative therapies, however, ask your care team for advice on which ones are most suited to you and fit into your overall treatment plan, as well as how to do them safely.
New Treatments Target Three Main Types Of Mbc
Metastatic breast cancer is not just one disease. Its actually a collection of diseases that are designated based on tumor testing results, explains Erica L. Mayer, M.D., a breast oncologist and senior physician at the Dana-Farber Cancer Institute in Boston. Much of the latest treatment research focuses on three main subtypestriple-negative, hormone receptor-positive, and HER2-positive cancer. In each category weve seen new drug approvals with exciting agents that attempt to target the specific kind of cancer and open the door for future therapies. Lets take a look at these developments now.
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Stem Cell Transplant Improves Progression
Who does this study affect? People who have been recently diagnosed with multiple myeloma.
What did this study find? The phase III DETERMINATION clinical trial found that including an autologous bone marrow/stem cell transplant early in the treatment plan for younger people with newly diagnosed multiple myeloma significantly improved progression-free survival. Progression-free survival is the amount of time during and after treatment that the cancer does not grow or spread further.
Multiple myeloma is a blood cancer that affects the plasma cells in the bone marrow. Bone marrow is the spongy tissue inside bones that creates different types of blood cells, including plasma cells. Plasma cells produce antibodies to help the body fight infection and they are an important part of the immune system. Multiple myeloma is most commonly diagnosed in people older than 60 and the median age at diagnosis is 70 years old.
The 722 participants in this study had newly diagnosed multiple myeloma and ranged in age from 18 to 65 years. They were randomly divided into 2 treatment arms, or groups.
What does this mean for patients? For younger people with multiple myeloma, initial treatment with an autologous stem cell transplant led to a median 21.4-month improvement in progression-free survival when compared with treatment without a stem cell transplant.
lead study author Paul G. Richardson, MD Dana-Farber Cancer Institute
It’s A Hopeful Time For Metastatic Breast Cancer Research
While no one wants to receive the news that their breast cancer has spread, there is hope: Treatments are better than ever and improving fast. Looking at the progress weve made over the past 20 years with metastatic breast cancer, there has been a dramatic shift from older treatment modalities that were mostly chemotherapy-based to our current modalities, which interrogate the specific cancer to understand what is making it grow and target that cause. Dr. Mayer says. I hope our continued efforts to pursue research will translate into many new therapies and strategies to help benefit patients with metastatic disease.
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Advances Improve Outcomes But Leave Space For Curative Strategies In Metastatic Breast Cancer
John T. Cole, MD, discusses how updates in HER2-positive breast cancer have affected sequencing strategies, selecting between CDK4/6 inhibitors in the adjuvant and metastatic settings of hormone receptor HRpositive breast cancer, and the need for additional therapies in triple-negative breast cancer.
Data with antibody-drug conjugates and small molecule inhibitors like tucatinib in HER2-positive breast cancer, CDK4/6 inhibitors in hormone receptor positive breast cancer, and immunotherapy and sacituzumab govitecan-hziy in triple-negative breast cancer have pushed the paradigms toward improved outcomes, said John T. Cole, MD, who added that despite all of these advances, curative-intent therapies are needed for these populations.
The theme is that it is a dynamic field. Its great for patients that so many things are happening, but we are still not curing a lot of patients. It is great to have improvements in progression-free survival and overall survival , but cure is really what we are going for. We have a lot of work left to do to achieve that, said Cole, in an interview with OncLive® following an Institutional Perspectives in Cancer webinar on breast cancer.
Genetic Testing For Inherited Gene Mutations
The National Comprehensive Cancer Network recommends everyone diagnosed with metastatic breast cancer get genetic testing for BRCA1 and BRCA2 inherited gene mutations . If you have a mutation in one of these genes, a PARP inhibitor may be included in your treatment plan.
Metastatic breast cancer can respond to many different drug therapies. This means the drugs can shrink the tumors.
However, over time, tumors can become resistant to drugs used to treat metastatic breast cancer.
Learn how your metastatic breast cancer will be monitored, including blood tests for tumor markers, and when drug therapies are likely to change. Also learn about scan anxiety .
Talk about quality of life issues with your health care providers and your family. This can help you decide what treatments are best for you.
Keep in mind how each treatment option fits in with your values and beliefs, your family situation, your finances and anything else that may be important to you at this stage of your life.
Joining a support group may also help you think through these issues.
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New Treatments For Metastatic Cancers
In 2016, some 40,000 women are expected to die from metastatic breast cancer, the most advanced stage of the disease , when cancer cells spread to other organs of the body. While there is no cure for metastatic breast cancer, recent breakthroughs in treatments have helped control the cancer and improve quality of life.
Other Uses Of Circulating Tumor Dna In Breast Cancer Treatment
If treatment with the drug alpelisib is being considered, circulating tumor DNA testing can be used to see if the cancer cells have a PIK3CA tumor gene mutation .
Our commitment to research
At Susan G. KomenÂ®, we are committed to saving lives by meeting the most critical needs in our communities and investing in breakthrough research to prevent and cure breast cancer. Our Research Program is an essential driving force for achieving this mission.
Since our inception in 1982, Komen has provided funding to support research grants that have greatly expanded our knowledge of breast cancer and helped us understand that breast cancer is not just a single disease but many diseases, unique to each individual.
To date, Komen has provided nearly $1.1 billion to researchers in 47 states, the District of Columbia and 24 countries to support research that has resulted in a better understanding of breast cancer earlier detection personalized, less invasive treatments for what was once a âone-treatment-fits-allâ disease and improvements in both quality of life and survival rates.
Learn more about our continuing investment in research and the exciting research that we are funding, because nothing would make us happier than ending breast cancer forever.
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Local Or Regional Treatments For Stage Iv Breast Cancer
Although systemic drugs are the main treatment for stage IV breast cancer, local and regional treatments such as surgery, radiation therapy, or regional chemotherapy are sometimes used as well. These can help treat breast cancer in a specific part of the body, but they are very unlikely to get rid of all of the cancer. These treatments are more likely to be used to help prevent or treat symptoms or complications from the cancer.
Radiation therapy and/or surgery may also be used in certain situations, such as:
- When the breast tumor is causing an open or painful wound in the breast
- To treat a small number of metastases in a certain area, such as the brain
- To help prevent or treat bone fractures
- When a cancer is pressing on the spinal cord
- To treat a blood vessel blockage in the liver
- To provide relief of pain or other symptoms anywhere in the body
In some cases, regional chemo may be useful as well.
If your doctor recommends such local or regional treatments, it is important that you understand the goalwhether it is to try to cure the cancer or to prevent or treat symptoms.
What Is Metastatic Breast Cancer
Metastasis is the process by which cancer cells spread. In the case of metastatic breast cancer, the cancer originated in breast tissue, then spread to other parts of the body.
Metastatic cancer is further described as local, regional or distant, depending on the location of the cancer cells in relation to the original tumor.
- Localized metastatic breast cancer often means the breast cancer has spread to nearby lymph nodes.
- The more distant locations include the bones, lungs, skin, liver and brain, although its possible for other parts of the body to be affected.
Its important to remember that every cancer is unique and that your experience may not necessarily be the same as that of another breast cancer patient. With a personalized treatment plan, metastatic breast cancer is typically treatable. A recent National Cancer Institute study found that the number of U.S. women living longer with distant metastatic breast cancer is growing, thanks to advances in treatments.
Its also important to prepare yourself with information about the disease, its symptoms and how its detected and treated.
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Expanded Access And Right To Try: Alternative Paths To Experimental Treatments For Metastatic Breast Cancer
If you would like to find out whether theres an experimental drug that could be beneficial for you, talk to your medical team. Make sure that youve thoroughly researched whether there are any clinical trials you can join. In most cases, you wont be eligible to request an experimental drug through Expanded Access or Right to Try unless participating in a clinical trial is not possible for you.
Doctors recommend enrolling in a clinical trial if youre eligible since your participation helps advance treatments for breast cancer and, by participating, you receive extra medical attention and monitoring of side effects during the trial.