Stage IV Breast Cancer Treatment Options

Video Transcript

Jane Meisel, MD <br>Winship Breast Oncologist <br>Pond5. <br>AudioJungle.

JANE MEISEL: So the treatment of stage IV breast cancer is complicated and has changed a lot over the course of even the last few years. Most patients with stage IV disease-- disease that's spread beyond the breast or surrounding lymph nodes-- won't be curable. It'll be treatable, and sometimes treatable for years or even decades, but probably not curable. And so each treatment decision has to be made with an understanding of, what are the patient's goals? What are their other limitations? How is this treatment going to impact their quality of life? For different types and subtypes of breast cancer, there are different treatment options. Chemotherapy is one of the things that we use, chemo or drugs that classically travel through the bloodstream and kill rapidly dividing cells. So that includes cancer cells, but it also includes other cells. So chemotherapy is not without its side effects. But can be really beneficial for the patients who have aggressive stage IV cancer and require it. We also have a growing number of targeted therapies for metastatic breast cancer, which has been really exciting, because more targeted therapies allow us to treat the breast cancer a little bit more focused with fewer side effects, because we're killing off cancer cells as opposed to normal cells. And immunotherapy, treatments that kind of harness the patient's own immune system to fight the cancer more effectively, is another kind of class of drugs that is also starting to make its way now into the breast cancer space. Maintaining quality of life with stage IV cancer is a really important question. So I think, for doctors, it's very important to have honest conversations with patients about what in their life is most important to them and what do they feel like the cancer is limiting them from doing so that we can then help them figure out how to manage that.

With stage IV, the breast cancer has spread to other parts of your body. Often the bones, brain, lungs, or liver are affected. Because multiple areas may be involved, focused treatments like surgery or radiation alone may not be enough.

Treatment of stage IV doesn’t cure the disease. But by shrinking the cancer, it can often slow it down, help you feel better, and let you live longer. Patients with stage IV breast cancer may live for years, but it’s usually life-threatening at some point.

Treatments

Chemotherapy is often the main treatment for this stage. It can slow down the growth of the cancer. It’s often used in combination with hormone therapy.

You can get chemo several different ways. You may take pills or liquids, but often the drugs are put right into your veins. Depending on the type of treatment, it may be given in cycles that allow your body breaks in between.

Hormone therapy can be helpful for women with hormone receptor-positive cancers. That means certain hormones stimulate growth of the cancer. In these women, medications can prevent the tumor from getting the hormone. These drugs include tamoxifen for all women and aromatase inhibitors such as anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara) for postmenopausal women. 

Fulvestrant (Faslodex) and toremifene (Fareston) are drugs that block hormone receptors.  These medicines are sometimes given to women with metastatic breast cancer. Women who haven't reached menopause may consider having their ovaries removed to stop them from making hormones that help cancer grow.

Targeted therapy is a newer treatment. About 20% of women with breast cancer have too much of a protein known as HER2, and it makes the cancer spread quickly. Women with HER2-positive cancer that has spread often take trastuzumab (Herceptin). It stops the protein from making the cancer cells grow. Other targeted therapies for HER2-positive positive cancer that may be prescribed include ado-trastuzumab emtansine (Kadcyla), lapatinib (Tykerb), neratinib (Nerlynx), or pertuzumab (Perjeta),

Palbociclib (Ibrance), ribociclib (Kisqali), and abemaciclib (Verzenio) are targeted therapies that block certain proteins called CDKs and slow cancer growth. They are given in certain women who have hormone receptor positive and HER2-negative cancers.

Continued

A new Class of drugs called PARP inhibitors has been found to help women who are HER2-negative but who have BRCA mutated breast cancer. PARP inhibitors include olaparib  (Lynparza) and talazoparib (Talzenna) and target a protein that helps cancer cells grow.

For postmenopausal women who have HER2-negative breast cancer and have tried other treatments for hormone-receptor positive cancer, the doctor may prescribe alpelisib (Piqray) along with fulvestrant or  everolimus (Afinitor) along with exemestane.

Immunotherapy drugs stimulate your immune system to find and destroy cancer cells.  In women with advanced hormone receptor negative and HER2-negative breast cancer the immunotherapy drug atezolizumab (Tecentriq) is sometimes given in combination with the chemotherapy paclitzxel (Abraxane). Atezolizumab blocks a protein called PD-L1.

Surgery and radiationare used in some cases. These treatments may help treat pain and other symptoms in areas where the cancer has spread.

Other drugs may help treat some of the side effects of breast cancer treatment, such as nausea and fatigue.

Clinical trials are open to many women with stage IV breast cancer. A clinical trial may give you access to cutting-edge treatments. Talk to your doctor to find out more about them.

WebMD Medical Reference Reviewed by Laura J. Martin, MD on July 18, 2019

Sources

SOURCES:

American Cancer Society: “How is breast cancer staged?” “Questions about chemotherapy.”

BreastCancer.org: “Palbociclib (Also Called Ibrance) Approved by FDA.”

National Comprehensive Cancer Network: Guidelines for Patients

National Cancer Institute: "Breast Cancer PDQ: Treatment Option Overview,” "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," “Adjuvant and Neoadjuvant Therapy for Breast Cancer,” “FDA Approval of Everolimus.”

MedlinePlus: “Tamoxifen.”

Novartis Oncology.

National Breast Cancer Foundation: “Stages.”

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