In stage IV breast cancer, the cancer has spread elsewhere in the body. Commonly affected areas may include the bones, brain, lungs, or liver. Because multiple areas may be involved, focused treatments like surgery or radiation alone may not be sufficient. So far, treatment of stage IV breast cancer does not provide a cure for the disease. By shrinking the cancer, treatment can slow down the disease, help make you feel better, and let you live longer. Although patients with stage IV breast cancer may live for years, it is usually life-threatening at some point. Many factors influence this.
Here are some of the standard treatments for stage IV breast cancer:
Stage I, II, IIIA, and operable IIIC breast cancer often requires a multimodality approach to treatment. Irrespective of the eventual procedure selected, the diagnostic biopsy and surgical procedure that will be used as primary treatment should be performed as two separate procedures. In many cases, the diagnosis of breast carcinoma is made by core needle biopsy. After the presence of a malignancy is confirmed, treatment options should be discussed...
Chemotherapy, or treatment with cancer drugs, is often the main option for this stage of breast cancer. It can slow down the growth of the cancer. Chemotherapy is often used in combination with hormone therapy or immunotherapy.
Hormone therapy can be helpful for women with hormone receptor-positive cancers. These are cancers that need hormones to grow. Tamoxifen has been used to block the effects of estrogen for decades. Newer drugs, like the aromatase inhibitors Arimidex, Aromasin, and Femara, are also effective in postmenopausal women. They reduce the amount of estrogen your body makes. By cutting off the supply of estrogen, you can often slow the growth of the cancer. Women who haven't reached menopause may consider having their ovaries removed to stop them from making hormones that help cancer grow or taking drugs that have the same effect.
Biological therapy is a newer approach. In about 25% of women with breast cancer, an excess of a protein known as HER2 makes the cancer spread quickly. Herceptin is a drug that's been approved to treat women with metastatic breast cancer that is HER2-positive. It stops this protein from making the cancer cells grow. It may also boost your immune system, giving it the strength to fight the cancer itself. It is most often used in combination with chemotherapy. Perjeta is also approved for advanced HER2-positive breast cancer. It can be given with Herceptin and Taxotere. Tykerb is another biological therapy sometimes used to treat HER2-positive advanced breast cancer after receiving prior therapy. Also, Kadcyla is a drug for use in patients with HER2-positive, late-stage breast cancer who were previously treated with Herceptin and a class of chemotherapy drugs called taxanes, which are commonly used to treat breast cancer. These may have been used in combination or separately. For HER2-negative breast cancer, Afinitor is taken with exemestane in postmenopausal women who have tried other treatments for hormone-receptor positive cancer.
Clinical trials are open to many women with stage IV breast cancer. A clinical trial may allow you access to cutting-edge treatments. Many new therapies -- new drugs, new treatments, and new combinations -- are in clinical trials now. Keep in mind that any successful treatment we have now started out in a clinical trial.
Surgery and radiation are used in some cases. These treatments may help treat pain and other symptoms in areas where the cancer has spread.
American Cancer Society.
National Comprehensive Cancer Network.
Clinical Practice Guidelines in Oncology, Breast Cancer, v.1.2004.
National Cancer Institute: "Breast Cancer PDQ: Treatment, Health Professional Version," "Breast Cancer PDQ: Treatment, Patient Version," "Understanding Breast Cancer: A Guide for Patients," and "What You Need to Know about Breast Cancer." News release, FDA.