Taking A Break From Or Stopping Treatment
Unlike treatment for primary breast cancer which comes to an end, most people diagnosed with secondary breast cancer will be on treatment continually.
It can be difficult to continue with daily routines while trying to manage ongoing side effects of treatment.
Because of this your specialist team may suggest a break from treatment. Alternatively you may wish to take a short break for a special occasion or a longer break to recover from the effects of treatment.
Your specialist team can talk this through with you and explain the possible effect on your condition.
Expanded Access And Right To Try: Alternative Paths To Experimental Treatments For Metastatic Breast Cancer
If you would like to find out whether theres an experimental drug that could be beneficial for you, talk to your medical team. Make sure that youve thoroughly researched whether there are any clinical trials you can join. In most cases, you wont be eligible to request an experimental drug through Expanded Access or Right to Try unless participating in a clinical trial is not possible for you.
Doctors recommend enrolling in a clinical trial if youre eligible since your participation helps advance treatments for breast cancer and, by participating, you receive extra medical attention and monitoring of side effects during the trial.
Medications For Mild Bone Pain
Bone pain often responds to heat, or to mild pain relievers such as ibuprofen , naproxen or acetaminophen .
Although you can get these medications without a prescription, check with your health care provider before taking them. For example, if you have a low platelet count, or your kidneys are not functioning normally, or you have heart failure, your health care provider may advise you not to take ibuprofen or naproxen.
Learn more about these medications in metastatic breast cancer care.
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Tucatinib Has Potential To Be First
Twenty percent of women with breast cancer have HER2-positive breast cancer, an aggressive disease fueling cancer growth through excess HER2 protein on tumor cells. If the cancer is not detected while still confined to the breast, up to 50 percent of these women develop cancer in their brains .
Since the late 1990s, drugs targeted to stop or slow the progression of HER2-positive breast cancer have continued to emerge. Tucatinib, which is taken by mouth, works in concert with two of these therapies by binding to the HER2 protein inside a cancer cell and prevents it from sending signals that promote cancer cell growth.
Dr. Jilani explains that the new drug regimen with tucatinib is designed to slow cancer progression and prolong a persons life, but not to cure the cancer. A patient continues to take the treatment as long as it is providing beneficial results.
Patients are living longer with metastatic breast cancer, she says. I am very hopeful this will be the new standard of care, the first-line treatment, in the near future for breast cancer patients with brain metastases.
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:
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Do you plan to do a biopsy of the metastatic cancer? Why or why not?
Learn more about Genetic Testing.
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How You Have Chemotherapy
You may have chemotherapy directly into your bloodstream through a drip . Some chemotherapy drugs are tablets or capsules that you swallow, such as capecitabine.
You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:
- central line
- PICC line
- portacath
If you don’t have a central line, you might have treatment through a thin short tube . The cannula goes into a vein in your arm each time you have treatment
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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Have Low White Blood Cell Counts
Low white blood cell counts can be life threatening. Low white blood cell counts were seen more often in patients receiving intravenous trastuzumab plus chemotherapy than in patients receiving chemotherapy alone.
Your doctor may check for signs of low white blood cell counts when he or she examines you.
Experience HYPERSENSITIVITY AND ADMINISTRATION-RELATED REACTIONS, which have been reported with HERCEPTIN HYLECTA. Serious and fatal reactions have been reported after treatment with intravenous trastuzumab products. Your doctor will monitor you for signs of these reactions. Contact your healthcare provider immediately if you experience any symptoms of hypersensitivity and administration-related reactions, including dizziness, nausea, chills, fever, vomiting, diarrhea, hives, swelling under the skin, breathing problems, or chest pain.
SIDE EFFECTS SEEN MOST OFTEN
The most common side effects seen in treatment of adjuvant breast cancer with HERCEPTIN HYLECTA were tiredness, joint pain, diarrhea, injection site reaction, upper respiratory tract infection, rash, muscle pain, nausea, headache, swelling, flushing, fever, cough, and pain in extremity.
The most common side effects seen in treatment of metastatic breast cancer are fever, chills, headache, infection, congestive heart failure, insomnia, cough, and rash.
You should contact your doctor immediately if you have any of the side effects listed above.
Study Participants Had Metastatic Or Inoperable Breast Cancer
The clinical trial, called DESTINY-Breast04, enrolled 557 adults who had metastatic or inoperable HER2-low breast cancer and had previously been treated with one or two types of chemotherapy. Nearly 90% of participants had hormone receptorpositive disease, meaning their tumors had receptors for the hormones estrogen and/or progesterone. The trial was funded by the developers of T-DXd, Daiichi Sankyo and AstraZeneca.
Two-thirds of participants were randomly assigned to receive T-DXd and the rest to receive their doctors choice of chemotherapy. T-DXd was given intravenously every 3 weeks and patients were followed for a median of about 18 months.
In the group that received T-DXd, the median time that people lived without their cancer getting worse was about 10 months, compared with 5 months in the chemotherapy group. People who received T-DXd survived for a median of 23.4 months overall, while those in the chemotherapy group survived for a median of 16.8 months.
The numbers were similar when the researchers looked specifically at study participants who had hormone receptorpositive disease.
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Who Will Treat And Care For Me
Youll be looked after by a team led by a cancer specialist .
Everyone diagnosed with breast cancer should have access to a specialist breast care nurse whos there to provide them with information and support. Some people will have a secondary breast cancer nurse specialist.
Other people who may be involved in your care include:
- GP has overall responsibility for your health when youre at home
- district or community nurse coordinates and delivers nursing care when youre at home
- palliative and supportive care team helps with managing symptoms
- occupational therapist can assess what aids and adaptations you may need
- social worker assess what welfare benefits you may be entitled to
- social services can provide practical information and support, such as home carers
- benefits and finance adviser gives specialist information on benefits, tax credits, grants and loans
- hospice supports you and your family and helps you live with secondary breast cancer
- provides hands-on care for people with secondary cancer in their own homes
When Can Bone Metastases Occur
Bone metastases may be present when metastatic breast cancer is first diagnosed, or the cancer may spread to the bones later.
The bones are the first site of metastases for almost half of women diagnosed with metastatic breast cancer . For many of these women, the bones will be the only site of metastases .
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Treatment For Advanced Breast Cancer With Brain Metastases
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Keywords:Tyrosine kinase inhibitor, Monoclonal antibody, Antibody-drug conjugate, Breast cancer, Brain metastases
Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.
Keywords:Tyrosine kinase inhibitor, Monoclonal antibody, Antibody-drug conjugate, Breast cancer, Brain metastases
Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.
Ovarian Ablation Or Suppression
In women who have not yet experienced the menopause, oestrogen is produced by the ovaries.
Ovarian ablation or suppression stops the ovaries working and producing oestrogen.
Ablation can be done using surgery or radiotherapy. It permanently stops the ovaries from working and means you’ll experience the menopause early.
Ovarian suppression involves using a medicine called goserelin, which is a luteinising hormone-releasing hormone agonist .
Your periods will stop while you’re taking it, although they should start again once your treatment is complete.
If you’re approaching the menopause , your periods may not start again after you stop taking goserelin.
Goserelin comes as an injection you have once a month.
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Radiation Therapies For Breast Cancer
Radiation therapy is one of the most common approaches to breast cancer treatment and can be utilized at any cancer development stage. A powerfully effective technique, radiation therapy is accomplished through X-rays and other high-energy particles bombarding cancer cells to kill them. It is often used after lumpectomies, where just the tumor is removed from the breast, and before mastectomies, the removal of the entire breast. Doing so helps prevent recurring growth leading to metastatic breast cancer.
New advances have been made in the application of radiation therapy within the entirety of the treatment process. Traditionally, after a lumpectomy, the entire breasts radiation is used to destroy the remaining cancer cells, which often requires many trips to the hospital over several weeks and holds a risk of exposing healthy tissue to excess radiation levels.
Blood Tests For Tumor Markers
In some cases, blood tests for tumor markers may be used to help monitor metastatic breast cancer to help see if the cancer is responding to treatment.
For example, you may have blood tests 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 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.
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Treatment Options For Metastatic Breast Cancer
A range of different treatments are available for metastatic breast cancer.
Everyone is different. Treatments that may be suitable for one woman may not be suitable for another. It may be that several different treatments are tried before finding one that the cancer responds to.The aim of treatment for metastatic breast cancer is to control the growth and spread of the cancer, to relieve symptoms and improve or maintain quality of life.
The treatments recommended will depend on:
- which treatments are most likely to control the breast cancer
- what side effects the woman can cope with.
Treatment for metastatic breast cancer usually involves treatment with one or more systemic therapies:
- hormonal therapy
Treatment for metastatic breast cancer may involve:
- radiotherapy
- surgery.
In addition to treatments to control the cancer, theres the option of palliative care to help reduce symptoms and improve quality of life. Its possible to have palliative care at the same time as active treatment for metastatic breast cancer.
In addition, some women choose to use complementary therapies or may be involved in a clinical trial.
Palliative Medicine: Living With The Disease
Treatment that does not aim to cure a disease, but instead aims to help you live with it and relieve symptoms like pain, is also called palliative treatment.” Palliative treatment is often thought to be treatment and care during the last few weeks of someones life. But you can have palliative treatment for many months or years. Depending on the patients symptoms and wishes, it can already start shortly after metastatic cancer is diagnosed.
Palliative treatment, care and support can either be provided in an outpatient setting at home or in an inpatient setting. A specially trained team consisting of doctors, nurses, physiotherapists, social workers, chaplains and volunteers manages the person’s care. The focus may be on coping with day-to-day activities or on accompanying someone nearing the end of life, depending on their physical and mental condition.
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Monitoring 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 .
Metastatic breast cancer can respond to many different drug therapies. This means the drugs can shrink the tumors.
However, over time, tumors can become resistant to drugs used to treat metastatic breast cancer.
Advanced Cancer That Progresses During Treatment
Treatment for advanced breast cancer can often shrink the cancer or slow its growth , but after a time, it tends to stop working. Further treatment options at this point depend on several factors, including previous treatments, where the cancer is located, a woman’s menopause status, general health, desire to continue getting treatment, and whether the hormone receptor status and HER2 status have changed on the cancer cells.
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Vaccine Treatment For Metastatic Breast Cancer
You may think of vaccines as a way to prevent disease, but researchers are testing a new kind that might help treat breast cancer. It works by activating the immune system — your body’s defense against germs — to find and kill cancer cells.
Treatment for metastatic breast cancer usually involves some combination of chemotherapy, hormone therapy, and targeted drugs. Immunotherapy, which stimulates your immune system to fight cancer, is sometimes also an option for some types of breast cancer. At this late stage, the cancer can’t be cured, but treatments like these can slow its spread and help you live longer.
The hope for vaccines is that they could one day create long-term action by the immune system to attack breast cancer cells, with fewer side effects than current treatments like chemotherapy. The FDA has not yet approved any vaccines to treat breast cancer. Researchers are studying the vaccines in clinical trials to check their safety and see how well they work.