Treatments For Metastatic Triple
One myth about treating TNBC is that there arent effective treatment options. The truth is that an array of treatments can improve your care. Your treatment options include many medicines and may also include targeted therapies that treat some triple-negative breast cancers with specific features.
How do you choose from the many available chemotherapy options? It is important to talk with your doctors about how you wish to balance the goals of keeping the cancer under control as long as possible and maintaining your ,or overall enjoyment of life.
Another important point about treating metastatic TNBC is that if you had early- disease, you can retry medicines you were treated with before. A certain treatment may have failed to get rid of the primary disease, but that treatment could still control it in the metastatic setting.
Common chemotherapy treatments for metastatic triple-negative disease are:
- , which kill cancer cells by stopping growth. Three anthracyclines used in metastatic breast cancer are:
Facts You Should Know About Triple
- Triple-negative breast cancer is an uncommon kind of breast cancer in which the cancer cells test negative for three common markers, the estrogen receptor , progesterone receptor , and a protein involved in cell growth known as HER2.
- The triple-negative status of a cancer means that anti-hormonal therapies and therapies targeted against the HER2 protein are not effective.
- About 10%-20% of all breast cancers are triple-negative.
- Doctors usually treat triple-negative breast cancers with surgery, chemotherapy, and in many cases, radiation therapy.
- Triple-negative cancers have a more aggressive course than other breast cancers and are more likely to recur over the first few years after diagnosis. After 5 years, the likelihood of recurrence decreases.
- A majority of cases of breast cancer in women with a BRCA-1 mutation are triple-negative.
What Are The Most Serious Side Effects Of Phesgo
PHESGO may cause heart problems, including those without symptoms and those with symptoms .
- The risk for and seriousness of these heart problems are highest in people who received both PHESGO and a certain type of chemotherapy
- Your doctor will check for signs of heart problems before, during, and after treatment with PHESGO. Based on test results, your doctor may hold or discontinue treatment with PHESGO
- Contact a healthcare professional immediately for any of the following: new onset or worsening shortness of breath, cough, swelling of the ankles/legs, swelling of the face, palpitations, weight gain of more than 5 pounds in 24 hours, dizziness or loss of consciousness
Receiving PHESGO during pregnancy can result in the death of an unborn baby and birth defects.
- Birth control should be used while receiving PHESGO and for 7 months after your last dose of PHESGO. If you are a mother who is breastfeeding, you should talk with your doctor about either stopping breastfeeding or stopping PHESGO
- If you think you may be pregnant, you should contact your healthcare provider immediately
- If you are exposed to PHESGO during pregnancy, or become pregnant while receiving PHESGO or within 7 months following the last dose of PHESGO, you are encouraged to report PHESGO exposure to Genentech at
PHESGO may cause serious lung problems.
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Stage Groups For Breast Cancer
Doctors assign the stage of the cancer by combining the T, N, and M classifications , the tumor grade, and the results of ER/PR and HER2 testing. This information is used to help determine your prognosis . The simpler approach to explaining the stage of breast cancer is to use the T, N, and M classifications alone. This is the approach used below to describe the different stages.
Most patients are anxious to learn the exact stage of the cancer. If you have surgery as the first treatment for your cancer, your doctor will generally confirm the stage of the cancer when the testing after surgery is finalized, usually about 5 to 7 days after surgery. When systemic treatment is given before surgery, which is typically with medications and is called neoadjuvant therapy, the stage of the cancer is primarily determined clinically. Doctors may refer to stage I to stage IIA cancer as “early stage” and stage IIB to stage III as “locally advanced.” Stage 0: Stage zero describes disease that is only in the ducts of the breast tissue and has not spread to the surrounding tissue of the breast. It is also called non-invasive or in situ cancer . Stage IA: The tumor is small, invasive, and has not spread to the lymph nodes . Stage IB: Cancer has spread to the lymph nodes and the cancer in the lymph node is larger than 0.2 mm but less than 2 mm in size. There is either no evidence of a tumor in the breast or the tumor in the breast is 20 mm or smaller .
Stage IIA: Any 1 of these conditions:
Chance Of Remission And Recurrence
When cancer goes into remission, tests that look for cancer cannot detect it. A doctor may refer to this pathological complete response.
Treatment may also cause partial remission. This means that treatment has destroyed a portion of the cancer but that tests can still find the cancer.
Stage 4 breast cancer will not go away completely. However, Breastcancer.org notes that treatment can help control the cancer for years. It notes that the cancer can be active at times and go into remission at other times.
Because stage 4 breast cancer is not curable, it will not disappear and then recur.
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Emotional And Spiritual Care
End-of-life care also includes emotional, mental, and spiritual therapy. A personâs healthcare team may include social workers, counselors, mental health professionals, and religious or spiritual advisors.
According to the Anxiety and Depression Association of America, up to 40 percent of people with cancer experience serious mental distress. This may include anxiety, depression, panic attacks, and post-traumatic stress disorder .
Medications, therapy, religious or spiritual rituals, and support groups can help a person cope with mental health issues and stress during this difficult time.
Caregivers may also need help with stress, anxiety, and depression. The palliative care team can usually also provide support and advice to caregivers for their emotional needs.
The Breast Cancer Healthline app provides people with access to an online breast cancer community, where users can connect with others and gain advice and support through group discussions.
Symptoms And Diagnosis Of Metastatic Breast Cancer
The most common parts of the body where breast cancer tends to spread are the bones, lungs, brain, and liver. But metastatic breast cancer can affect other parts of the body, as well.
Metastatic breast cancer symptoms can be very different depending on the cancers location, but may include:
biopsy of any suspicious area
a tap, removal of fluid from the area with symptoms to check for cancer cells a pleural tap removes fluid between the lung and chest wall a spinal tap removes fluid from around the spinal cord and a tap of fluid in the abdomen removes fluid in the abdominal cavity
These tests may also be used if you have no history of breast cancer and your doctor is having trouble determining the cause of your symptoms.
When breast cancer spreads to other parts of the body, its important to confirm whether the cancer has certain characteristics that may influence your treatment options, such as HER2 status and hormone receptor status. If you have been diagnosed with metastatic breast cancer years after an early-stage breast cancer diagnosis, it may seem logical to assume that the hormone receptor status and HER2 status are the same. But research has shown that the hormone receptor status and HER2 status of early-stage breast cancer can be different than that of a metastatic recurrence.
A biopsy may be done to determine these factors that can influence your treatment, which will be listed in your pathology report.
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How Does Chemotherapy Work
Chemotherapy. Chemotherapy uses one or more drugs to kill cancer cells and slow cancer growth. The drugs are taken orally or intravenously. Afterward, they travel through the bloodstream. This way, the drugs can target the original site of the cancer as well as areas in the body where the cancer cells have spread.
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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Integrative Therapies For Metastatic Breast Cancer
You may find it beneficial to add integrative therapies to your treatment plan. There are many evidence-informed integrative modalities to boost the mind and body. Practices like gentle yoga, meditation, massage and music therapy may feel enjoyable and reduce stress and anxiety levels.
To help our patients maintain quality of life after a metastatic breast cancer diagnosis, our team of breast cancer experts may offer supportive care services to help manage side effects of the disease and its treatments. These may include:
Before starting any integrative therapies, however, ask your care team for advice on which ones are most suited to you and fit into your overall treatment plan, as well as how to do them safely.
The Effects Of Chemotherapy And Natural Chemicals
Chemotherapy is like pouring weed killer on a garden. The flowers get as damaged and die right along with the weeds, but then even more resistant weeds find their way to the surface. Chemotherapy attacks every cell in the body. Hair cells stop their ability to hold onto the hair follicle in many chemo treatments because the chemo has attacked a healthy cell. Neuropathy is induced because the chemo attacks healthy nerve cells. Organs such the heart and kidneys, even bones can be permanently damaged because chemotherapy indiscriminately attacks healthy cells and cancer cells.
To the contrary several natural chemicals can create a specific programmed cell death of cancer cells by penetrating the cancer cell membrane. Apoptosis attaches a genetic message for a cell to self-destruct. Omega 3s, Resveratrol, Vitamin C, pine tree bark and an exhaustive list of morphing substances found in nature can have this miraculous affect, especially when delivered directly into the bloodstream intravenously. It would not be fair to say that alternative cancer therapy is without side effects, but those effects in no way rank in the same caustic category of chemotherapies.
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From Cured To Stage 4
Others, like Teri Pollastro, a 54-year-old stage 4 patient from Seattle, respond surprisingly well.
Diagnosed with early stage ductal carcinoma in situ in 1999, Pollastro underwent a mastectomy but did not receive chemotherapy, radiation or tamoxifen, since her cancer was ER negative.
âThey used the C-word with me, they told me I was cured,â she said. âEvery time I went back to my oncologist, he would roll his eyes at me when I had questions.â
In 2003, Pollastro switched to Seattle Cancer Care Alliance where she saw Dr. Julie Gralow, a breast cancer oncologist and clinical researcher at Fred Hutchinson Cancer Research Center. Gralow discovered Pollastroâs cancer had metastasized to her liver.
âMy husband and I were in shock,â said Pollastro of her mets diagnosis. âYou donât go from being cured to stage 4.â
Pollastro went on Herceptin, a type of immunotherapy for women with HER2-positive metastatic breast cancer, and did six months of chemotherapy.
âI felt better right away with the treatment,â she said. âBut the problem is, it stopped . Thatâs what you can expect with mets. And thereâs always some residual cancer. And that starts percolating.â
And along with mets, she also had to deal with many misconceptions regarding her disease.
The Mercer Island, Washington, mother of two, who often counsels newly diagnosed patients, sometimes even found it difficult to relate to early stage breast cancer survivors.
What Is The Life Expectancy For Stage 4 Breast Cancer
Stage 4 breast cancer life expectancy can vary depending on several factors. The following factors can affect your life expectancy with metastatic breast cancer:
- Amount of hormone receptors and HER2 receptors on cancerous cells
- Tissues that the cancer has affected
There is still not a clear answer for how long can you live with stage 4 breast cancer because it can vary greatly from patient to patient. Other factors such as past and current treatments being used also can have an effect on the life expectancy for patients.
What Is The Process Of Determining How Far A Cancer Has Spread
After someone is diagnosed with breast cancer, doctors will try to figure out if it has spread, and if so, how far. This process is called staging. The stage of a cancer describes how much cancer is in the body. It helps determine how serious the cancer is and how best to treat it. Doctors also use a cancers stage when talking about survival statistics.
What Does It Mean To Have Stage 4 Breast Cancer
Stage 4 breast cancer means that the cancer has spread to other areas of the body, such as the brain, bones, lung and liver.
Although Stage 4 breast cancer is not curable, it is usually treatable and current advances in research and medical technology mean that more and more women are living longer by managing the disease as a chronic illness with a focus on quality of life as a primary goal. With excellent care and support, as well as personal motivation, Stage 4 breast cancer may respond to a number of treatment options that can extend your life for several years.
How To Handle Emotions
Coping with the many symptoms that can occur with stage 4 breast cancer can be frustrating and discouraging, and people sometimes wonder if they will have to feel poorly the rest of their lives. Anxiety and depression are also severe for some people with advanced disease.
Fortunately, palliative care team consults are now offered at many cancer centers. While hospice is a form of palliative care, palliative care can be helpful even with early, curable tumors. Working with a palliative care team to address physical and emotional issues frees you up to work with your oncologist on issues that treat your cancer specifically.
While the research is also young, it appears that those people who receive palliative care consults not only have a better quality of life with advanced cancer, but they may actually live longer, too.
What Should I Know About Side Effects With Phesgo
- Not all people have serious side effects however, side effects with PHESGO therapy are common. It is important to know what side effects may happen and what symptoms you should watch for
- Your doctor may stop treatment if serious side effects happen. Be sure to contact your healthcare team right away if you have questions or are worried about any side effects
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What Should I Ask My Healthcare Provider About Metastatic Breast Cancer
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.
Diagnosis And Treatment Planning
A complete diagnosis usually takes more than one doctors visit. It may involve scans, blood tests, and a biopsy. Your doctor will work with a team to figure out:
- If you have breast cancer or another kind of cancer
- The type and subtype of breast cancer
- The places in your body it has spread
If you had breast cancer in the past, your doctor will confirm whether it is the same type of breast cancer as before. Breast cancer that has spread to another part of the body is still breast cancer. The site where the cancer is found may affect your treatment options.
The process of learning about treatment options and choosing one is called treatment planning. You will be asked to make choices at the start of treatment and again along the way. Here are some steps you can take to feel more in control and better able to make decisions that are right for you.
Look for a doctor with expertise in metastatic breast cancer. Consider communication style, approach to treatment, location, insurance, and the availability of clinical trials, among other factors.
Keep a list of questions. Ask about the best way to get answers to your questions. Bring a friend or family member to visits to listen and take notes. Tell your team about any symptoms or side effects.
Getting a Second Opinion
Learn more about the steps you can take to get a second opinion downloading our Metastatic Breast Cancer book.
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