How Are Clinical Trials Helping To Improve Treatments
Scientists continue to conduct clinical trials to develop and test treatments for breast cancer.
These trials may help them develop new treatment options and learn which types of people are most likely to benefit from available treatments. Over time, this might lead to more effective and personalized treatment plans.
One 2018 trial found that chemotherapy doesnt benefit most women with early stage breast cancer that is hormone-positive and HER2-negative. These women may benefit from surgery and hormone therapy instead.
Researchers in many other trials are also trying to determine whether certain combinations of therapies work better in certain types of breast cancer, report the authors of a 2019 review .
Scientists are also studying ways to improve breast cancer screening and diagnosis to detect breast cancer in the earliest stage possible.
For example, the tomosynthesis mammographic imaging screening trial is evaluating the potential benefits of 3-D mammography.
This is a new technology that produces images from different angles around the breast to build a multidimensional picture.
There is no natural cure for breast cancer. Medical treatments are necessary to remove, shrink, or slow the growth of tumors.
That said, you may use certain complementary therapies and lifestyle changes alongside standard medical treatments to help:
- control symptoms of breast cancer
- ease side effects of treatment
- improve quality of life
For example:
How Does Immunotherapy Work
Immunotherapy is a type of treatment that uses the bodys own immune system to attack cancer cells.
The immune system works by attacking substances in the body it doesnt recognize. This includes viruses, bacteria, and cancer cells. Cancer cells present a big challenge, because they may not seem very different from normal cells to the immune system. Immunotherapy helps the immune system work better to fight the cancer cells.
Different types of immunotherapy work in different ways. Some types work by boosting your immune system to help it work better. Others give your immune system more tools, such as antibodies, to attack specific cancer cells.
There are four main types of immunotherapy that researchers are studying to treat metastatic breast cancer:
- checkpoint inhibitors
What Is Metastatic Breast Cancer
Metastatic breast cancer is not a specific type of breast cancer. Its the most advanced stage of breast cancer.
Metastatic breast cancer is breast cancer that has spread beyond the breast and nearby lymph nodes to other parts of the body .
Although metastatic breast cancer has spread to another part of the body, its still breast cancer and treated as breast cancer.
For example, breast cancer that has spread to the bones is still breast cancer . Its not the same as cancer that starts in the bone. Breast cancer cells have invaded the bones. So, its treated with breast cancer drugs rather than treatments for cancer that began in the bones.
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New Therapies May Offer Hope For Patients With Metastatic Breast Cancer
With more than two million new cases diagnosed in 2018, breast cancer is the most common cancer in women worldwide. The disease represents about 25% of all cancers in women. Incidence rates vary widely across the world, from 27 per 100,000 in Middle Africa and Eastern Asia to 85 per 100,000 in Northern America. Breast cancer is also the fifth most common cause of death from cancer in women globally, with an estimated 522,000 deaths annually
An estimated 90% of all breast cancer is diagnosed at an early stage. And approximately 70% of all breast cancers are HR+, HER2-, the most common subtype of the disease. Even within this subtype, HR+, HER2- breast cancer is a complex disease, and many factors, including cancer which spread to the lymph nodes and the biology of the tumor, can impact the risk of recurrence. Recent data shows that about 30% of people diagnosed with HR+, HER2- early breast cancer are at risk of their cancer returning, potentially leading to incurable metastatic disease.
Although an advanced disease, most women with metastatic or stage IV breast cancer are treated with systemic therapy. This treatment may include hormone therapy, chemotherapy, targeted therapy, or a combination of these options.
No an end-stage cancer While some people may refer to metastatic breast cancer as end-stage cancer, the disease is NOT hopeless and many people continue to live long, productive lives with breast cancer in this stage.
Myth #: When Breast Cancer Travels To The Bone Brain Or Lungs It Then Becomes Bone Cancer Brain Cancer Or Lung Cancer
Not true. Breast cancer is still breast cancer, wherever it travels in the body. However, the characteristics of the cells can change over time. For example, a breast cancer that tested negative for hormone receptors or an abnormal HER2 gene might test positive when it moves to another part of the body, or vice versa . Keep in mind that the cancer cells are trying to survive in the body, so they can change, says Dr. Gupta. We always emphasize rechecking the biology.
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Blood Tests For Tumor Markers
In some cases, blood tests for tumor markers may be used to help monitor metastatic breast cancer.
For example, you may have blood tests every few months for cancer antigen 15-3 or cancer antigen 27.29 . These tests are similar. Health care providers usually check one, but not both of these blood tests.
Whether the tumor marker test score rises or falls over time may give some information on tumor response to a drug or tumor spread.
Tumor marker tests are not helpful in every case. Some people with rising tumor marker levels dont have tumor growth, and some people with tumor growth have normal or unchanged tumor marker levels.
Health care providers dont make treatment decisions based on serum tumor marker testing alone. They may combine findings from a tumor marker test with information on symptoms and findings from imaging tests . This combined information can help your health care providers understand if a treatment is working well for your cancer.
Talk with your health care provider about whether tumor marker testing is right for you.
Myth #: Metastatic Breast Cancer Is Curable
Whether metastatic breast cancer is someones first diagnosis or a recurrence after treatment for earlier-stage breast cancer, it cant be cured. However, treatments can keep it under control, often for months at a time. People with MBC report fielding questions from family and friends such as, When will you finish your treatments? or Wont you be glad when youre done with all of this? The reality is they will be in treatment for the rest of their lives.
A typical pattern is to take a treatment regimen as long as it keeps the cancer under control and the side effects are tolerable. If it stops working, a patient can switch to another option. There may be periods of time when the cancer is well-controlled and a person can take a break. But people with MBC need to be in treatment for the rest of their lives.
As Breastcancer.org Community member Vlnprh of Wisconsin comments: The vast majority of people have no idea what MBC treatment involves. They somehow think that you will undergo something similar to early-stage patients surgery, radiation, chemo, whatever and then be done. They want to see you as a pink-tutu-wearing cheerleader jumping up and down declaring that you have beaten this disease
Amarantha of France writes: The one I get over and over is, How long will you be on this chemo? I mean doesn’t it end sometime? Yes, it ends when it stops working and then we go on to another treatment lather, rinse, repeat I guess until we run out of options.
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Summary Of Treatment Options For Metastatic Breast Cancer
Hormone receptor-positive, HER2-negative breast cancer
Hormonal therapy is considered the standard initial treatment for HER2-negative metastatic breast cancer that is also hormone receptor-positive, and is often given in combination with targeted therapy. However, chemotherapy may also be given. A clinical trial may also be an option for treatment at any stage.
Hormone receptor-negative, HER2-negative breast cancer
In general, chemotherapy or targeted therapy is given for treatment of triple-negative breast cancer. A clinical trial may also be an option for treatment at any stage.
HER2-positive breast cancer that has spread to parts of the body other than the brain
In general, HER2-targeted therapy is regularly added to treatment for HER2-positive breast cancer that has spread. The drugs used depend on the treatments already given and whether the cancer is hormone receptor-positive. The treatment recommendations for first-line, second-line, and third-line or higher treatment are listed below. A clinical trial may also be an option for treatment at any stage.
First-line treatment
Second-line treatment
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Second-line treatment is used for people with early-stage breast cancer who had the cancer either spread during initial treatment with trastuzumab or return within 12 months after stopping treatment with trastuzumab. It is also used for people whose cancer worsens while receiving first-line treatment.
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The preferred second-line treatment is the drug T-DM1.
Support For Your Caregivers
Your loved ones might also need help coping. Having a family member or friend with metastatic cancer is challenging, especially for people who help care for you. They can try the ways of coping above. Or your health care team can suggest other tips. For example, there are in-person and online support groups for family members of people with cancer.
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I Have To Prioritize And Try Not To Sweat The Small Stuff
For Sendelbach, each week begins with a list of her priorities. Obviously, getting to my doctors appointments is very important, she says. But if the clothes arent folded, is that a dire situation? Absolutely not!
Sendelbach has learned to make compromises: If her husband and son have to pick up their clean clothes from the couch, she can live with that.
I have learned, she says, to look at every situation and ask if this is going to truly make a difference in my day or my familys day for better or worse. If the answer is no, then that task might be left undone.
It wasnt always this way for Sendelbach, though. When she was first diagnosed with cancer, her son was just a year old and she had been married for only two and a half years. You know how it is when you first have a baby if everything isnt perfect, then the world is falling apart! she laughs. Now, to us we ate, were all still alive, the house is acceptable if were good, its all okay.
Why Does My Provider Need To Test The Metastatic Tumor
Your care team will test the metastases to figure out the biology of the tumor, which can help guide your treatment plan. Providers may test tumors for:
- Hormone receptor status: If the cancer is hormone receptor-positive, hormonal therapy may be your first treatment.
- HER2 status: Human epidermal growth factor receptor 2 is a protein that is overexpressed on some breast cancer cells. HER2-positive cancer responds to specific HER2-targeted therapies.
- PIK3CA gene mutation: If a tumor is hormone receptor-positive and HER2-negative, your provider may test for this gene mutation. Specific targeted therapies can be used to treat tumors with this mutation.
- PD-L1 status: Tumors that are hormone receptive-negative and HER2-negative may be tested for PD-L1 status. If the PD-L1 test is positive, you may be recommended to receive a combination of immunotherapy and chemotherapy.
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Treatment Options For Metastatic Breast Cancer
- Surgery: If breast cancer has spread to another part of your body, surgery many not be recommended because its unlikely to remove all the cancer cells. Still, if you have painful lesions in your bones or blockages in your liver, your doctor may recommend surgery. If your first diagnosis of breast cancer was metastatic, called de novo by doctors, your doctor may recommend surgery to remove the tumor in the breast.
- Chemotherapy: If the cancer is growing quickly or is growing even though youre on other treatments, your doctor will likely recommend chemotherapy. Chemotherapy is a systemic treatment because the medicines affect the entire body. Chemotherapy works by destroying or damaging cancer cells as much as possible.
- Radiation Therapy: For metastatic disease, radiation is used to:
- ease pain
- improve breathing by opening a blocked airway
- reduce pressure on a pinched nerve
In some cases, a treatment may stop working and the cancer may start growing. If this happens, you and your doctor will talk about other treatment options.
Taking A Break From Treatment For Metastatic Breast Cancer
Living with metastatic breast cancer can be like running a long race. You need to pace yourself. This can mean that you sometimes take a break from your treatments so your body can rest and recover. Talk to your medical team about your personal goals and quality of life, and work out a treatment plan that includes breaks when you need them.
When you take a break from treatment, you might be surprised to find that you feel pretty good and that the cancer may be controlled for an extended period of time. While you probably won’t see your medical team as often while you’re taking a break from treatment, it’s important to stay in touch with them. Set up a schedule to make sure you check in on a regular basis.
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Palliative And Supportive Care
Palliative and supportive care can be helpful at any stage of your illness to:
- prevent and relieve symptoms, such as pain or fatigue
- help you deal with any other physical, emotional, social and spiritual effects of secondary breast cancer
People often think of palliative care as being associated with end-of-life treatment, so are worried when its mentioned as part of their care.
However, many people benefit from having advice from a palliative care team much sooner, alongside their medical treatment.
Palliative care usually involves a team of healthcare professionals such as:
- specialist nurses
- physiotherapists
- occupational therapists
You can be referred by your specialist team, GP or specialist nurse depending on your situation.
Your needs and those of your family will be assessed by the palliative care doctor or nurse, who may see you at the hospital, hospice or in your own home.
If palliative care input is no longer needed, you can be discharged but be seen again when required. It can continue up to and including end-of-life care.
Diagnosis Of Stage 4 Breast Cancer
If you are diagnosed with breast cancer, you may have further tests to determine the extent that the cancer has spread throughout the body. This is called staging. It helps you and your doctors decide on the best treatment options for you.
In addition the numbered staging system, the TNM staging system is also commonly used for breast cancer staging.
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Thinking About Stopping Treatment
Many people reach a point when they decide not to have any more cancer treatment. This is often because the side effects from treatment are significantly reducing their quality of life, and they prefer to have supportive care and symptom control only.
This is never an easy decision to make. Sometimes people feel under pressure to have any treatment offered. Family and friends may also find it hard to accept their loved one has stopped having cancer treatment.
Its a very personal decision, so if you dont want to carry on with treatment, try not to feel guilty about something that you feel is the right step for you.
Whatever you decide it shouldnt make any difference to the care and support available to you.
If youd like to talk to someone about any aspect of your treatment and care, you can on 0808 800 6000.
A More Treatable Kind Of Metastatic Cancer
A plan for stereotactic body radiation therapy to treat a metastatic lung tumor.
Rarely are the terms cure and metastatic cancer used together. Thats because cancer that has spread from where it originated in the body to other organs is responsible for most deaths from the disease.
But in 1995, two cancer researchers put forth a controversial concept: There is a state of cancer metastasis that isnt necessarily fatal. They called it oligometastatic cancer, describing it as existing between a cancer that is contained to where it originated and one that has spread extensively throughout the body.
In oligometastatic cancer, the patient has only a few, usually small metastases . For some patients, this form of metastatic cancer should be amenable to a curative therapeutic strategy, Ralph Weichselbaum, M.D., and Samuel Hellman, M.D., both from the University of Chicago, wrote some 25 years ago.
At the time, and still today, most people with metastatic cancer are treated only with therapies meant to kill cancer cells anywhere they may be in the body, known as systemic treatment. The assumption being that any evidence of metastatic cancer, Dr. Weichselbaum said, means that metastases are everywhere, and thats not necessarily true.
Its taken time, but over the last 5 years or so, the duos hypothesis has been put to the test, primarily in small clinical trials.
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