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How Is Metastatic Breast Cancer Treated

Everolimus And Hormone Therapy

What is the Treatment for Metastatic Breast Cancer?

Everolimus is an mTOR inhibitor. mTOR inhibitors are a class of drugs that may increase the benefit of hormone therapy.

Everolimus is FDA-approved for the treatment of hormone receptor-positive, HER2-negative metastatic breast cancers in postmenopausal women. The combination of everolimus and the aromatase inhibitor exemestane can slow the growth of such cancers better than exemestane alone .

Everolimus is a pill.

Everolimus

Some possible side effects include mouth ulcers, infections, rash, fatigue, diarrhea and decreased appetite.

In rare cases, it can cause lung inflammation, which can cause death. Tell your health care provider right away if you have shortness of breath or other breathing problems while taking this drug.

Adapted from select sources .

Questions Your Health Care Provider May Ask You About Your Pain

  • Where is the pain?
  • When did the pain start?
  • How long has the pain lasted?
  • Has the pain changed in any way?
  • Is there anything that makes the pain worse or better?
  • How intense is the pain? Is it mild, moderate or severe? Or, on a scale from 1-10, with 10 being the worst, how would you describe your pain?
  • What is your pain level now? Most of the time? Is that level OK to you?
  • Describe the pain .
  • Does the pain come and go, or do you feel it all the time?
  • Does the pain affect your ability to perform or enjoy daily activities?
  • Does the pain interfere with your sleep? Your appetite? Does it affect your mood?
  • What do you think is causing the pain?
  • How do you feel about pain control?

Finding A Counselor Or Support Group

People with metastatic breast cancer have very different issues from those with early stage breast cancer. So, a support group for people with metastatic cancer of any kind will be more helpful than a support group for people with early stage breast cancer.

Your oncologist, nurse or social worker may be able to help you find a counselor, local support group or an online support group. You can also call the Komen Breast Care Helpline at 1-877 GO KOMEN or email at for help finding a support group.

Find a list of resources to help you find a support group in your area.

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Figure 512 Types Of Pain

Type of pain

Description

Neuropathic

  • Sharp, tingling, burning or shooting feeling in one place or extending down an arm or leg
  • Pain is caused by nerves injured by cancer treatments, infection or the cancer itself, or by pressure from the cancer on the spinal cord
  • Can be caused by surgery, radiation therapy or chemotherapy that injures nerves, or a viral infection

Visceral

  • Sharp, aching, cramping or gnawing feeling thats not in one place
  • Pain caused when tumors spread to organs or block the bowel, and cause swelling

Somatic

  • Stabbing, aching, pressure or throbbing feeling in one place
  • Pain is caused by injury to skin, muscle or bone from cancer treatments or the cancer itself

Other

  • Headaches, muscle strain and other types of pain that occur in daily life and may or may not be caused by breast cancer or treatment

What Should I Ask My Healthcare Provider About Metastatic Breast Cancer

HER2

If youve been diagnosed with metastatic breast cancer, ask your provider:

  • What are my treatment options?
  • What is my prognosis?
  • What side effects can I expect?
  • Will complementary therapy help me feel better?
  • What if I want to stop treatment?
  • How can I feel my best during treatment?

A note from Cleveland Clinic

Metastatic breast cancer is advanced breast cancer. Providers classify it as stage 4 breast cancer. It happens when cancer cells, often left behind after previous breast cancer treatment, start to spread to other parts of the body. While there is no cure for metastatic breast cancer, treatment can prolong your life and help you feel better. There are many medications available, so if one treatment isnt working, your care team can try a different approach. If you notice any symptoms or dont feel your best, especially if youve undergone breast cancer treatment in the past, talk to your healthcare provider.

Last reviewed by a Cleveland Clinic medical professional on 04/14/2021.

References

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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.

Symptoms Of Metastatic Breast Cancer

Symptoms depend on where the cancer has metastasized. According to Habibi, common areas include the bones of the spine, the lungs and the liver. The symptoms can be back pain, shortness of breath, cough and fatigue.

Some types, including triple negative breast cancer, can also spread to the brain. The patient can experience headache, convulsions, changes in mood, and difficulty with speech or field of vision, Habibi says.

People who have been treated for breast cancer should be on the lookout for symptoms such as:

  • Back or neck pain
  • Seizures
  • Vision changes

Reporting these symptoms is important, says Habibi. Patients are usually the first and best people to notice something is not right, and can ask for guidance from their physicians.

After completion of the active phase of cancer care, and in the absence of specific symptoms, we usually do not recommend routine metastatic workup.

Doing a lot of unnecessary testing can harm the patient, he explains. Small abnormalities in one test can lead to additional test and biopsies, which can be very stressful to the patient, and repeated testing without symptoms has not been shown to improve outcomes.

However, patients should continue with their routine follow-ups as prescribed by their surgeon, medical oncologist and primary care doctor, the latter of whom plays a very important role in the survivorship phase.

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Metastatic Breast Cancer Treatment

Metastatic breast cancer can have different presentations for each patient, and can behave differently from one person to the next. But for most, individualized treatment can slow the spread of cancer, lessen the impact of symptoms or both.

We see patients with a whole host of presentations and degrees of aggressiveness. Were not looking at all metastatic diagnoses with the same lens. When planning treatment and supportive care, we look at each individual patient and consider all aspects of their health and well-being.

The mainstay of therapy in the setting of metastatic disease is systemic therapy, Habibi explains.

Systemic therapies use medicines, and may include:

Local therapy: Examples of this approach include surgery and radiation directed at one or more specific spots where breast cancer has spread. Local therapy can be used to address oligometastatic breast cancer, which is breast cancer that has spread to just one spot or to a limited number of areas.

If a metastatic area remains stable with treatment, it can be treated as a chronic disease, Habibi says, noting that in these situations, the strategy is preventing the cancer from advancing. For oligometastatic breast cancer, he says that a combination of chemotherapy, radiation treatments or surgery to remove cancerous areas can address symptoms and extend life.

Regional therapy includes surgery or radiation to treat metastatic cancer in nearby affected lymph nodes.

Hematologist And Oncologist Paula Klein Md Explains The Newer Treatment Types To Prolong Life With Metastatic Breast Cancer

Breakthroughs in metastatic breast cancer treatment

Finding out you have metastatic breast cancer is never easy, but todays treatment options are better than ever before. Theres still no cure for stage IV breast cancer, but treatment can help slow cancer growth and prolong your life. Whats more, newer treatments emerge all the time.

Its been a very exciting decade in advanced breast cancer for all of our different tumor types, says Paula Klein, MD, hematologist and oncologist at the Dubin Breast Center at Mount Sinai Health System. Doctors now have very exciting new drugs to improve treatment outcomes and extend life, says Dr. Klein.

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Will I Need More Than One Treatment For Metastatic Breast Cancer

Medications are important for metastatic breast cancer to help control its spread. Resistance to therapies may develop, which can lead your care team to recommend a change in treatment.

When you start a treatment regimen, you and your care team will see how:

  • The cancer responds to the therapy.
  • The side effects impact you.

If the treatment isnt working or the side effects are unbearable, your care team can discuss switching the treatment method. They may recommend a different drug, dosage or schedule.

There are many treatments available. If one therapy isnt working for you for whatever reason, there is usually another one you can try.

How Having Metastatic From The Start Might Influence Treatment

There are some advantages for women diagnosed with de novo metastatic breast cancer compared to women who have progressed following an early breast cancer. The main advantage is that their cancer is treatment naïve, meaning it has not previously been exposed to any anti-cancer treatments and is therefore likely to be more responsive to treatment. There have been some reports of small numbers of women who may even be cured from metastatic breast cancer in this circumstance. In addition, there are more treatment options available than for those who have received previous treatment for early breast cancer who may have already used up some of their options.

The one positive was that my oncologist said that he more or less had an open book of treatments that he could offer me.

Another positive that women sometimes describe is that they can feel the cancer in their breast getting smaller once treatments starts. Mammograms and breast ultrasounds may be used as a way of checking that the cancer in the breast is responding to treatment. Many women find this reassuring, knowing that the treatment they are having is working for them.

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When It Is Used

How soon chemotherapy is recommended for treatment depends on the particular type of breast cancer you have, whether or not your tumor is estrogen receptor or HER 2 receptor-positive, and whether or not hormonal therapies are effective for your tumor.

Chemotherapy is usually recommended as the first-line metastatic cancer treatment for:

  • People who have estrogen-receptor-positive tumors that have become resistant to hormonal medications such as tamoxifen or aromatase inhibitors
  • People who have HER2 positive tumors that are estrogen receptor-negative
  • People who have tumors that are both estrogen receptor and HER2 negative
  • Cases in which hormonal therapies are effective against estrogen receptor-positive tumors and a rapid reduction in the tumor is needed

Whats The Outlook For Metastatic Breast Cancer

HER2

The right treatment plan can improve survival for people with metastatic breast cancer. However, survival rates vary and are dependent on a number of factors including type/biology of the breast cancer, parts of the body involved and individual characteristics. About 1 in 3 women live at least five years after diagnosis. Some live 10 years or longer. Your care team will discuss your prognosis with you in more detail.

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How To Make A Treatment Plan For Metastatic Breast Cancer

After a diagnosis of metastatic breast cancer, its helpful to take the time you need to gather as much information as possible. Once you are ready, you can make plans and informed decisions about your care, treatment, and quality of life.

You may already have a medical oncologist if this is a recurrence of a previous breast cancer diagnosis. If appropriate, your oncologist can recommend other specialists who can join your medical team. Together, you will develop a metastatic breast cancer treatment plan.

If metastatic breast cancer is your first breast cancer diagnosis , you probably dont have a medical oncologist. Your primary care physician can recommend an oncologist and other specialists to you so you can put together your medical team.

The doctors on your medical team may be involved in your care at the same time or at different points throughout your care. Either way, everyone on your medical team needs to communicate with one another about your tests and treatments.

Your breast cancer medical team may include a number of specialists:

You may meet with some of these specialists in person, while others will consult only with your medical oncologist.

If youve been diagnosed with metastatic breast cancer, its important to communicate with your medical team to ensure youre getting the support you need.

Some questions you may want to ask include:

  • Do you plan to do a biopsy of the metastatic cancer? Why or why not?

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Insight On Metastatic Breast Cancer Treatment

When breast cancer spreads beyond the breast and the lymph nodes, its known as metastatic breast cancer. Most commonly, breast cancer spreads to the brain, bones, lung and liver. Wherever it spreads, metastatic breast cancer brings a unique set of physical and mental challenges.

To better understand metastatic breast cancer, including the best ways to cope with a diagnosis and treatment, we spoke with Jennifer Litton, M.D. Heres what she had to say.

Who is most at risk for metastatic breast cancer?

Breast cancer survivors who had large, aggressive tumors, those whose tumor spread to multiple lymph nodes under the arm, and those whose disease didnt respond well to therapy given prior to surgery are more likely to develop metastatic breast cancer. Also, if breast cancer goes undiagnosed and untreated for a long time, a patient is more likely to eventually be diagnosed with metastatic disease.

How is metastatic breast cancer typically treated?

Because breast cancer isnt a single disease, treatment can be complex. There isnt a standard step A, B, C, then D. Treatment depends on the subtype of breast cancer, so well look at the patients biology, the location of the tumor as well as the patients current symptoms.

What supportive care options are available to metastatic breast cancer patients?

What are some side effects of metastatic breast cancer treatment?

What advice do you have for patients with metastatic breast cancer?

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How Pain Medications Are Given

There are many ways to take opioid and non-opioid pain medications. Most are pills taken by mouth.

For people who have trouble swallowing pills, some medications are available in liquid form or a special tablet or strip that dissolves inside the cheek. Pain medications can also be put into feeding tubes. A few pain relievers can be taken in the form of rectal suppositories.

Fentanyl and buprenorphine come in a patch form. This patch is placed on the skin over an area of fat, and releases pain medication continuously into the fat over several days.

In cases of severe pain, when oral medications dont relieve the pain or when a person cant take medications by mouth, many drugs can be given by injection or by vein .

Types Of Metastatic Breast Cancer Treatments

Advancements in metastatic breast cancer treatment

There are various treatments for metastatic breast cancer. Your oncologist, or cancer specialist, may recommend a systemic treatment. These treatments, such as chemotherapy, hormonal therapy, and immunotherapy, circulate throughout the body to target and destroy cancer cells. Your doctor will select the most effective therapy based on where the secondary cancer is located. Metastatic breast cancer treatment options include:

  • chemotherapy

  • surgery

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Metastases In Internal Organs And The Skin

Metastases in skin or internal organs for instance, in the lungs or the liver can be specifically treated if

  • there are no other metastases in the body,
  • metastases are only found in one lung or in one lobe of the liver ,
  • the tumor has not grown back in the same place ,
  • there is no second tumor, and
  • there was more than one year between the first treatment and the occurrence of the metastases.

Surgery is an option for lung metastases if there is only one single metastatic tumor or if the metastases are found in only one lung. The operation is usually followed by treatment with medication.

Metastases that only occur in one lobe of the liver can also be surgically removed. Radiofrequency ablation is an alternative to surgery. In this procedure, a probe is used to increase the temperature of the metastatic tissue and damage it so much that it can no longer grow. Both surgery and RFA are usually followed by treatment with medication.

Metastases sometimes arise in a part of the lungs called the pulmonary pleura too. This can lead to the build-up of fluid in the pleural cavity . The medical term for this is pleural effusion. Built-up fluid can cause breathing difficulties and pain. Surgery can be done or medication can be taken to seal up this space and prevent fluid from building up there.

Radiotherapy can sometimes also be used in other parts of the body such as the lungs and liver, in order to relieve symptoms and temporarily slow down or stop tumor growth.

Can Metastatic Breast Cancer Go Into Remission

Metastatic breast cancer may never go away completely. But treatment can control its spread. Cancer may even go into remission at some points. This means you have fewer signs and symptoms of cancer.

A treatment break may be considered in certain situations, including if remission occurs or if someone is experiencing intolerable side effects. A pause in treatment can help you feel your best and improve your quality of life.

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How To Tell If The Treatment Is Working

Every few months, youâll get X-rays and other scans to see if the cancer has grown, shrunk, or stayed the same. Youâll get a physical exam, too. Tell your doctor if you notice any symptoms.

Your doctor may order a test to check for “tumor markers.” Some cancer tumors release these signs, which can show up in your blood. If the test shows that these markers are rising, it could mean that the cancer is growing or spreading.

Doctors will look at all your test results and your symptoms to decide whether your treatment is working.

Sometimes cancer can no longer be seen on scans. Your doctor may say you have âno evidence of disease.â This is something to celebrate, but the cancer isn’t gone. Cells are still circulating in your body, so youâll continue treatment.

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