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What Chemotherapy Is Used For Metastatic Breast Cancer

Endocrine Therapy In Postmenopausal Women

Chemotherapy for Metastatic Breast Cancer in 2017

Treatment with a single endocrine agent is usually continued until disease progression. Considerations are as follows:

  • AIs have been shown to be more effective than tamoxifen for adjuvant therapy and metastatic disease.

  • Patients who experience relapse or have progressive disease on tamoxifen may be switched to an AI.

  • Patients who experience relapse or progress while receiving a nonsteroidal AI may be changed to a steroidal AI or a selective ER-downregulator .

  • Fulvestrant regimen is 500 mg IM on days on days 1, 15, 29 and once monthly thereafter or in combination with palbociclib 125 mg PO once daily days 1-21.

  • Optionally, consider the androgenic agent fluoxymesterone 10 mg PO BID or the progestational agent megestrol acetate 40 mg PO QID or estradiol 2 mg PO BID.

  • Systemic chemotherapy should be reserved for patients with hormone-insensitive disease or for patients with symptomatic hormone-sensitive disease in whom all hormone therapy options have failed or who are moderately to severely symptomatic and in urgent need of symptom palliation.

  • The options for cytotoxic-containing chemotherapy include single-agent therapy and combination cytotoxic therapy.

What Is Targeted Therapy For Her2

When a cancer is HER2-positive, it means that the cancer cells make too much HER2 protein, which can cause tumors to grow more rapidly than with other forms of breast cancer.

Drugs that target the HER2 proteins are the primary treatment for this type of breast cancer, given along with chemotherapy. Your oncology team may refer to these medications as targeted therapy or HER2-directed therapy.

Trastuzumab and pertuzumab are the most commonly used drugs used to treat HER2-positive breast cancer. Neratinib is another drug that is sometimes given after trastuzumab.

Some other targeted therapy drugs, such as lapatinib or ado-trastuzumab emtansine , are mainly used to treat more advanced HER2-positive breast cancers.

Herceptin and Perjeta are given at the same time as chemotherapy through an IV. HER2-directed therapy is usually given over a longer period of months than chemotherapy.

Herceptin alone is usually continued after chemotherapy has finished, every three weeks for a total of one year.

Side effects for HER2-targeted therapies may include:

  • sleep problems
  • redness at the IV site
  • diarrhea

Longer Term Side Effects

Fatigue

Tiredness is commonly reported during treatment. This may be a direct effect of the drugs or may be due to other factors such as disrupted sleep patterns.

  • Try to get adequate rest but also try to exercise regularly. Go for a walk outside each day as this can actually give you more energy.
  • Find something that you actually enjoy doing and also try to incorporate exercise into your usual day, e.g. walk upstairs rather than taking the lift, park further away from where you want to go and walk the extra distance. Build this up gradually.
  • Your GP, practice nurse or a physiotherapist can work with you to devise a specific exercise plan for you.
  • Let others help when your energy levels are low.

If your fatigue doesn’t allow you to exercise, discuss this with your GP.

Usually energy levels recover after treatment finishes but this commonly takes time. In some cases full recovery may take 12 months or more.

Cognitive changes

Some people notice they are having concentration and short-term memory problems following their chemotherapy. This is often referred to as chemo brain. The severity and duration of symptoms differ from person to person. For some people the symptoms are very mild and resolve soon after treatment stops, but others may find their daily life is noticeably affected for a much longer period, restricting their ability to return to work in their pre-treatment capacity.

Menopause/fertility

Heart conditions

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Local Or Regional Treatments For Stage Iv Breast Cancer

Although systemic drugs are the main treatment for stage IV breast cancer, local and regional treatments such as surgery, radiation therapy, or regional chemotherapy are sometimes used as well. These can help treat breast cancer in a specific part of the body, but they are very unlikely to get rid of all of the cancer. These treatments are more likely to be used to help prevent or treat symptoms or complications from the cancer.

Radiation therapy and/or surgery may also be used in certain situations, such as:

  • When the breast tumor is causing an open wound in the breast
  • To treat a small number of metastases in a certain area, such as the brain
  • To help prevent bone fractures
  • When an area of cancer spread is pressing on the spinal cord
  • To treat a blood vessel blockage in the liver
  • To provide relief of pain or other symptoms

In some cases, regional chemo may be useful as well.

If your doctor recommends such local or regional treatments, it is important that you understand their goalwhether it is to try to cure the cancer or to prevent or treat symptoms.

Side Effects Of Breast Cancer Chemotherapy

Use of eribulin as an earlier

Chemotherapy usually works by attacking rapidly dividing cells. This means that chemotherapy can harm not only cancer cells but also healthy cells that are dividing rapidly, like the ones that cause your hair to grow.

Whether you have side effects from breast cancer chemotherapy will depend on the details of your treatment plan. The care teams at MSK are committed to helping you feel your best during and after treatment. During treatment, well watch carefully for your reaction to the drugs and adjust the drugs or dose as necessary. Well also continue to monitor you for possible long-term effects after your treatment ends.

We offer a variety of other specialized services to support you during your treatment. Many MSK patients find that our Integrative Medicine Service can be a valuable part of their treatment plan. Programs include massage, acupuncture, hypnotherapy, meditation, visualization, music therapy, and nutritional counseling.

One side effect of chemotherapy can be hair loss. MSK offers scalp cooling to help minimize hair loss. Learn more about scalp cooling, or ask your care team for more information.

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When Can Metastatic Breast Cancer Occur

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.

Metastatic breast cancers come from breast cancer cells that remained in the body after treatment for early breast cancer. The breast cancer cells were always there but were dormant and could not be detected. For some unknown reason, the cancer cells began to grow again. This process is not well-understood.

Treatments For Stage 4 Breast Cancer

    The following are treatment options for ductal carcinoma and lobular carcinoma. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

    Stage 4 means that the breast cancer has spread to other parts of the body. It is also called advanced breast cancer, or metastatic breast cancer. Treatments cannot completely cure metastatic breast cancer, but they can control it very well, sometimes for many years. Doctors may offer one treatment until it stops working and then give another one.

    The treatments offered for stage 4 breast cancer depend on the hormone-receptor status and the HER2 status of the cancer cells. They will also depend on where the cancer has spread, if it is causing any symptoms and your overall health.

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    Analysis Of Metastatic Progression

    At the end point of the experiment, animals were sacrificed to assess metastatic burden. Lungs were inflated with an OCTPBS solution, excised, and immediately formalin-fixed. Livers were excised and fixed. Whole mount fluorescent imaging of lungs and livers was conducted using an Olympus phase objective 1.25× in the RFP and GFP channels. Images were linearly stitched. The quantification of the metastatic burden was performed using flow cytometry analysis. Briefly, lungs and livers were chopped and digested in 2 mg/mL collagenase and 2 mg/mL BSA for 1 h at 37 °C at 160 RPM. After passing through a 0.70 m strainer, cells were washed with PBS and resuspended in FACS buffer. GFP and DsRed were detected in the FITC and PE channels, respectively, using an SH800 . Data were analyzed using the FlowJo V10 software .

    Electrochemotherapy For Breast Cancer That Has Spread To The Skin

    Optimizing Chemotherapy for Metastatic Breast Cancer

    Sometimes breast cancer cells can start growing in the skin. It may start to grow on or near the scar after an operation to remove the primary cancer. Or it can grow in other parts of the body. This is secondary or metastatic breast cancer in the skin.

    The skin may become itchy, red and painful.

    Electrochemotherapy is a way of getting chemotherapy into cancer cells. It is a combination of:

    • chemotherapy injected into the tumour or bloodstream
    • an electric pulse to send the chemotherapy into the cancer cells

    This treatment can shrink the skin secondaries and help to relieve symptoms such as pain.

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    Menstrual Changes And Fertility Issues

    For younger women, changes in menstrual periods are a common side effect of chemo. Premature menopause and infertility may occur and may be permanent. Some chemo drugs are more likely to cause this than others. The older a woman is when she gets chemotherapy, the more likely it is that she will go through menopause or become infertile as a result. When this happens, there is an increased risk of bone loss and osteoporosis. There are medicines that can treat or help prevent bone loss.

    Even if your periods have stopped while you are on chemo, you may still be able to get pregnant. Getting pregnant while on chemo could lead to birth defects and interfere with treatment. If you are pre-menopausal before treatment and are sexually active, its important to discuss using birth control with your doctor. It is not a good idea for women with hormone receptor-positive breast cancer to take hormonal birth control , so its important to talk with both your oncologist and your gynecologist about what options would be best in your case. Women who have finished treatment can safely go on to have children, but it’s not safe to get pregnant while on treatment.

    If you think you might want to have children after being treated for breast cancer, talk with your doctorbeforeyou start treatment. Learn more from our section on fertility concerns for women with cancer.

    Adjuvant And Neoadjuvant Drugs

    • Ixabepilone
    • Eribulin

    Although drug combinations are often used to treat early breast cancer, advanced breast cancer more often is treated with single chemo drugs. Still, some combinations, such as paclitaxel plus gemcitabine, are commonly used to treat advanced breast cancer.

    For cancers that are HER2-positive, one or more drugs that target HER2 may be used with chemo.

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    The Types Of Radiotherapy

    The type of radiotherapy you have will depend on the type of breast cancer and the type of surgery you have. Some women may not need to have radiotherapy at all.

    Types of radiotherapy include:

    • breast radiotherapy after breast-conserving surgery, radiation is applied to the whole of the remaining breast tissue
    • chest-wall radiotherapy after a mastectomy, radiotherapy is applied to the chest wall
    • breast boost some women may be offered a boost of high-dose radiotherapy in the area where the cancer was removed however, this may affect the appearance of your breast, particularly if you have large breasts, and can sometimes have other side effects, including hardening of breast tissue
    • radiotherapy to the lymph nodes where radiotherapy is aimed at the armpit and the surrounding area to kill any cancer that may be in the lymph nodes

    Single Vs Combination Therapy

    Combination chemotherapy regimens for metastatic breast ...

    Unlike adjuvant therapy for early-stage breast cancer, which almost always entails using a combination of drugs, single-agent therapy is often used for metastatic breast cancer. The use of combination chemotherapy is usually limited to times when cancer is rapidly progressive.

    A few combinations that are commonly used include Xeloda and Taxotere , and Gemzar and Taxol .

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    Where Is Chemotherapy Given

    Unless youre having chemotherapy as tablets, youll normally be given your treatment at hospital as an outpatient or day case. This means youll be able to go home on the same day.

    You may be at the hospital for a short time only. However, because of tests, waiting times and how long it takes to prepare and give the chemotherapy drugs, some people are there for most of the day. You may be asked to have blood tests a few days before you have your chemotherapy.

    You might find it helpful to take things to help pass the time as well as snacks and drinks. You may be able to take someone to go with you to keep you company. Talk to your chemotherapy nurse to find out if this is possible.

    In some areas chemotherapy may be given in a mobile treatment centre or in your home.

    With some types of chemotherapy you may be given your first treatment as an inpatient and may need to stay in hospital overnight.

    Increased Risk Of Leukemia

    Very rarely, certain chemo drugs can cause diseases of the bone marrow, such as myelodysplastic syndromes or even acute myeloid leukemia, a cancer of white blood cells. If this happens, it is usually within 10 years after treatment. For most women, the benefits of chemo in helping prevent breast cancer from coming back or in extending life are far likely to exceed the risk of this rare but serious complication.

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    Approaches For Treating Metastatic Breast Cancer

    Learn how chemotherapy, biologic therapy and more are used to treat metastatic breast cancer.

    Also called MBC, metastatic breast cancer is cancer that initially began in the breasts, but has metastasized, meaning it has spread to other areas of the body.

    Each case of MBC is different. While the lungs, liver, bones and brain are the most common areas affected by MBC, breast cancer cells can spread to virtually any organ or tissue. Because of this, treating MBC is highly individualized process that takes into account the size, location and characteristics of the cancer calls, as well as many factors about the patient, including symptoms and medical history. There is no cure for MBC, but treatments can slow the spread of the cancer, relieve symptoms, prolong life and improve quality of life.

    Here is an overview of some of the different approaches used to treat MBC.

    Chemotherapy Chemotherapy drugs are medicines that damage and kill cancer cells. Unfortunately, chemotherapy also damages healthy cells. There are more than a dozen different chemotherapy drugs that are used in the treatment of MBC, and chemotherapy is often used in combination with other treatments. As with any other treatment for MBC, the choice of what drugs or combination of drugs depends on the characteristics of the cancer, as well as the needs and medical history of the patient.

    Where You Have Chemotherapy

    Evolution of Chemotherapy for Metastatic Breast Cancer

    You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so its a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.

    You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.

    For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.

    Clare Disney : Hello, my name is Clare and this is a cancer day unit.

    So when you arrive and youve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.

    Morning, Iris. My name is Clare. I am the nurse who is going to be looking after you today. Were going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?

    Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.

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    Docetaxel Every 3 Weeks Paclitaxel Weekly

    Taxanes are among the most widely used chemotherapy agents in the treatment of MBC. Several studies including a recent meta-analysis support the benefit of taxanes on clinical outcomes, including OS, time to progression and response rates in MBC . Taxanes stabilize microtubules, leading to cell cycle arrest and, eventually, cell death . Paclitaxel , docetaxel , and nab-paclitaxel are approved drugs for the treatment of recurrent and MBC. Paclitaxel is approved to be administered weekly or every three weeks . Docetaxel can be administered every three weeks or weekly . Docetaxel is associated with a high risk of fluid retention, which is ameliorated by premedication with dexamethasone . Both paclitaxel and docetaxel require the use of solvents to enhance their solubility. Paclitaxel is mixed with the castor oil derivative Cremophor EL and docetaxel is formulated with the solvent polysorbated 80. These solvents have been associated with allergic reactions and peripheral neuropathy . To decrease the risk of allergic reactions, patients are pretreated with corticosteroids.

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