Myth #: If An Earlier
Ninety percent of MBC diagnoses occur in people who have already been treated for an earlier-stage breast cancer. Many people are under the impression that remaining cancer-free for five years means that a metastatic recurrence cant happen. However, distant recurrences can occur several years or even decades after initial diagnosis. Factors such as original tumor size and the number of lymph nodes involved can help predict the risk of recurrence.
For example, a 2017 survey of 88 studies involving nearly 63,000 women diagnosed with early-stage, hormone-receptor-positive breast cancer found that the risk of distant recurrence within 20 years ranged from 13% to 41%, depending on tumor size and lymph node involvement.
As KatyK of Idaho comments: that you are cured if you are cancer-free five years after initial diagnosis. I fell for that one myself. When I was diagnosed with MBC 12 years after initial diagnosis I was shocked. I thought I was cured, which to me means all better. Nope! Not even sure medically what cured means.
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Symptoms Of Brain Metastases
Symptoms of brain metastases depend on the location, size and number of growths in the brain, or the amount of swelling. Metastases can push on or cause swelling in specific areas causing specific symptoms. Not everyone with a brain metastasis will have symptoms but most do.
The most common symptoms are:
- Not being able to move parts of your body, like an arm or leg
- Changes in emotions or how a person acts
- Problems hearing, seeing, or swallowing
- Nausea or vomiting
Special/molecular Considerations For Therapy Selection
HER 2 positive breast cancer
Approximately 25% of patients with HER2-positive breast cancer will develop brain metastases. Those with HER2-positive disease have demonstrated a significant survival benefit with the use of systemic anti-HER2 therapy. One proposed mechanism behind the propensity of HER2-positive disease to metastasize to the brain is the inability of trastuzumab to cross the BBB.
HER2-directed therapies for breast cancer can be classified into three subgroups: monoclonal antibodies such as trastuzumab and pertuzumab, small-molecule tyrosine kinase inhibitors such as lapatinib and neratinib, and the antibody-drug conjugate ado-trastuzumab emtansine . The American Society of Clinical Oncology has recommendations on disease management for advanced HER2-positive breast cancer and brain metastases, which we have outlined in Table 1.
Lapatinib with capecitabine is considered a treatment option for progressive brain metastasis and when local therapy has failed, or re-radiation is not feasible, especially when an oral systemic treatment option is preferred. More recently, the TKI neratinib was studied in a phase II trial among 40 patients with HER2-positive breast cancer with brain metastases who had progressed after at least one line of therapy. The intracranial response rates were modest at 8% with this agent.
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Symptoms Of Breast Cancer
Breast cancer can have several symptoms, but the first noticeable symptom is usually a lump or area of thickened breast tissue.
Most breast lumps are not cancerous, but its always best to have them checked by a doctor.
You should also see a GP if you notice any of these symptoms:
- a change in the size or shape of one or both breasts
- discharge from either of your nipples, which may be streaked with blood
- a lump or swelling in either of your armpits
- dimpling on the skin of your breasts
- a rash on or around your nipple
- a change in the appearance of your nipple, such as becoming sunken into your breast
Breast pain is not usually a symptom of breast cancer.
Find out more about the symptoms of breast cancer.
Strides Are Being Made In The Treatment Of Brain Metastases From Breast Cancer
New drugsfor HER2-positive breast cancer are able to overcome some of the obstacles that have made brain metastases challenging to treat, according to , the Susy Yuan-Huey Hung Professor of Oncology at Stanford University School of Medicine in California, who described the promising treatment landscape at the 2022 Miami Breast Cancer Conference.1
Specifically, some monoclonal antibodies, antibody-drug conjugates, and targeted agents can penetrate the blood-brain barrier and reach metastatic sites in the central nervous system . Their brain-specific activity has led to improved quality of life and longer overall survival for patients who develop brain metastasis along with breast cancer, said Dr. Pegram, who is also Medical Director of the Clinical and Translational Research Unit and Associate Dean for Clinical Research Quality at Stanford.
As systemic control improves for treating metastatic disease, particularly for HER2-positive breast cancer, the brain is increasingly becoming a sanctuary site. Many patients develop brain metastases when they are actually responding in the extracranial space to anticancer treatments, Dr. Pegram said. Its remarkable how most of our chemotherapeutic drugs have poor penetration of the CNS. By contrast, antitumor antibodies can penetrate the blood-brain barrier and can access tumor targets on cancer cells in the brain.
Therapeutic Breakthroughs
Screening and Treatment
REFERENCES
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If youre diagnosed with lung cancer, its especially important to pay attention to symptoms of brain metastasis, including: decreases in memory, attention, and reasoning. headaches caused by. Decreased food intake and darkened urine production also are symptoms that occur during the finalstagesofbraincancer. Emotional Changes The patient’s mood may transform and he may become.
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Sep 10, 2020 · Brain metastases develop most often in people with lung cancer, breast cancer, and melanoma, but also with other types of cancer. Brain metastases can be found at the same time as the primary cancer or later. Brain metastases are usually single spots, but some types of cancer can cause meningitis .. The brainstrust end-of-life care resource. have independent, factual information available on EOLC when living with a brain tumour for patients, caregivers and stakeholders. can articulate the challenges around EOLC so that you can be more open in your discussions. Click here to download the complete EOLC resource.
Lung cancer is the most common form of brainmetastasis. In fact, lung cancer staging often involves a brain scan. Brain metastases will likely be assessed through the Tumor, Node, Metastasized staging system . Sometimes, individuals are diagnosed with brain or spinal metastases before they realize they have another, primary cancer.
Focal Treatment Of Brain Metastases
Focal treatment including surgery, WBRT, and stereotactic radiosurgery is indicated for the treatment of intracranial metastases across all intrinsic subtypes of breast cancer. However, the type of focal treatment strategy depends upon the extent of CNS disease and other disease- and patient-specific characteristics. An individualized approach is preferred, assimilating the above variables with clinical presentation. The approach to focal treatment of brain metastases in breast cancer is also based upon the intrinsic subtype of breast cancer and should be decided on a case-by-case basis. For example, salvage radiation is likely a first line-therapy among those with TNBC due to limited systemic options. However, a patient with HER2-positive disease may benefit from aforementioned systemic therapy options and may be able to forgo focal therapy.
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Immunotherapy For Metastatic Brain Tumors
Cancer immunotherapy is a fast-growing field of research that seeks to develop drugs, vaccines and other therapies that trigger the immune systems natural abilities to fight cancer. Many immunotherapy drugs for metastatic brain tumors act as checkpoint inhibitors. Normally, tumor cells can evade attack by activating certain proteins that disarm your immune system. Checkpoint inhibitors prevent tumor cells from exploiting this process.
Immunotherapy drugs to treat metastatic brain tumors include:
Myth #: If Youre Diagnosed With Metastatic Breast Cancer You Did Something Wrong Or Didnt Get The Right Treatment The First Time
When some people hear stage IV breast cancer, they assume something must have been missed along the way to let the cancer get that far. There is a misconception that breast cancer always develops in orderly steps from stages I to II, III, and then IV and that theres plenty of time to catch it early. People with MBC can face misguided assumptions that they must have skipped mammograms or self-exams, or they didnt control risk factors such as not exercising enough, watching their weight, or eating healthy. But a person can do everything right and still get MBC. Although regular screenings increase the odds of diagnosing breast cancer at an earlier stage, they cant guarantee it.
Another major misconception: If youre diagnosed with metastatic cancer after being treated for an early-stage breast cancer, you must have chosen the wrong treatment regimen or it wasnt aggressive enough. But between 20% and 30% of people with an earlier-stage breast cancer will eventually go on to develop MBC and theres often no good explanation as to why. And it can happen to anyone. Treatments can reduce the risk of recurrence, but they cant eliminate it.
As Illimae of Houston notes: that a stage IV diagnosis equals negligence on the part of the patient. In my case, it had spread before I ever felt a lump. I felt it Saturday and saw my doc on Monday, I ignored nothing, sometimes it just happens that fast.
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Risk Factors For Brain Metastasis
According to a 2020 review , the risk factors for brain metastasis are similar to the general risk factors for metastatic breast cancer. These include having:
- a tumor with a high histological grade, which means that the cells look more irregular under a microscope and may be more likely to grow and spread quickly
- breast cancer thats already spread to nearby tissues or lymph nodes
- a breast cancer diagnosis at an early age
If youve received a breast cancer diagnosis, remember that having any of the above risk factors doesnt mean that youll certainly develop brain metastasis. It means youre at an elevated risk compared with others without risk factors.
Symptoms Causes And Treatment
What happens if your breast cancer spreads to your brain? Sometimes, brain metastases are found when breast cancer is first diagnosed, but the majority of the time, brain metastases occur as a distant recurrence of an early-stage breast cancer that was treated in the past. What symptoms may occur, and what treatment options are available if your breast cancer spreads to your brain?
Overall, brain metastases occur in 15% to 24% of women with metastatic breast cancer. As survival improves, however, this number is expected to increase.
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Consider A Clinical Trial
Doctors and scientists continue to research new approaches for treating cancer, including brain metastases. These new approaches are tested in clinical trials.
If youre interested in trying an experimental treatment option, talk with your oncology care team about clinical trials that you may be eligible for. You can also find a searchable database of NCI-supported clinical trials
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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What Is The Prognosis Of Brain Metastasis
After a metastatic breast cancer diagnosis, no matter where it is in the body, one of the hard parts can be the uncertainty around how long treatments will keep the cancer under control. Its completely normal to feel some concern or anxiety about this. You may find yourself looking for information about prognosis, the likely outcome of a disease.
People diagnosed with brain metastasis can live for several years. Systemic therapies to treat your cancer subtype, and local therapies to ease symptoms and side effects, can both help preserve your quality of life.
Right now, experts cant predict how long one person might live with brain metastases compared to another. Its important to know that existing survival statistics are always a few years old, because it takes time to track and gather data. Newer, effective treatments are being used all the time and because these treatments are newer, they are not factored into statistics created from data thats a few years old.
Figuring out life expectancy also means looking at breast cancer subtype, your health before cancer, and current lifestyle choices, such as smoking and nutritional habits. If youre curious about your own situation and believe knowing more will help you, talk with your care team. You can also learn more about life expectancy on our StageIV prognosis page.
What Can I Expect While Living With Metastatic Breast Cancer
Your care team will monitor you every few months to check if the cancer is responding to treatment, and also to see if you are having any side effects. The process of restaging the cancer includes:
- History/physical exam.
- Imaging tests, including CTs and bone scan or PET scan.
Before your scans or tests, its normal to feel anxiety. It may help to bring a friend or family member to the appointment with you.
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How Do You Decide Which Metastatic Brain Cancer Treatment Is Right For You
Your neurosurgeon will discuss the most appropriate treatment approach with you by considering these and other factors:
- The type of primary cancer, your response to treatment and current status
- The location and number of metastatic tumors within the brain or spine
- Your general health and preferences regarding potential treatment options
- Your current symptoms
Along with benefits, doctors also consider the potential risks and side effects of any treatment. Many patients are worried about the effects of radiation. Others hesitate about the idea of surgery. Tell your doctor about your concerns they are important to consider.
Talking To Your Healthcare Provider
It is crucial that you talk to your oncologist and healthcare team about any and all symptoms you are experiencing. Some of these symptoms, such as pain, are under-treated in people with metastatic cancer. This is not because healthcare providers fail to treat the symptoms, but because they are simply unaware that a person is coping with them.
Breast Cancer Doctor Discussion Guide
Get our printable guide for your next healthcare provider’s appointment to help you ask the right questions.
With all of the talk about people with cancer being brave or strong, you might hesitate to share symptoms that could make you appear frightened or weak. Yet facing metastatic cancer is frightening, and being able to share your concerns is a sign of strength, not weakness. There is a lot that can be done to ease most of the symptoms of metastatic breast cancer, but the only way that your oncologist can know what you are feeling is if you are brave enough to speak up.
In addition, sharing your symptoms, even if they may seem of little consequence to you, may help your oncologist better recognize the extent of your disease, anticipate potential complications, and suggest the best possible treatments for your disease.
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How Is Metastatic Breast Cancer Treated
Although metastatic breast cancer currently cant be cured, it can be treatable with hormonal therapy, chemotherapy, biologic targeted treatments, and novel drug combinations.
Treatment for brain metastases whether originating in the breast or other part of the body takes a variety of forms, including:
- Radiation therapy
- Systemic treatment such as chemotherapy and/or targeted therapy
Care teams at the Metastatic Breast Cancer Program at Dana-Farber develop personalized treatment approaches for each patients specific type of cancer, as well as an individual plan of care and support for them and their loved ones.
Treatment For Patients With Her2 Bm
For the treatment of patients with ER+/HER2 BCBM, some responses have been observed with tamoxifen, aromatase inhibitors, and fulvestrant, and therefore, in the absence of therapeutic alternatives, these low-toxicity treatments have a place in paucisymptomatic ER+ patients.
Studies assessing late-line agents that target cyclin-dependent kinases 4 and 6 have been published. In an open-label, Phase 2 trial, abemaciclib was proposed for the treatment of patients with ER+/HER2 or ER+/HER2+ BCBM. Patients in Part B did not reach the primary endpoint, the investigator-assessed objective response rate . Patients in Part A had an intracranial ORR of 5.2%, an intracranial clinical benefit rate of 24% and a median PFS of 4.9 months with some long responses . A subgroup of 8 patients in this study had surgical resection of BM while undergoing treatment, and it was shown in the resected samples that therapeutic levels of abemaciclib were reached in BM, demonstrating abemaciclib and its active metabolites penetrated the BBB.
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Testing For Metastatic Breast Cancer
Once youve explained to your health care provider that youre concerned about new symptoms, they will likely ask you for a detailed health history which could include a physical exam.
They may then conduct an X-ray, ultrasound scan, MRI, or CAT scan and order a blood test or tumor biopsy. If youre currently undergoing treatment, then a scan regimen may currently make up part of your health care. This can vary depending on your cancer and treatment plan.
Patients with metastatic breast cancer will routinely have scans every few months to check on their status of the cancer, Dr. Teplinksy says. These scans may be CT scans and bone scans or PET scans. Sometimes, other scans are done as well. These scans will help your health care provider to monitor your cancer and identify if it has spread.
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