When Metastatic Cancer Can No Longer Be Controlled
If you have been told your cancer can no longer be controlled, you and your loved ones may want to discuss end-of-life care. Whether or not you choose to continue treatment to shrink the cancer or control its growth, you can always receive palliative care to control the symptoms of cancer and the side effects of treatment. Information on coping with and planning for end-of-life care is available in the Advanced Cancer section of this site.
Symptoms Of Metastatic Cancer
Metastatic cancer does not always cause symptoms. When symptoms do occur, what they are like and how often you have them will depend on the size and location of the metastatic tumors. Some common signs of metastatic cancer include:
- pain and fractures, when cancer has spread to the bone
- headache, seizures, or dizziness, when cancer has spread to the brain
- shortness of breath, when cancer has spread to the lung
- jaundice or swelling in the belly, when cancer has spread to the liver
Hormone Therapy For Premenopausal Women
For premenopausal women with metastatic breast cancer, hormone therapy almost always begins with ovarian suppression and either an aromatase inhibitor, tamoxifen or other hormone therapy drug.
Ovarian suppression lowers hormone levels in the body so the tumor cant get the estrogen it needs to grow. This may involve surgery to remove the ovaries or, more often, drugs to stop the ovaries from producing hormones.
Combining ovarian suppression and a hormone therapy drug improves survival over either treatment alone .
If breast cancer progressed during past treatment with a hormone therapy drug, the same hormone therapy drug may not be an option for treatment.
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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.
How Her2+ Breast Cancer Is Diagnosed
There are many steps in the process of diagnosing breast cancer.
If a person has a symptom that is concerning to them, such as a lump in their breast, they should discuss it with their healthcare provider. The healthcare provider will likely start by taking a medical history and performing a physical exam. This can help them determine what is causing the symptoms. The next step in the process is imaging.
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What Is Metastatic Cancer
Cancer that spreads from where it started to a distant part of the body is called metastatic cancer. For many types of cancer, it is also called stage IV cancer. The process by which cancer cells spread to other parts of the body is called metastasis.
When observed under a microscope and tested in other ways, metastatic cancer cells have features like that of the primary cancer and not like the cells in the place where the metastatic cancer is found. This is how doctors can tell that it is cancer that has spread from another part of the body.
Metastatic cancer has the same name as the primary cancer. For example, breast cancer that spreads to the lung is called metastatic breast cancer, not lung cancer. It is treated as stage IV breast cancer, not as lung cancer.
Sometimes when people are diagnosed with metastatic cancer, doctors cannot tell where it started. This type of cancer is called cancer of unknown primary origin, or CUP. See the Carcinoma of Unknown Primary page for more information.
Diagnosing Metastatic Breast Cancer
Getting a clear picture of where breast cancer has spread is essential for creating a personalized treatment plan. Your care team will likely use a combination of the following tests and tools to diagnose both localized and advanced breast cancer:
Ultrasound exam: With this imaging technique, sound waves create a picture of internal areas of the body.
Magnetic resonance imaging : This procedure produces detailed images using magnetic fields and radio waves.
Blood chemistry studies: A blood sample is taken to measure the amounts of certain substances that are released by your organs and tissues. A higher or lower amount of a particular substance may be a sign of disease.
Breast biopsy: A biopsy is the removal of cells or tissues so a pathologist may view them through a microscope. Your original breast cancer diagnosis was likely confirmed with a biopsy.
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Abemaciclib Palbociclib And Ribociclib And Hormone Therapy
The CDK4/6 inhibitors FDA-approved for metastatic breast cancer treatment are:
CDK4 and CDK6 are enzymes important in cell division. CDK4/6 inhibitors are a class of drugs designed to interrupt the growth of cancer cells.
Although the CDK4/6 inhibitors abemaciclib, palbociclib and ribociclib have not been compared directly to one another, studies show similar results with each drug .
A CDK4/6 inhibitor in combination with hormone therapy can be used to treat hormone receptor-positive, HER2-negative metastatic breast cancers. Compared to treatment with hormone therapy alone, this combination can give people more time before the cancer spreads and increase overall survival .
The CDK4/6 inhibitor abemaciclib may also be used alone to treat hormone receptor-positive, HER2-negative cancers that have progressed during past hormone therapy and chemotherapy .
Abemaciclib, palbociclib and ribociclib are pills.
The table below lists some possible side effects for CDK4/6 inhibitors.
For a summary of research studies on the use of CDK4/6 inhibitors in treating metastatic breast cancer, visit the Breast Cancer Research Studies section.
Breast Cancer Cell Lines
Part of the current knowledge on breast carcinomas is based on in vivo and in vitro studies performed with cell lines derived from breast cancers. These provide an unlimited source of homogenous self-replicating material, free of contaminating stromal cells, and often easily cultured in simple standard media. The first breast cancer cell line described, BT-20, was established in 1958. Since then, and despite sustained work in this area, the number of permanent lines obtained has been strikingly low . Indeed, attempts to culture breast cancer cell lines from primary tumors have been largely unsuccessful. This poor efficiency was often due to technical difficulties associated with the extraction of viable tumor cells from their surrounding stroma. Most of the available breast cancer cell lines issued from metastatic tumors, mainly from pleural effusions. Effusions provided generally large numbers of dissociated, viable tumor cells with little or no contamination by fibroblasts and other tumor stroma cells.Many of the currently used BCC lines were established in the late 1970s. A very few of them, namely MCF-7, T-47D, MDA-MB-231 and SK-BR-3, account for more than two-thirds of all abstracts reporting studies on mentioned breast cancer cell lines, as concluded from a Medline-based survey.
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Different Drugs Same Target
Breast cancers that are HER2-positive tend to be aggressive, with the excess HER2 protein on tumor cells fueling the cancers growth. In the late 1990s, trastuzumab was among the first targeted cancer therapies to be approved by FDA, after trials showed it could improve survival in women with metastatic HER2-positive breast cancer.
Over time, other HER2-targeted therapies emerged, some with alternative mechanisms for disrupting HER2 activity in cancer cells. Drugs like trastuzumab and pertuzumab are monoclonal antibodies that bind to the HER2 protein above the cancer cells surface, preventing it from acting or enlisting the immune system to help destroy cells that produce it.
Tucatinib, on the other hand, is a member of a class of drugs known as tyrosine kinase inhibitors . These drugs work by binding to the part of the HER2 protein that is inside the cell and preventing it from sending signals that promote cell growth. Other HER2-targeted TKIs include neratinib and lapatinib .
Some TKIs have multiple targets. But, compared with other HER2-targeted drugs, tucatinib appears to be relatively selective for HER2that is, its less likely to bind to related proteins, explained Stanley Lipkowitz, M.D., Ph.D., chief of the Womens Malignancies Branch in NCIs Center for Cancer Research. That selectivity limits the risk of side effects seen with other HER2-targeted TKIs that inhibit other targets, Dr. Lipkowitz said.
Paclitaxel Bevacizumab And Sunitinib:
Sunitinib is an oral multi kinase inhibitor that blocks multiple molecular targets that is affecting the growth, proliferation, and metastatic progression of cancer. It increases the circulating vascular endothelial growth factor. Mayer et al. concluded that patients receiving the three drug regimen had unacceptable high level toxicity with discontinuations. Poor tolerability was noted in the regimen with paclitaxel, bevacizumab, and sunitinib.
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Trastuzumab And Docetaxel With Trastuzumab Docetaxel Carboplatin:
A pivotal phase 3 study conducted by Salmon et al. demonstrated that the combination of trastuzumab and chemotherapy significantly prolonged time to progression and overall survival compared with chemotherapy alone in patients with HER2 positive MBC. Carboplatin predominantly cause interstrand DNA cross links. It nonspecifically affects the cell cycle. Carboplatin is used as first line agent in recurrent ovarian carcinoma. It was approved in 2005 by USFDA. Valero et al. reported that there was no significant difference between docetaxel, trastuzumab and docetaxel, trastuzumab, carboplatin . Time to progression in TH regimen was 11.1 months and in TCH was 10.4 months. Response rate in the both regimen was 72%, overall survival rate was 37.1 month in TH regimen, and 37.4 in TCH regimen .
Can Metastatic Breast Cancer Be Cured
There is no cure for metastatic breast cancer. Once the cancer cells have spread to another distant area of the body, its impossible to get rid of them all. However, the right treatment plan can help extend your life and improve its quality.
Metastatic breast cancer treatment aims to shrink tumors, slow their growth and improve your symptoms.
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What Are The Symptoms Of Metastatic Breast Cancer
The symptoms of metastatic breast cancer vary depending on where the cancer has spread in the body. Evelyn Toyin Taiwo, MD, hematologist and oncologist at Weill Cornell Medicine and NewYork-Presbyterian Brooklyn Methodist Hospital, tells Health these symptoms, based on which part of the body is affected, include:
- Bone: New, unexplained pain in bones and joints commonly seen in the hip or lower back
- Liver: Abdominal pain or discomfort
Treatment Updates For Metastatic Breast Cancer
Elina Delgado, PharmD, BCPS, Assistant ProfessorKiernan A Taylor, PharmD Candidate 2022Phyllis Tran, PharmD Candidate 2022William Carey University School of Pharmacy, Tradition CampusDepartment of Pharmacy PracticeBiloxi, Mississippi
US Pharm. 2021 46:42-46.
ABSTRACT:About one in eight women will be diagnosed with breast cancer in her lifetime. Of these, 6% will have metastatic disease that carries a 5-year survival rate of about 29%. The year 2020 brought about FDA approval for three new agents targeting varying forms of metastatic breast cancer in the hope that more women will be able to successfully combat this stage of disease. The approval of Trodelvy provides a second-line treatment option for patients with triple-negative metastatic breast cancer. For patients with HER2+ metastatic breast cancer, Tukysa and Margenza are new second- and third-line options available.
To date, there is no single standard of care for MBC. Treatment goals for MBC consist of prolonging survival, palliating symptoms, and delaying the progression of the disease, since MBC remains incurable. Treatment for MBC includes chemotherapy , surgery, radiation, hormonal therapy, immunotherapy, and gene therapy.6,8 Treatment plans are individualized based on the benefits and risk factors of therapeutic agents, previous treatment, and clinical status.
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Immunotherapy To Treat Metastatic Breast Cancer
Cancer immunotherapy medicines work by helping your immune system work harder or more efficiently to fight cancer cells.
Your immune system is made up of a number of organs, tissues, and cells that work together to protect you from foreign invaders that can cause disease. When a disease- or infection-causing agent, such as a bacterium, virus, or fungus, gets into your body, your immune system reacts and works to kill the invaders. This self-defense system works to keep you from getting sick.
Immunotherapy uses substances either made naturally by your body or man-made in a lab to boost the immune system to:
Learn more about immunotherapies used to treat metastatic breast cancer.
Chemotherapy For Metastatic Breast Cancer
Chemotherapy is used as a treatment for most people who have metastatic breast cancer. Whether it is used first-line or not depends on your receptor status, previous treatments, and other factors.
Chemotherapy is a systemic treatment that attacks cancer cells wherever they happen to be in the body. One exception to this is the brain, where the passage of many of these drugs is limited by the protective blood-brain barrier.
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Triple Negative Breast Cancer
With this type of breast cancer, the breast cancer cells dont have ER+ or PR+ receptors. They dont overproduce the HER2 protein, so hormone therapy isnt very effective.
Instead, triple negative stage 4 breast cancer is usually treated with chemotherapy. Radiation therapy may also be an option, depending on the site of metastasis.
Treatment For Metastatic Breast Cancer
If youve been diagnosed with metastatic breast cancer, its important to know there are a number of different treatment options for you and your doctors to consider. Most treatment decisions depend on where in the body the cancer has spread, the cancers characteristics , and any cancer treatments youve had in the past.
Doctors usually treat metastatic breast cancer in any part of the body with systemic medicines, which treat cancer throughout the entire body. Chemotherapy, hormonal therapy, targeted therapies, and immunotherapy are all systemic medications. Local treatments that target a specific part of the body, such as surgery or radiation, are sometimes recommended.
You and your doctor need to be in agreement about the approach to your care. Its up to you whether or not you want to try a recommended treatment, especially if various treatment options are available to you. For example, your doctor may recommend a treatment that is given more frequently or one that may have more severe side effects than another treatment.
Remember that you can change your mind about your treatment choices. You may want to alter your treatment plan depending on how its affecting your daily life, family, or finances. Your treatment plan isnt written in stone. You can talk to your doctor about changing your treatment approach at any time.
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What Are The Symptoms Of Bone Metastasis In Breast Cancer
All three doctors say that new, progressive pain in your bones or joints is the most common symptom of metastatic breast cancer in bones. “I always tell patients to inform me if there’s pain that’s not getting better,” says Dr. Tsarwhas. This can sometimes be confused with arthritis or other pre-existing chronic pain issues, he says, which is why it’s important for breast cancer patients to be proactive about any new pain they encounter.
New fractures or unexplained fractures can also be a sign of bone metastasis, Dr. Tsarwhas adds. Cancer can weaken bones and make them break more easily. “New lumps or bumps in the lymph node area…could be a sign of recurrent breast cancer as well,” he says.
A person with metastatic breast cancer in their bones may also experience more general cancer symptoms, such as fatigue, lack of appetite, and extreme, unexplained weight loss.
What Causes Her2+ Breast Cancer
Breast cancer starts when the cells in the ducts or the lobules of the breast begin to grow uncontrollably, due to the DNA in the cell becoming abnormal.
As part of this abnormal process, sometimes these cells have too many HER2 proteins on the outside of the cells. This extra HER2 protein tells the cells to keep growing, even though they shouldnt be. As this process continues, a mass in the breast forms, and over time, it can begin to grow and spread into other areas of the body.
It is not often known what the trigger is that alters the DNA inside the cell to become abnormal. There are, however, some gene mutations that have been shown to increase someones risk of developing cancer. Though not the only ones, two of these genes are BRCA1 and BRCA2. These genes can be passed down through family members, and the person who gets them has a higher risk of getting breast cancer.
Besides genetics, there are other factors that have been found to increase the risk of developing breast cancer. These risk factors include:
- Increasing age
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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.