Indications For Cytotoxic Chemotherapy In Advanced Breast Cancer
Cytotoxic chemotherapy is a therapeutic option for many patients with MBC. Chemotherapy is generally recommended as first line treatment for patients with hormone receptor -negative breast cancer, patients with Human Epidermal Growth Factor Receptor 2 -positive disease , patients with HR-positive breast cancer with symptomatic visceral crisis or with endocrine resistance .
For patients with MBC in whom chemotherapy is recommended, the decision on a specific therapy should be individualized based on disease- and patient-related factors such as tumor biology, disease growth rate and presence of visceral metastases, menopausal status, comorbidities, prior therapies and patient preference. For instance, in patients with limited tumor burden or minimal cancer-related symptoms, single-agent treatment is less toxic and overall survival is similar when compared with combination chemotherapy. A meta-analysis by Dear et al., included 2,317 patients with MBC from 12 randomized clinical trials to assess the effect of combination chemotherapy compared to the same drugs given sequentially. This study showed higher tumor response rates in the combination arm , however, there was no difference in OS between combination versus sequential monotherapy and the risk of febrile neutropenia was higher in the combination arm . The appropriate patients for combination chemotherapy are those in which a rapid response is needed due to symptomatic disease, large tumor burden and rapid progression.
A Family History Of Breast Cancer And Other Factors Increase The Risk Of Breast Cancer
Risk factors for breast cancer include the following:
- A personal history of breast disease.
- A of breast cancer in a .
- Inherited changes in the or genes or in other that increase the risk of breast cancer.
- Breast that is dense on a .
- Exposure of breast tissue to made by the body. This may be caused by:
- at an early age.
- Older age at first birth or never having given birth.
- Starting at a later age.
Older age is the main risk factor for most cancers. The chance of getting cancer increases as you get older.
Breast Cancer Risk Assessment Tool uses a woman’s risk factors to estimate her risk for breast cancer during the next five years and up to age 90. This online tool is meant to be used by a . For more information on breast cancer risk, call 1-800-4-CANCER.
For Metastatic Breast Cancer
Chemo can be used as the main treatment for women whose cancer has spread outside the breast and underarm area to distant organs like the liver or lungs. Chemo can be given either when breast cancer is diagnosed or after initial treatments. The length of treatment depends on how well the chemo is working and how well you tolerate it.
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Side Effects Of Breast Cancer Chemotherapy
Chemotherapy usually works by attacking rapidly dividing cells. This means that chemotherapy can harm not only cancer cells but also healthy cells that are dividing rapidly, like the ones that cause your hair to grow.
Whether you have side effects from breast cancer chemotherapy will depend on the details of your treatment plan. The care teams at MSK are committed to helping you feel your best during and after treatment. During treatment, well watch carefully for your reaction to the drugs and adjust the drugs or dose as necessary. Well also continue to monitor you for possible long-term effects after your treatment ends.
We offer a variety of other specialized services to support you during your treatment. Many MSK patients find that our Integrative Medicine Service can be a valuable part of their treatment plan. Programs include massage, acupuncture, hypnotherapy, meditation, visualization, music therapy, and nutritional counseling.
One side effect of chemotherapy can be hair loss. MSK offers scalp cooling to help minimize hair loss. Learn more about scalp cooling, or ask your care team for more information.
Treatments For 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 . The breast cancer cells have invaded the bones. Its not the same as cancer that starts in the bones. So, its treated with breast cancer drugs rather than treatments for cancer that began in the bones.
If youve been diagnosed with metastatic breast cancer, youre not alone. Its estimated there were more than 168,000 women living with metastatic breast cancer in the U.S. in 2020 . Men can also get metastatic breast cancer.
Some people have metastatic breast cancer when they are first diagnosed with breast cancer . This is called de novo metastatic breast cancer.
Most often, metastatic breast cancer arises years after a person has completed treatment for early or locally advanced breast cancer. This may be called a distant recurrence.
A diagnosis of metastatic breast cancer is not your fault. You did nothing to cause the cancer to spread.
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Chemotherapy For Breast Cancer
Chemotherapy uses anti-cancer drugs that may be given intravenously or by mouth. The drugs travel through the bloodstream to reach cancer cells in most parts of the body. Sometimes, if cancer spreads to the spinal fluid, which surrounds and cushions the brain and spinal cord, chemo may be given directly into in this area .
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From Cured To Stage 4
Others, like Teri Pollastro, a 54-year-old stage 4 patient from Seattle, respond surprisingly well.
Diagnosed with early stage ductal carcinoma in situ in 1999, Pollastro underwent a mastectomy but did not receive chemotherapy, radiation or tamoxifen, since her cancer was ER negative.
âThey used the C-word with me, they told me I was cured,â she said. âEvery time I went back to my oncologist, he would roll his eyes at me when I had questions.â
In 2003, Pollastro switched to Seattle Cancer Care Alliance where she saw Dr. Julie Gralow, a breast cancer oncologist and clinical researcher at Fred Hutchinson Cancer Research Center. Gralow discovered Pollastroâs cancer had metastasized to her liver.
âMy husband and I were in shock,â said Pollastro of her mets diagnosis. âYou donât go from being cured to stage 4.â
Pollastro went on Herceptin, a type of immunotherapy for women with HER2-positive metastatic breast cancer, and did six months of chemotherapy.
âI felt better right away with the treatment,â she said. âBut the problem is, it stopped . Thatâs what you can expect with mets. And thereâs always some residual cancer. And that starts percolating.â
And along with mets, she also had to deal with many misconceptions regarding her disease.
The Mercer Island, Washington, mother of two, who often counsels newly diagnosed patients, sometimes even found it difficult to relate to early stage breast cancer survivors.
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The Following Types Of Treatment Are Used:
Surgery
Most patients with breast cancer have to remove the cancer.
is the removal of the during surgery. The sentinel lymph node is the first in a group of lymph nodes to receive from the . It is the first lymph node the cancer is likely to spread to from the primary tumor. A substance and/or blue is near the . The substance or dye flows through the lymph to the lymph nodes. The first lymph node to receive the substance or dye is removed. A views the under a to look for cancer . If cancer cells are not found, it may not be necessary to remove more lymph nodes. Sometimes, a sentinel lymph node is found in more than one group of nodes. After the sentinel lymph node biopsy, the removes the tumor using or . If cancer cells were found, more lymph nodes will be removed through a separate . This is called a .
Types of surgery include the following:
may be given before surgery to remove the tumor. When given before surgery, chemotherapy will shrink the tumor and reduce the amount of tissue that needs to be removed during surgery. Treatment given before surgery is called preoperative therapy or .
After the doctor removes all the cancer that can be seen atthe time of the surgery, some patients may be given ,chemotherapy, , or after surgery, to kill any cancer cells that are left. Treatment given after the surgery, tolower the risk that the cancer will come back, is called or .
Radiation therapy
Chemotherapy
Possible Side Effects Of Immune Checkpoint Inhibitors
Side effects of these drugs can include fatigue, cough, nausea, skin rash, poor appetite, constipation, and diarrhea.
Other, more serious side effects occur less often.
Infusion reactions: Some people might have an infusion reaction while getting these drugs. This is like an allergic reaction, and can include fever, chills, flushing of the face, rash, itchy skin, feeling dizzy, wheezing, and trouble breathing. Its important to tell your doctor or nurse right away if you have any of these symptoms while getting these drugs.
Autoimmune reactions: These drugs remove one of the protections on the body’s immune system. Sometimes the immune system starts attacking other parts of the body, which can cause serious or even life-threatening problems in the lungs, intestines, liver, hormone-making glands, kidneys, or other organs.
Its very important to report any new side effects to your health care team quickly. If serious side effects do occur, treatment may need to be stopped and you may get high doses of corticosteroids to suppress your immune system.
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Does Chemotherapy Have A Benefit
The higher the score, the more likely the benefit from chemotherapy will be. Below a certain score, chemotherapy is known to have no benefit. However, theres a significant grey area of women for whom the benefit is unclear. The researchers looked at this intermediate group. They concluded that for most women in this group over the age of 50,
Menstrual Changes And Fertility Issues
For younger women, changes in menstrual periods are a common side effect of chemo. Premature menopause and infertility may occur and could be permanent. If this happens, there is an increased risk of heart disease, bone loss, and osteoporosis. There are medicines that can treat or help prevent bone loss.
Even if your periods stop while you are on chemo, you may still be able to get pregnant. Getting pregnant while on chemo could lead to birth defects and interfere with treatment. If you have not gone through menopause before treatment and are sexually active, its important to discuss using birth control with your doctor. It is not a good idea for women with hormone receptor-positive breast cancer to take hormonal birth control , so its important to talk with both your oncologist and your gynecologist about what options would be best for you. When women have finished treatment , they can safely go on to have children, but it’s not safe to get pregnant while being treated.
If you think you might want to have children after being treated for breast cancer, talk with your doctor soon after being diagnosed and before you start treatment. For some women, adding medicines, like monthly injections with a luteinizing hormone-releasing hormone analog, along with chemo, can help them have a successful pregnancy after cancer treatment. To learn more, see Female Fertility and Cancer.
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Breast Cancer Is Sometimes Caused By Inherited Gene Mutations
The in cells carrythe information that isreceived from a persons parents. Hereditary breast cancer makes upabout 5% to 10% of all breast cancer. Some genes related tobreast cancer are more common in certain ethnic groups.
Women who have certain gene , such as a BRCA1 or BRCA2 mutation, have an increased risk of breast cancer. These women also have an increased risk of , and mayhave an increased risk of other cancers. Men who have a mutatedgene related to breast cancer also have an increased risk of breast cancer. For more information, see.
There are tests that can detect mutated genes. These are sometimes done formembers of families with a high risk of cancer. For more information, see .
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 typically described based on how far its spread from the original cancer site:
Regional metastatic breast cancer means the original tumor has spread to nearby lymph nodes .
Distant metastatic breast cancerrefers to breast cancer that has spread to distant locations or metastatic sites, including the bones, lungs, liver and brain, although its possible for breast cancer to metastasize to the skin or other parts of the body.
Its important to remember that every cancer is unique and that each patients 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 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 have information about the disease, its symptoms and how its detected and treated.
This article will cover:
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Stage 4 Breast Cancer
Advanced breast cancer refers to cancer that has spread beyond the breast to other parts of the body. This process of spreading from the original location to a new location is known as metastasis.
The most common places of breast cancer spread include the bones, liver, lung, and brain. However, breast cancer may also spread to other organs.
The majority of women who are diagnosed with metastatic breast cancer have been diagnosed with an earlier stage of breast cancer before. In this instance, the original cancer in the breast is called the primary cancer. However, for some women, a diagnosis of metastatic breast cancer may be their first diagnosis of cancer .
Treatment Of Stage Iv Breast Cancer
Stage IV cancers have spread beyond the breast and nearby lymph nodes to other parts of the body. When breast cancer spreads, it most commonly goes to the bones, liver, and lungs. It may also spread to the brain or other organs.
For women with stage IV breast cancer, systemic drug therapies are the main treatments. These may include:
- Some combination of these
Surgery and/or radiation therapy may be useful in certain situations .
Treatment can often shrink tumors , improve symptoms, and help some women live longer. These cancers are considered incurable.
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Understanding The Conventional Cancer System
Standard oncology insists on following typical chemotherapy protocols, despite documentation that indicates ineffectiveness with advanced stage cancers. Why, do you ask?
Well, you should know that virtually all cancer Center use fundamentally identical variations of protocol regimens because they follow each other. In fact, the more prestigious the organization, the more this occurs. It is not uncommon to attend their respective board meetings and hear the discussion repeatedly return to using the same old non-proven method.
Unbelievably, most new and innovative cancer information and treatments are coming from outside the United States. “It doesn’t work,” or “It isn’t proven” seem to be the popular answers given to patients with alternative curiosities. This is ironic, knowing that research indicates that traditional treatments ARE regularly being proven to NOT work
What Are The Side Effects Of Chemotherapy For Breast Cancer
Chemotherapy side effects vary based on what kind of drugs you take and for how long. Common chemotherapy side effects include:
- Numbness or tingling.
During chemotherapy treatment, many people still work, exercise and care for their families. For others, the treatment can be exhausting and time-consuming. It may be difficult to keep up with usual activities.
Speak with your healthcare provider about the risks and benefits of chemotherapy. You may manage side effects with supportive medications, such as anti-nausea drugs. Chemotherapy side effects generally go away after you finish treatment.
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Increased Risk Of Leukemia
Very rarely, certain chemo drugs, such as doxorubicin , can cause diseases of the bone marrow, such as myelodysplastic syndromes or even acute myeloid leukemia, a cancer of white blood cells. If this happens, it is usually within 10 years after treatment. For most women, the benefits of chemo in helping prevent breast cancer from coming back or in extending life are far likely to exceed the risk of this rare but serious complication.
Starting With Neoadjuvant Therapy
Most often, these cancers are treated with neoadjuvant chemotherapy. For HER2-positive tumors, the targeted drug trastuzumab is given as well, often along with pertuzumab . This may shrink the tumor enough for a woman to have breast-conserving surgery . If the tumor doesnt shrink enough, a mastectomy is done. Nearby lymph nodes will also need to be checked. A sentinel lymph node biopsy is often not an option for stage III cancers, so an axillary lymph node dissection is usually done.
Often, radiation therapy is needed after surgery. If breast reconstruction is planned, it is usually delayed until after radiation therapy is done. For some, additional chemo is given after surgery as well.
After surgery, some women with HER2-positive cancers will be treated with trastuzumab for up to a year. Many women with HER2-positive cancers will be treated first with trastuzumab followed by surgery and then more trastuzumab for up to a year. If after neoadjuvant therapy, any residual cancer is found at the time of surgery, ado-trastuzumab emtansine may be used instead of trastuzumab. It is given every 3 weeks for 14 doses. For women with hormone receptor-positive cancer that is in the lymph nodes, who have completed a year of trastuzumab, the doctor might also recommend additional treatment with an oral targeted drug called neratinib for a year.
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