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
Treatment can often shrink tumors , improve symptoms, and help some women live longer. These cancers are considered incurable.
The Course Of Epidermal Growth Factor Receptor 2
Breast cancer is one of malignant tumors affecting womens health. The Global Cancer Statistics published in February 2015 showed that there were around 1.67 million women suffering from breast cancer, more than 500,000 patients died of breast cancer, and the incidence and mortality all ranked first among cancers in women . According to the latest published data on cancer incidence and mortality by our National Cancer Center, the number of cases of breast cancer ranks first in female cancers, while the number of deaths of women with breast cancer ranks only sixth , indicating preliminarily, that, through the tireless efforts of scholars in the field of breast cancer for decades, our breast cancer treatment has accomplished an international standard.
Thus, at the 10th Shanghai International Forum on Breast Cancer recently organized by the Chinese Anti-Cancer Association Breast Cancer Committee , Fudan University Cancer Hospital, and the Shanghai Cancer Institute, experts and scholars in the field of breast cancer from China and the United States had an discussion and exploration on the current status of HER2-positive breast cancer treatment to promote the development of anti-HER2 targeted therapy.
Outcomes Of The Entire Cohort
Median follow-up was 6.8 years. LRR, DM, DFS, and OS rates at 5 years for the whole group was 7.6%, 23.1%, 75.1%, and 86.9%, respectively. There were significant differences in LRR, DM and DFS among HER2-, HER2+ + T, and HER2+ T groups . However, there was no significant difference in OS among the three groups .
Figure 2 KaplanMeier plots of locoregional recurrence , distant metastasis , disease-free survival , and overall survival of patients grouped according to HER2 status and trastuzumab treatment. HER2, HER2-negative HER2+ + T, HER2-positive with trastuzumab HER2+ T, HER2-positive without trastuzumab.
Further log-rank pairwise comparisons showed the HER2+ + T group had significantly lower LRR, DM and higher DFS at 5 years than that in the HER2+ T group . The HER2 group also had significantly lower LRR, DM and higher DFS at 5 years than that in the HER2+ T group . However, there were no significant differences in LRR , DM or DFS at 5 years between the HER2+ + T group and HER2 group.
Univariate and multivariate analyses of prognostic factors for LRR, DM, DFS and OS are shown in Tables 2 and 3. In multivariate analyses, the combination of HER2 status and trastuzumab treatment was an independent prognostic factor for LRR , DM and DFS . Other independent prognostic factors were the treatment period, age, stage, neoadjuvant chemotherapy, and hormonal therapy.
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Breast Cancer Stages: How Is Metastatic Breast Cancer Diagnosed
Breast cancer screenings and tests can be daunting, but one of the simplest ways that your health care provider will explain your diagnosis to you is through the different breast cancer stages .
Stages can be split into anatomic stages and prognostic stages. Knowing your anatomic stage may give you a better understanding of the size of your tumor and the treatment options available to you.
These are the five breast cancer stages:
Stage 0: Cancer cells are found only in the ducts of the breast and have not spread to other breast tissue. This stage is also known as non-invasive cancer or ductal carcinoma in situ.
Stage I: Cancer can only be found in the breast tissue or in the lymph nodes near the breast . Lymph nodes are small, bean-shaped structures that are part of the bodys immune system.
Stage II: Cancer has grown in size, reaching 2 to 5 cm or more, but is still only in the breast. The lymph nodes near the breasts may contain cancer cells too.
Stage III: Cancer has spread further into the breast, or the tumor is a larger size than in earlier stages. It may have also spread to the chest wall or the skin on your breast. At this stage, cancer cells may also be found in lymph nodes in the armpit or collarbone, not just near the breast.
Stage IV: Cancer has spread to other parts of the body. This is known as metastatic breast cancer. Its the most advanced stage of breast cancer.
Stage The Stage Is The Main Prognostic Factor For Breast Cancer There Is Less Risk That Early Stage Breast Cancer Will Come Back So It Has A More Favourable Prognosis Breast Cancer Diagnosed At A Later Stage Has A Greater Risk Of Recurrence So It Has A Less Favourable Prognosis Doctors Will Consider If Cancer Has Spread To Lymph Nodes And The Size Of The Tumour When They Predict A Prognosis
If cancer has spread to lymph nodes
Whether or not cancer has spread to lymph nodes is the most important prognostic factor for breast cancer. Breast cancer that has spread to lymph nodes has a higher risk of coming back and a less favourable prognosis than breast cancer that has not spread to the lymph nodes.
The number of lymph nodes that contain cancer is also important. The more positive lymph nodes there are, the higher the risk that breast cancer will come back. Breast cancer that has spread to 4 or more lymph nodes has the highest risk for recurrence.
The size of the tumour
The size of the tumour is the 2nd most important prognostic factor for breast cancer. The tumour size will affect prognosis no matter how many lymph nodes have cancer in them.
Breast tumours that are 5 cm or larger are more likely to come back after treatment than smaller tumours. Breast tumours that are smaller than 1 cm and have not spread to the lymph nodes have a very favourable prognosis.
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Is The Cancer In My Lymph Nodes
Whether your breast cancer has spread to your lymph nodes the filtering mechanisms in your armpits and elsewhere in the body that are part of the immune system is one of the most important predictors of the severity of your disease.
Involvement of the lymph nodes changes the treatment plan, says Dr. Abraham. When breast cancer cells have spread to the lymph nodes, we tend to discuss more aggressive treatment options, such as chemotherapy.
Metastatic Breast Cancer Survival Rate
Although this form of cancer isnt curable, the good news is that it is very treatable. In fact, recent developments in treatment mean that people with a metastatic breast cancer diagnosis can have a better quality of life. The five-year survival rate after diagnosis for people with stage four breast cancer is 29%, according to the American Cancer Society .
Dr. Eleonora Teplinsky, head of breast medical oncology at Valley Health System, says: We have made remarkable strides in breast cancer in the last decade. New drugs keep getting approved. Were seeing improved survival. People are able to live their lives, work, travel, and be with their families.
If youve recently received a metastatic breast cancer diagnosis, then you may well feel frightened and overwhelmed. Those feelings are completely valid and normal. Your health care provider will be able to walk you through treatment options and provide information on emotional support for you and your loved ones.
Below, Dr. Teplinsky explains everything you need to know about metastatic breast cancer, including symptoms and how its diagnosed.
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Treating Aggressive Breast Cancers
Women diagnosed with breast cancer undergo testing to determine the form of the disease and whats driving its growth. This information is key to developing an individualized treatment strategy. Choice of treatment also depends on how extensive the cancer is within the breast, whether it has metastasized, and whether the patient is menopausal.
When either HER2-positive or triple-negative breast cancer is diagnosed early, surgery is often performed to remove the tumor and its surrounding tissue or the entire breast . Nearby lymph nodes sometimes are removed as well.
Neoadjuvant therapy, a treatment given as a first step before the primary treatment, is standard for both HER2-positive and triple-negative breast cancers if the tumor can be surgically removed. Chemotherapy is often used as a neoadjuvant therapy before surgery to shrink the tumor. The goal is to reduce the area that needs to be removed so the surgery can be less extensive, possibly avoiding a mastectomy. For HER2-positive cancer, chemotherapy may be combined with targeted therapy, medication that acts on the specific cause of the cancer.
After neoadjuvant therapy and surgery, the treatment strategies for HER2 and triple-negative breast cancers differ.
Chemo Plus Herceptin Can Put Metastatic Her2
- Tags:HER2 Enriched Breast Cancer, Invasive or Infiltrating Ductal Carcinoma, Invasive or Infiltrating Lobular Carcinoma, Luminal B Breast Cancer, Chemotherapy for Metastatic Cancer, Planning/Considering Chemotherapy, Targeted Therapy for Metastatic Cancer, Planning/Considering Targeted Therapy, Metastatic Recurrence, Metastatic/Advanced-stage: Stage IV, HER2/neu Positive Cancer, Standard Chemotherapy Dose, and Herceptin
Metastatic breast cancer is advanced-stage breast cancer that has spread to parts of the body away from the breast, such as the bones or the liver. Metastatic breast cancer usually is considered treatable but not curable.
Still, a small study found that 9% of women diagnosed with HER2-positive, metastatic breast cancer that was treated with chemotherapy and the targeted therapy Herceptin were in remission for at least 3 years. Remission means there was no detectable cancer. Doctors call remission this long a durable remission. The study was presented at the September 2011 European Multidisciplinary Cancer Conference .
If you’ve been diagnosed with advanced-stage, HER2-positive breast cancer, you might want to talk to your doctor about this study and what the results might mean for your treatment plan. You can learn more about Herceptin and Tykerb by visiting the Breastcancer.org Targeted Therapies pages.
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What Tests Assess Her2
There are two approved tissue testing methods for HER2 status. In 2013, the American Society of Clinical Oncologists and the College of American Pathologists issued an updated joint clinical practice guideline about HER2 testing for breast cancer. The two approved methods currently used in the U.S. to test for HER2 are
- immunohistochemistry and
- in-situ hybridization .
IHC testing uses specially labeled antibodies to show how much of the HER2 protein is present on the cancer cell surface, while ISH testing measures the number of copies of the HER2 gene inside each cell.
There are two main types of ISH tests:
- fluorescence and
- bright-field ISH.
Fluorescence in situ hybridization is referred to as FISH. Both of these tests are performed on the tumor sample that is removed at the time of surgery.
It’s Easy To Get The Care You Need
See a Premier Physician Network provider near you.
If youve been diagnosed with HER2-positive breast cancer, take a deep breath. And keep reading.
All breast cells have a protein called HER2. The protein controls how your cells grow, divide, and repair themselves.
Some women diagnosed with breast cancer about 1 in 5 are found to have higher than normal levels of HER2, called HER2-positive. Their HER2 proteins dont work correctly and cause their breast cancer to grow out of control.
If your breast cancer is HER2-positive, your cancer will be more aggressive, it can grow rapidly, and unfortunately it can spread to other places in your body quickly, explains Selyne Samuel, MD, a breast surgeon and breast surgical oncologist.Although HER2-positive cancer is much more common in women, some men with breast cancer are also found to be HER2-positive.
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Survival For All Stages Of Breast Cancer
Generally for women with breast cancer in England:
- Around 95 out of every 100 women survive their cancer for 1 year or more after diagnosis
- Around 85 out of every 100 women will survive their cancer for 5 years or more after diagnosis
- Around 75 out of every 100 women will survive their cancer for 10 years or more after diagnosis
Cancer survival by stage at diagnosis for England, 2019Office for National Statistics
These statistics are for net survival. Net survival estimates the number of people who survive their cancer rather than calculating the number of people diagnosed with cancer who are still alive. In other words, it is the survival of cancer patients after taking into account that some people would have died from other causes if they had not had cancer.
Will I Need Radiation
Most oncologists generally recommend radiation treatment for all breast cancer patients who undergo only removal of the tumor .
For women who undergo whole-breast removal, radiation may be recommended for those who are considered high-risk, especially those with tumors larger than 5 centimeters and with more than four cancerous lymph nodes.
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What Is The Recurrence Rate For Her2
- HER2-positive tumors tend to grow faster than tumors that do not express the HER2 protein. However, recurrence rates vary and depend upon more than simply the HER2 status of the tumor.
- Like other breast cancers, recurrence rates depend upon the extent of spread of the tumor at the time of diagnosis of the tumor along with other characteristics of the tumor.
- The development of anti-HER2 therapies has significantly improved the outlook for patients with HER2-positive breast cancer.
What Is The Stage Of My Cancer
Cancer staging is a standardized way of classifying the severity of a patients cancer. There are various systems that use number or letter codes to designate the cancers status and how far it may have spread.
You may have heard of Stages 0 through IV, which reflect a tumors size and the extent of metastasis. A higher stage means a larger tumor and wider distribution of cancer cells.
Your doctor uses staging to plan your treatment, gauge your prognosis and communicate with other cancer specialists. What stage your cancer is in also will help determine whether youre eligible for clinical trials which offer newer treatment options.
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A Number Of Clinical Studies Provided Evidence
Since the development and usage of trastuzumab, the international field of breast cancer study has carried out a number of large scale classic adjuvant therapy in clinical studies, including NSABP B-31, NCCTG9831, HERA, FinHer and BCIRG006, etc. , all having explored the efficacy, the treatment time and the best treatment modality using trastuzumab in HER2-positive breast cancer patients. The results of these studies have subsequently confirmed that the adoption of trastuzumab for HER2-positive breast cancer can reduce the risk of recurrence of early breast cancer by about 50% and lower the risk of death by about 30%.
N9831 and NSABP B-31 studies have compared the adjuvant treatment efficacy in HER2-positive breast cancer patients with AC-T program with or without trastuzumab, jointly analysing the patient overall survival and disease-free survival . The results showed that the DFS rate of patients with trastuzumab had significantly improved over the group of patients without trastuzumab treatment , the OS rate was also significantly increased . The cumulative incidences of distant metastasis in the trastuzumab usage group had an absolute reduction of 9.6%.
Expert Review And References
- American Cancer Society. Breast Cancer. 2015: .
- de Boer M, van Dijck JA, Bult P, Borm GF, Tjan-Heijnen VC. Breast cancer prognosis and occult lymph node metastases, isolated tumor cells, and micrometastases. Journal of the National Cancer Institute. Oxford University Press 2010.
- Lonning PE. Breast cancer prognostication and prediction: are we making progress?. Annals of Oncology. Oxford: Oxford University Press 2007.
- Morrow M, Burstein HJ, and Harris JR. Malignant tumors of the breast. DeVita VT Jr, Lawrence TS, & Rosenberg SA. Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins 2015: 79: 1117-1156.
- Tripathy D, Eskenazi LB, Goodson, WH, et al. Breast. Ko, A. H., Dollinger, M., & Rosenbaum, E. Everyone’s Guide to Cancer Therapy: How Cancer is Diagnosed, Treated and Managed Day to Day. 5th ed. Kansas City: Andrews McMeel Publishing 2008: pp. 473-514.
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How Are Breast Tumors Tested For Her2
Either a test called an immunohistochemistry test or fluorescence in situ hybridization test is used to find out if cancer cells have a high level of the HER2 protein.
See Testing Biopsy and Cytology Specimens for Cancer and Understanding Your Pathology Report: Breast Cancerto get more details about these tests.
When Herceptin Is Used
Herceptin can be used to treat:
- early-stage HER2 positive breast cancer, following surgery and/or radiotherapy and chemotherapy, to reduce the risk of the cancer coming back
- advanced HER2 positive breast cancer that has spread from the breast , to slow the growth of the cancer and increase survival time
- advanced HER2 positive stomach cancer that has spread out of the stomach
- advanced HER2 positive gastro-oesophageal cancer, which affects where the food pipe meets the stomach
If you have breast, oesophageal or stomach cancer, you will have tests to check if the cancer is HER2 positive before herceptin is offered.
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Annual Hazard Rate Of Lrr
Figure 4 shows the annual LRR patterns of the three groups in the entire cohort, HR+ cohort, and HR cohort. Visual inspection of the LRR hazard curves showed a difference in LRR patterns between the HER2 group and HER2+ + T group and HER2+ T group. In the entire cohort, the annual hazard rate of LRR in the HER2+ T group was consistently higher than that in the HER2 group or HER2+ + T group. The annual LRR curve of the HER2+ T group displayed an obvious double-peaked pattern, with an early peak at ~2.5 years and a late peak at ~9 years. The annual LRR curve of the HER2+ + T group displayed a single early peak at ~2.5 years. The annual LRR curve of the HER2 group displayed a continuously low risk without an obvious peak . The observed difference in LRR among these three groups occurred mainly during the first 5 years rather than beyond 5 years. The annual LRR rate of HER2, HER2+ + T, and HER2+ T groups was 1.4%, 1.3% and 3.0% during the first 5 years , and 0.5%, 0.4% and 1.9% after 5 years , respectively.
Figure 4 Annual hazard rates for locoregional recurrence of the entire group , HR-positive patients , and HR-negative patients grouped according to HER2 status and trastuzumab treatment. HR, hormonal receptor-negative HR+, hormonal receptor-positive HER2, HER2-negative HER2+ + T, HER2-positive with trastuzumab HER2+ T, HER2-positive without trastuzumab.