New Treatments For Metastatic Breast Cancer

How Long Can You Have Breast Cancer Without Knowing

Breast cancer has to divide 30 times before it can be felt. Up to the 28th cell division, neither you nor your doctor can detect it by hand. With most breast cancers, each division takes one to two months, so by the time you can feel a cancerous lump, the cancer has been in your body for two to five years.

Drug Delivers Chemotherapy Payload To Tumor Cells

T-DXd, which is given by infusion into a vein, is a type of drug known as an antibodydrug conjugate. Such drugs consist of a monoclonal antibody, in this case trastuzumab, chemically linked to a cell-killing chemotherapy drugin this case, deruxtecan.

The trastuzumab component of T-DXd acts as a homing device that helps the drug deliver its chemotherapy payload directly to tumor cells that have HER2 on their surface. The antibodydrug conjugate is then ferried inside the cell, where the attached chemotherapy drug is released and kills the cell.

Once its released, the chemotherapy portion of T-DXd can also enter and kill nearby tumor cellseven those that have little or no HER2. This unique bystander effect of T-DXd is thought to be a key reason that the drug is effective against HER2-low tumors whereas other drugs that target HER2 are not, Dr. Modi said.

T-DXd is already approved for the treatment of adults with advanced or metastatic HER2-positive breast cancer who have previously been treated with other HER2-targeted therapies, based on results of the earlier DESTINY-Breast03 clinical trial.

Other HER2-targeted antibodydrug conjugates in development are showing promise in early-phase studies, Dr. Modi noted.

Targeted Therapies For Stage Iv Breast Cancer

Targeted therapies are also called personalized or precision medicine. Targeted therapies respond to specific molecular, biological, and genetic traits of different types of MBC. They can stop or slow the growth or spread of breast cancer cells by disrupting their biology, functionality, or other traits.

There are several new targeted therapies approved for stage IV breast cancer. New targeted therapies also present many possibilities for combination treatments. Combination treatments offer more options, improve quality of life, and extend survival rates for people living with stage IV breast cancer.

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Expert Review And References

• Bursein HJ, Harris JR, Morrow M. Malignant tumors of the breast. Devita, V. T., Jr., Lawrence, T. S., & Rosenberg, S. A. Cancer: Principles & Practice of Oncology. 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins 2008: 43.2: pp. 1606-54.
• Foxson SB, Lattimer JG & Felder B. Breast cancer. Yarbro, CH, Wujcki D, & Holmes Gobel B. . Cancer Nursing: Principles and Practice. 7th ed. Sudbury, MA: Jones and Bartlett 2011: 48: pp. 1091-1145.
• National Cancer Institute. Breast Cancer Treatment Health Professional Version. Bethesda, MD: National Cancer Institute 2010.
• Breast cancer. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. National Comprehensive Cancer Network 2010.
• 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.

Surgery To Treat Metastatic Breast Cancer

In some cases, doctors may recommend surgery for metastatic breast cancer. Your doctor may suggest surgery for a few different reasons.

Doctors usually dont recommend surgery when breast cancer has spread to another part of the body because its unlikely to get rid of all the cancer cells. This is especially true if the cancer has spread to more than one location. Still, in some cases, doctors may recommend surgery or radiation therapy to prevent broken bones or cancer cell blockages in the liver, or to ease pain and other symptoms.

Nearly 10% of women diagnosed with metastatic breast cancer have de novo metastatic disease. It’s unclear how many men are diagnosed with de novo disease. De novo means the cancer is first detected and diagnosed at stage IV, after it has already spread to other parts of the body.

Some research suggests that some women with de novo metastatic breast cancer may have better survival rates if they have surgery to remove the primary tumor in the breast. If you are diagnosed with de novo metastatic disease, you may want to ask your doctor if surgery to remove the breast tumor would be a good option for your specific situation.

Surgery to remove metastatic breast cancer isnt common, but a small study suggests that some women can benefit from surgery to remove breast cancer that has metastasized to the liver if the cancer has the following characteristics:

Learn more about Liver Metastasis.

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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?

Learn more about Genetic Testing.

It’s A Hopeful Time For Metastatic Breast Cancer Research

While no one wants to receive the news that their breast cancer has spread, there is hope: Treatments are better than ever and improving fast. Looking at the progress weve made over the past 20 years with metastatic breast cancer, there has been a dramatic shift from older treatment modalities that were mostly chemotherapy-based to our current modalities, which interrogate the specific cancer to understand what is making it grow and target that cause. Dr. Mayer says. I hope our continued efforts to pursue research will translate into many new therapies and strategies to help benefit patients with metastatic disease.

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Genetic Testing For Inherited Gene Mutations

The National Comprehensive Cancer Network recommends everyone diagnosed with metastatic breast cancer get genetic testing for BRCA1 and BRCA2 inherited gene mutations . If you have a mutation in one of these genes, a PARP inhibitor may be included in your treatment plan.

The NCCN has an animated video on genetic testing to guide metastatic breast cancer treatment.

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.

Learn how your metastatic breast cancer will be monitored, including blood tests for tumor markers, and when drug therapies are likely to change. Also learn about scan anxiety .

Talk about quality of life issues with your health care providers and your family. This can help you decide what treatments are best for you.

Keep in mind how each treatment option fits in with your values and beliefs, your family situation, your finances and anything else that may be important to you at this stage of your life.

Joining a support group may also help you think through these issues.

The National Comprehensive Cancer Network has an animated video on how to talk with your doctor about metastatic breast cancer.

Are We Close To A Cure

Every cancer is different, so finding a one-size-fits-all cure is unlikely anytime soon.

Research is targeting various methods, including gene editing, that have potential benefit for future treatments. Research is ongoing and new therapies are continually tested.

While living with metastatic breast cancer, there are ways to help improve your physical, emotional, and financial well-being.

In 2018, the released guidelines for improving the quality of life for people undergoing treatment.

The guidelines suggest the following steps:

• Talk with your healthcare professional about managing pain and side effects from your treatment, such as nausea or fatigue, as well as other potential issues, like sexual health and fertility.
• If youre experiencing depression or anxiety, check to see if a therapist or counselor is available at your cancer center, or join a breast cancer support group. Your healthcare team may have recommendations.
• For help covering the cost of your treatment, talk with a financial counselor about assistance programs.

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Metastatic Breast Cancer Treatment

As hard as it is to hear, metastatic breast cancer cannot be cured today. Unlike breast cancer that remains in the breast or nearby lymph nodes, medical treatments cant get rid of all the cancer thats spread to other parts of the body.

However, metastatic breast cancer can be treated. Treatment focuses on extending life and maintaining quality of life.

Your treatment plan is guided by many factors, including:

• The biology of the tumor
• Where the cancer has spread
• Your symptoms
• Your overall health, age, menopausal status and other medical issues
• Personal goals and preferences

Learn more about getting a second opinion.

Chemotherapy To Treat Metastatic Breast Cancer

Chemotherapy destroys or damages cancer cells as much as possible and, therefore, doctors recommend it as a treatment for metastatic breast cancer. Because chemotherapy medicines are systemic treatments meaning they affect the entire body doctors generally recommend chemotherapy if:

• the cancer is growing quickly

Doctors often combine chemotherapy with targeted therapies, which are medicines that target specific characteristics of cancer cells.

Each persons chemotherapy treatment plan is different. But there are some general guidelines that doctors follow when using chemotherapy to treat metastatic breast cancer:

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  If youve had chemotherapy before or do not have severe organ dysfunction, your doctor may recommend using only one chemotherapy medicine at a time to treat metastatic disease. This way you can get benefits with fewer possible side effects.

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  In general, doctors use most chemotherapy medicines to treat metastatic disease until side effects become a problem or the medicines stop being effective.

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  Some chemotherapy medicines seem to work better against cancer tumors when they are combined. Research has shown that combining treatments has contributed to a better overall prognosis for some metastatic cancers.

For men diagnosed with hormone receptor-positive, metastatic breast cancer, ASCO recommends any of the hormonal therapy medicines as the first treatment.

Learn ore about Hormonal Therapy.

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Looking For A New Standard Of Care

So Lyons set out on a search for existing drugs that would have an effect on semaphorin 7a and stop cancer cell growth. For her efforts, the nonprofit organization METAvivor which funds research specifically on stage 4 metastatic breast cancer presented her with its Translational Research Award earlier this year. The grant award includes funds for Lyons to continue her collaborative research with Borges.

Lyons has identified two promising drugs for this lab research so far: immunotherapy, and a drug called venetoclax . These drugs are currently under study for ER-positive breast cancer, and this project hopes to better define who could derive the best benefit from them. Through the efforts of two other CU Cancer Center researchers Dan Pollyea, MD, MS, and Craig Jordan, PhD venetoclax recently secured FDA approval for the treatment of acute myeloid leukemia .

Im part of the Department of Medicine Outstanding Early Career Scholar program with Dan, and when he presented his work on venetoclax, there was some evidence that the molecule it targets might be involved in our pathway as well, Lyon says. We obtained advice on venetoclax studies from Dr. Jordans lab, and when tested in the lab, the tumors that were resistant to ER-positive drugs were sensitive to venetoclax.

How Is Metastatic Breast Cancer Diagnosed

One of the most important tests when someone is diagnosed with metastatic breast cancer is a tumor biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. A biopsy can be done from many parts of the body, including lymph nodes, lungs, liver, bone, skin, or body fluids.

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Combined Targeted And Hormonal Therapy

Kisqali and Ibrance provide benefits when given with hormone therapy. They belong to the class of drugs called selective cyclin-dependent kinase inhibitors.

These drugs inhibit the cyclin-dependent proteins kinase 4 and 6 . When these proteins become overactive, they help cancer cells rapidly divide and grow.

Thus, they precisely target CDK4/6. The goal is to stop the uncontrollable growth and division of cancer cells.

This drug works best when given with hormone therapies. This stops the estrogens stimulation of cancer cell growth.

Hormone receptor-positive breast cancers grow faster when stimulated by hormones. This includes estrogen and/or progesterone. Hormone therapies work to reduce the levels of these hormones.

Hormone therapies include Femara , an aromatase inhibitor, and Faslodex . Ribociclib, palbociclib, and letrozole are pills that you take by mouth. Fulvestrant comes in a pre-filled syringe thats injected into the muscle.

This combination regimen offers better survival for women with breast cancer. This specifically included those with metastatic, HER2-negative, or HR-positive types.

Are You Or A Family Member Dealing With Cancer

This article discussed the latest options for metastatic breast cancer treatment. OncoPower offers on demand care for patients in active cancer treatment and cancer survivors. You can ask a board-certified oncologist using our Ask-A-Doc tool, or order for a second opinion. Youll have FREE access to oncologists with Ask-a-Doc tool 24/7. You can ask any number of questions without a credit card number.

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Selective Estrogen Receptor Degraders

Selective estrogen receptor degraders are a type of hormone therapy. These anti-estrogen drugs bind to the estrogen receptor in a tumor cell. They cause the receptor to be broken down by the cell.

Other SERDs are under study for the treatment of metastatic breast cancer, including several drugs that are pills .

Monitoring For Potentially Serious Lung Inflammation

The rates of side effects seen with T-DXd and chemotherapy were similar. The most common severe side effects of T-DXd were reduced levels of white and red blood cells and fatigue.

T-DXd can also cause a potentially serious type of lung inflammation called interstitial lung disease. In DESTINY-Breast04, 45 people in the T-DXd group developed this side effect, and 3 died as a result. By contrast, only one person in the chemotherapy group developed this lung condition and it was mild.

Patients receiving T-DXd must be carefully monitored and promptly treated if they develop signs of lung inflammation, Dr. Modi said.

Because oncologists are already using T-DXd to treat some women with breast cancer, they are now more aware of this possible complication and know so much more about how to diagnose it earlier and how to treat it better, said oncologist Patricia LoRusso, D.O., Ph.D., of Yale Cancer Center, who was not involved with the study.

This knowledge, Dr. LoRusso said, has cut the rate of severe interstitial lung disease seen in people treated with T-Dxd since the drug first came into use a few years ago.

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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.

Metastatic Breast Cancer Facts

According to the Metastatic Breast Cancer Network , breast cancer that has spread outside of the breast to other organs such as bones, liver, lung or brain has metastasized it is still breast cancer, and the misunderstanding around that is probably the biggest misconception around MBC, says Comen.

It’s the misconception that metastatic disease is liver cancer or bone cancer when, in fact, metastatic breast cancer is breast cancer cells living in a new location,” Comen explains. “Even when asking about a patients family history, Ill hear, ‘My mom had breast cancer in her 40s and then later had bone cancer,’ but almost always it was metastatic breast cancer. So its important to understand family history, but also because it really informs a patients awareness of how we will treat the disease. And the way we treat liver or bone cancer is very different from how we treat metastatic breast cancer.”

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Of the 3.5 million people living with a history of breast cancer in the U.S., an estimated 155,000 are stage IV.

There are approximately 40,000 breast cancer deaths each year, with men representing 1%. It’s a number that has remained essentially unchanged for 20 years, notes MBCN, adding, “All deaths from breast cancer are caused by metastatic breast cancer.”

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