Not long ago, the main goal of treating metastatic breast cancer -- meaning the disease has spread well beyond the breast -- was to keep a woman comfortable. But a lot has changed in the past decade. Now treatment can help many women live longer, better, and disease-free for periods of time.
Pamela Drullinsky, MD, a cancer doctor at Memorial Sloan Kettering Cancer Center in New York, says many doctors now see metastatic breast cancer as a chronic illness, because it can be managed for years. “This is similar to [people with diabetes] taking insulin,” she says. “It is still incurable but can be controlled.”
Here's how to take charge of your diagnosis and live better with metastatic breast cancer.
The uncertainties of having metastatic breast cancer can make you feel like you've lost control of your life. A treatment plan will help you feel more in control. To create one:
Learn as much as you can about where your cancer has spread and what type of tumor you have. Your treatment will depend largely on these things.
Think about your main goal for treatment. Do you want to get rid of the new cancer, or relieve symptoms? Talk to your doctor about realistic goals.
Decide whether you want to use the same medical team or add other doctors.
Even if you're happy with your doctors, it's a good idea to get a second opinion to confirm that you're getting the best treatment possible. "It is also important to be evaluated at an academic or research institute that may have cutting-edge trials,” says Tiffany Troso-Sandoval, MD. She is a cancer doctor at Memorial Sloan Kettering Cancer Center.
The most common treatments for metastatic breast cancer are ones that travel through your blood, treating your entire body. Most likely you'll start with one or more of these:
Anti-estrogen therapies. If your breast cancer is hormone receptor-positive, your body's estrogen makes the cancer cells grow faster. In that case, there's a good chance your cancer will respond to an anti-estrogen drug like Arimidex, Aromasin, Faslodex, Femara, or Tamoxifen. These drugs prevent cancer cells from getting the estrogen they need to grow. Clinical trials are also using newer medicines in combination with these.
Targeted therapies. Herceptin (trastuzumab), Perjeta (pertuzumab), and Tykerb (lapatinib) are likely treatments if your breast cancer has high amounts of the protein HER2, which helps cancer cells grow. When used alone or with chemotherapy, these drugs can shrink tumors, slow cancer growth, and, in some cases, help you live longer than chemotherapy alone. If your breast cancer doesn't have the HER2 protein, your doctor may use another type of targeted therapy, Afinitor. In combination with another drug, it can help stop the growth of some types of advanced breast cancer.
Chemotherapy. This can control cancer and improve your quality of life with metastatic cancer. If your cancer is hormone receptor-negative (meaning an anti-estrogen treatment is unlikely to work), you may get small doses of one chemotherapy drug at a time. “This can minimize side effects and make the drugs more effective over a longer period of time,” Troso-Sandoval says.
Other treatments. You may get surgery to remove tumors at the original cancer site or another site where it has spread. This can prevent or ease symptoms and may extend your life. Radiation can shrink your tumors and ease pain. Other medications can ease painful symptoms where cancer has spread.