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:
Complete blood count (CBC)
CT scan of the brain
CT scan of chest abdomen pelvis
Doctor's breast exam
Estrogen and progesterone receptor
HER2 receptor status
Minimally invasive breast biopsy
Sentinel lymph node biopsy
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 therapycan be helpful for women with hormone receptor-positive cancers. These are cancers that need hormones to grow. Tamoxifen (Soltamox, Nolvadex) has been used to block the effects of estrogen for decades. Newer drugs, like the aromatase inhibitors anastrozole (Arimidex), exemestane (Aromasin), and letrozole (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. Letrozole can be given with palbociclib (Ibrance), which inhibits a protein that controls cancer cell division and growth. 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. Trastuzumab (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. Pertuzumab (Perjeta) is also approved for advanced HER2-positive breast cancer. It can be given with trastuzumab and docetaxel (Taxotere). Lapatinib (Tykerb) is another biological therapy sometimes used to treat HER2-positive advanced breast cancer after receiving prior therapy. Also, trastuzumab emtansine (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, everlimus (Afinitor) is taken with exemestane in postmenopausal women who have tried other treatments for hormone-receptor positive cancer. Palbociclib (Ibrance), on the other hand, is taken by postmenopausal women who have not received hormone therapy. The drug is taken along with letrozole.
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.
Jennifer Robinson, MD on April 11, 2015