While living with metastatic breast cancer can present challenges, there are a number of treatment options available. With ongoing research, more advances are being made every year.
Treating metastatic breast cancer may include a mix of treatment options such as hormonal therapy, chemotherapy, radiation therapy, surgery and targeted therapies. These treatments focus on maintaining a patient’s quality of life while minimizing side effects. The goal for many patients is to stay on treatment as long as it is successfully relieving symptoms and stopping tumor growth.
Maintaining good communication with the members of your health care team is especially important to discuss how treatment is affecting your quality of life.
Hormonal Treatments. Doctors generally recommend hormonal therapy for estrogen receptor—or progesterone receptor-positive breast cancer that is either early stage or metastatic. These treatments prevent estrogen from attaching to receptors on breast cancer cells. As a result, estrogen cannot get in the cells, and tumor growth is slowed.
There are many drugs that can be effective in treating hormone-receptor positive breast cancer, including tamoxifen (Nolvadex and others), aromatase inhibitors such as an anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin) and fulvestrant (Faslodex). Tamoxifen is effective both before and after menopause, but all aromatase inhibitors only work in postmenopausal women.
Targeted Treatments. Targeted treatments are drugs that are directed against specific cell mechanisms thought to be important for cancer cell survival and growth. This targeting helps spare healthy tissues and causes fewer side effects than chemotherapy. There are many targeted treatments for patients, including newer drugs and drugs that have been available for a number of years. Tamoxifen was the first targeted therapy developed for breast cancer and is still used today. Trastuzumab (Herceptin) is a monocolonal antibody that targets HER2, an antigen that is overexpressed on tumor cells. Lapatinib (Tykerb) also targets HER2.
Everolimus (Affinitor) was recently approved by the U.S. Food and Drug Administration (FDA) for the treatment of postmenopausal women with advanced breast cancer. The drug boosts the effectiveness of hormone therapy. In 2012, the FDA also approved a monocolonal antibody, pertuzumab (Perjeta) for women with HER2-positive metastatic breast cancer as first-line treatment in combination with trastuzumab and docetaxel.
Chemotherapy is still used as a treatment for metastatic breast cancer and is sometimes used in combination with other agents. Research advances are producing new chemotherapy drugs and also revisiting the use of older drugs by using them in different schedules, combinations and dosages to maximize the benefits. Drugs used to treat metastatic breast cancer include taxanes such as docetaxel (Taxotere), paclitaxel (Taxol) and albumin-bound paclitaxel (Abraxane), anthracyclines such as doxorubicin (Adriamycin) or epirubicin (Ellence) or capecitabine (Xeloda).
During the course of your treatment, it’s important to remember that doctors are trying to maintain a balance of keeping your cancer under control and maintaining your quality of life as best as possible. Living with metastatic breast cancer can be stressful and difficult for patients and their families. But as you work with your health care team to care for your emotional, psychological and physical well being, you can feel empowered and in charge of your care.