Study And Patient Population Characteristics
Online Resource 3 presents the study and patient characteristics of the 25studies included in this review. Overall, the studies covered more than 10,000 patients, of which 4097 patients had HER2+ BC with BM. Across all studies, the observation/enrollment period started as early as 1988 and ended as late as 2020 . Geographically, studies were conducted in Europe , North America , the Asia-Pacific region , and Turkey .
Among studies reporting the median age of patients at the time of their initial BC diagnosis , the median age range was 43 to 55years. The sex distribution was typically not reported, although three studies did report including 100% females . Only two studies reported on race, which included 67% white patients and 58% white patients .
Twelve studies included only patients with HER2+ status , while the remaining studies reported on patients in whom a subset were HER2+, ranging from 10.1% to 58.2% . Among the seven studies that enrolled patients with or without BM , the prevalence of BM in patients with HER2+ BC ranged from 7.8% to 56.0% . Twenty-one studies provided information on hormone receptor status among patients with HER2+ BC, reporting a range of 24.2% to 71.0% of patients with HR+ status , while four studies did not report on HR status .
How Long Can You Live With Stage 4 Breast Cancer
Many patients and caregivers wonder, is stage 4 breast cancer curable, or is stage 4 breast cancer always terminal? This can depend on many factors such as the subtype of disease and the extent of metastasis. Despite stage 4 cancer being the least likely to be cured or go in remission, many patients live for several years after a diagnosis of metastatic cancer. In rare cases, some patients will end up beating metastatic breast cancer. However, once breast cancer is in stage 4, it has spread to other tissues and organs around the body, which can make it more difficult to treat.
Is Metastatic Cancer Always Fatal
In most cases, metastatic cancer is not curable. However, treatment can slow growth and ease many of the associated symptoms. Its possible to live for several years with some types of cancer, even after it has metastasized. Some types of metastatic cancer are potentially curable, including melanoma and colon cancer.
Breast Cancer Support And Resources
There are many resources and support groups for breast cancer survivors. Theres no obligation to stick with a group. You can try it out and move on whenever youre ready. You might be surprised to learn that you have a lot to offer others as well.
The American Cancer Society has a variety of support services and programs. You can call the 24/7 helpline at 800-227-2345, visit the
Is Stage 4 Breast Cancer Curable
Theres currently no cure for stage 4 breast cancer, but with treatments it can be kept under control, often for years at a time.
People with metastatic breast cancer need to receive treatments for the rest of their lives. If a certain treatment stops being effective, another treatment regimen may be tried.
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Brain Metastasis Activity Signals
Beyond pulmonary concerns, the panel discussed brain metastases and how the emergence of newer agents looks to give the combination of tucatinib , trastuzumab, and capecitabine a challenge. The final HER2CLIMB trial OS analysis for example demonstrated that the combination improved outcomes compared with trastuzumab/capecitabine alone in patients with HER2-positive metastatic breast cancer who had stable or active brain metastases.5 At a median follow-up of 29.6 months, the addition of tucatinib resulted in a median OS of 21.6 months vs 12.5 months with trastuzumab and capecitabine alone in patients with active and stable brain metastases .
Among patients with active brain metastases , the tucatinib regimen resulted in a median OS of 21.4 months vs 11.8 months with trastuzumab and capecitabine alone . Among those with stable brain metastases , the median OS was 21.6 months vs 16.4 months , in the experimental and control arms, respectively .
Those with stable and active brain metastases who received the addition of tucatinib experienced an improvement in median central nervous system -PFS compared with trastuzumab/ capecitabine alone, at 9.9 months and 4.2 months , respectively .5
In a subgroup analysis of DESTINY-Breast03, investigators reported outcomes for patients with brain metastases. At a median follow-up of 15.9 months, the median PFS was 15.0 months with trastuzumab deruxtecan vs 3.0 months with T-DM1 . The 12-month PFS rates were 72.0% vs 20.9% , respectively.
What Is The Best Treatment 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.
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Treatment Guidelines For Metastatic Breast Cancer
Although the exact treatment for metastatic breast cancer varies from person to person, guidelines help ensure high-quality care. These guidelines are based on the latest research and agreement among experts.
In addition, the National Cancer Institute has treatment overviews.
The Centers for Disease Control and Prevention recommends people with cancer and their caregivers get the seasonal flu shot.
Survival Rates Of Stage 4 Breast Cancer
Unfortunately, cancer cells often become more difficult to treat and may develop drug resistance once they spread. According to the Australian Institute of Health and Welfare , the 5-year survival rate for women whose breast cancer is metastatic at first diagnosis is 32%, compared to the 91% on average for all breast cancer patients.
Factors affecting survival rate of metastatic breast cancer
Survival rates can provide an estimate of what percentage of patients with the same stage of breast cancer are still alive after a certain period of time . However, they cannot predict how long any specific individual with breast cancer will live. The length of survival time for people with metastatic breast cancer can vary significantly from person to person, but there are a number of factors which can influence this including:
- Response to treatment
- The extent and location of metastases
- The presence of other health issues not related to cancer
- The specific subtype of breast cancer . This is very important, as some types of cancer can be more aggressive than others and respond differently to treatment.
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You May Not Know Im Sick By Looking At Me
I may look perfectly healthy, but Im sick, says Silberman. Treatment is hard. I sleep a lot. I still travel, but its difficult. I just visited a friend in Utah for four days, and it wore me out for two weeks.
Just because someone doesnt look like she has advanced-stage cancer, she can be very sick. It can be an invisible illness, says Silberman. You tell somebody you have cancer, but if you have hair, sometimes they dont believe you.
What Is Stage 4 Breast Cancer
What is stage 4 breast cancer? Also referred to as stage iv breast cancer, is considered stage 4 once it has spread beyond the breast tissue and nearby lymph nodes to other organs or parts of the body. In most cases, breast cancer will spread to the bones, lungs, or liver. Not as often, but in some cases, breast cancer can also spread to other organs such as the brain.
A stage 4 breast cancer diagnosis is confirmed by examining factors of the American Joint Committee on Cancer TNM system, which includes:
- Size of the tumor
Take the breast cancer quiz to learn more about stage 4 breast cancer.
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Exploring Why Some Cancers Grow And Spread And Others Dont
For years, doctors and researchers have noted that not all cancers are alike. Some patients tumors grow quite slowly and never spread beyond the site where they first formed. But for other patients, their tumors grow rapidly and spread like wildfire.
In the early 1980s, after the discovery that a mutated gene called HER2 could stimulate excessive cell growth and division, many scientists wondered if certain genes might make cancers grow and spread rapidly. Researchers around the world began searching for genes that spur cancer growth.
Fda Approves Tucatinib Plus Trastuzumab For Ras Wild
The FDA has granted accelerated approval to tucatinib in combination with trastuzumab for adult patients with RAS wild-type, HER2-positive unresectable or metastatic colorectal cancer that has progressed after treatment with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy.
The FDA has granted accelerated approval to tucatinib in combination with trastuzumab for adult patients with RAS wild-type, HER2-positive unresectable or metastatic colorectal cancer that has progressed after treatment with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy.1
The approval is supported by data from the phase 2 MOUNTAINEER trial , which showed that patients treated with the doublet achieved an overall response rate of 38% per blinded independent central review . Of those who responded to the regimen, 3.6% achieved a complete response and 35% had a partial response. The median duration of response by BICR was 12.4 months .
The median progression-free survival was 8.2 months , and the median overall survival was 24.1 months .2
Historically, patients with HER2-positive metastatic CRC who have progressed following frontline therapy have had poor outcomes, John Strickler, MD, lead study investigator and an associate professor of medicine at Duke University Medical Center, stated in a press release. The FDA approval of a chemotherapy-free combination regimen that specifically targets HER2 is great news for these patients.
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Is Stage 4 Breast Cancer Painful
Stage iv metastatic breast cancer can be painful for patients similar to other cancer types. Because the prognosis of metastatic cancer is often less favorable, many patients question is stage 4 breast cancer painful? It depends on several factors such as, where the cancer has and what type of cells are being affected. For example, if the cancer has spread to the bone, patients may experience persistent bone pain. Palliative treatments can be given to patients to help relieve symptoms such as pain. These treatments can include chemotherapy, hormone therapy, or radiation therapy.
Treatment Mechanism Of Action And Outcomes After Brain Metastasis
HER2-targeted monoclonal antibodies
Table presents information on anti-HER2 treatment type by mechanism of action, and disease progression and survival after BM. Four studies evaluated survival among patients receiving a HER2-targeted monoclonal antibody after BM diagnosis and reported that overall survival was longer in patients who received trastuzumab after local therapy compared with patients who did not receive trastuzumab . In Ahn et al. , Berghoff et al. , and Brufsky et al. , the difference in median OS after BM between trastuzumab users and nonusers was 7.8months, 10months, and 13.8months, respectively. Niwinska et al. reported that among patients with HR+ status, trastuzumab users had a 11-month longer median OS compared with nonusers , and among patients with HR- status, trastuzumab users had a 6-month longer median OS compared with nonusers . One study evaluated survival among patients receiving HER2-targeted monoclonal antibody combination therapy and reported that OS was longer in patients who received trastuzumab + pertuzumab compared to those who received other HER2-targeted therapy or no HER2-targeted therapy .
Table 4 Effect of Treatment Mechanisms of Action on Survival, Tumor Response, Time to Progression
HER2-targeted non-monoclonal antibodies
Tyrosine kinase inhibitor combination therapies
Any anti-HER2 therapy
Quality of studies
Table 5 Quality of Studies Included
You can also search for this author inPubMed
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Living With Metastatic Breast Cancer
An advanced breast cancer diagnosis often elicits a flood of emotions: fear, confusion, sadness, anger and worry. Patients may wonder, Why me? It’s normal to think its unfair, so take the time to process these thoughts, speak with the care team to understand the 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. Patients may continue to work, enjoy life and spend time with family and friends, even if sometimes they may 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 the risk of infection and provide patients with more energy for enjoying life.
Light exercise may give the mind and body a boost, helping patients feel energized. This is especially true after spending time in the fresh air. Always seek medical advice before making changes to any diet or exercise routines.
There Are Good Days And Bad Days
There are days when I say to myself, Ive had enough. I cant take it anymore, says Rosen. But I want to keep on living. I love my life. Overall, I have a great life except for the cancer.
Rosen has a few mantras she uses when things get tough. A lot of the tough times are treatment related, she says. I refer to those as bumps in the road, and , This too shall pass.
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Different Drugs Same Target
Breast cancers that are HER2-positive tend to be aggressive, with the excess HER2 protein on tumor cells fueling the cancers growth. In the late 1990s, trastuzumab was among the first targeted cancer therapies to be approved by FDA, after trials showed it could improve survival in women with metastatic HER2-positive breast cancer.
Over time, other HER2-targeted therapies emerged, some with alternative mechanisms for disrupting HER2 activity in cancer cells. Drugs like trastuzumab and pertuzumab are monoclonal antibodies that bind to the HER2 protein above the cancer cells surface, preventing it from acting or enlisting the immune system to help destroy cells that produce it.
Tucatinib, on the other hand, is a member of a class of drugs known as tyrosine kinase inhibitors . These drugs work by binding to the part of the HER2 protein that is inside the cell and preventing it from sending signals that promote cell growth. Other HER2-targeted TKIs include neratinib and lapatinib .
Some TKIs have multiple targets. But, compared with other HER2-targeted drugs, tucatinib appears to be relatively selective for HER2that is, its less likely to bind to related proteins, explained Stanley Lipkowitz, M.D., Ph.D., chief of the Womens Malignancies Branch in NCIs Center for Cancer Research. That selectivity limits the risk of side effects seen with other HER2-targeted TKIs that inhibit other targets, Dr. Lipkowitz said.
Metastatic Breast Cancer: The Basics
Metastatic breast cancer , is breast cancer that has spread beyond the breast and the surrounding lymph nodes to other parts of the body, Nancy Lin, MD, an oncologist who specializes in breast cancer at Dana-Farber Cancer Institute in Boston, told Health.
Approximately 30% of breast cancer patients will develop metastatic breast cancer following an initial earlier-stage diagnosis, according to a review in the Journal of Internal Medicine. Meanwhile, the American Society of Clinical Oncology reports that just 6% of women have metastatic breast cancer when they are first diagnosed.
“Basically what’s happening is the cancer cells are growingthey get into the bloodstream which then allows them to travel to distant sites ,” Evelyn Toyin Taiwo, MD, hematologist and oncologist at Weill Cornell Medicine and NewYork-Presbyterian Brooklyn Methodist Hospital, told Health.
Metastatic breast cancer cells most often take up residence in the bones, liver, lungs, and brain, said Dr. Taiwo, but they can spread anywhere in the body.
It’s still unclear to science how or why certain cancers metastasize, and others don’t, said Dr. Lin, or why breast cancer cells seem to prefer spreading to those specific regions of the body. The type of cancer may play a role in where it metastasized.
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Systemic Treatments For Stage Iv Breast Cancer
Treatment often continues until the cancer starts growing again or until side effects become unacceptable. If this happens, other drugs might be tried. The types of drugs used for stage IV breast cancer depend on the hormone receptor status, the HER2 status of the cancer, and sometimes gene mutations that might be found.
What Is Radiation Therapy
Radiation therapy and/or surgery may also be used in certain situations, such as: When the breast tumor is causing an open wound in the breast To treat a small number of metastases in a certain area, such as the brain. To help prevent bone fractures. When an area of cancer spread is pressing on the spinal cord.
Andrew And Traceys Story
All the statistics only talk about the number of women affected what they dont mention is the effect on the people that love them parents, children, siblings, extended family, friends. My wife, Tracey, was diagnosed with breast cancer in late 2010 and was told it had spread to her liver and lung in 2012. Firstly, theres the pain that you have to watch your partner go through the ongoing pain from metastasis the spread of the cancer from her breasts to her spine, ribs, liver and lung. Secondly theres the fear. Fear of losing her sooner rather than later and being alone. Andrew, Husband of Tracey, diagnosed 2010.