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. These treatments work in different ways. Some are designed to prevent estrogen or progesterone from attaching to receptors in breast cancer cells. Others are designed to reduce the amount of hormones that circulate in the body and attach to estrogen or progesterone receptors. By blocking hormones, these treatments deprive tumor cells of the stimulation that fuels their growth.
- Fulvestrant (Faslodex) is an estrogen-blocking drug. It attaches to estrogen receptors and changes their shape, preventing the receptors from working properly, which slows the growth of breast cancer cells. Fulvestrant is given as an injection and is approved only for postmenopausal women with metastatic breast cancer whose tumors have not responded well to other hormone treatments, such as tamoxifen.
Targeted Treatments. Targeted treatments focus on specific molecules and cell mechanisms thought to be important for cancer cell survival and growth, taking advantage of what researchers have learned in recent years about how cancer cells grow. Targeted treatments are meant to spare healthy tissues and cause less severe side effects than chemotherapy.
A number of targeted treatments have been developed for metastatic breast cancer:
- Trastuzumab (Herceptin) is the standard treatment for HER2-positive breast cancer. Typically taken for one year, trastuzumab can also be given over longer periods to women with metastatic breast cancer.
- Ado-trastuzumab emtansine (Kadcyla), also known as T-DM1, is a combination of trastuzumab and a chemotherapy drug. T-DM1 is used to treat HER2-positive metastatic breast cancer in women who have already received treatment with the targeted treatment trastuzumab and chemotherapy that included a taxane such as docetaxel or paclitaxel. The trastuzumab is designed to block HER2 receptors on the surface of breast cancer cells to prevent HER2 from attaching to them and stimulating their growth. The chemotherapy is delivered deep into the cancer cells to kill them and to damage their ability to multiply; it also alerts the body’s immune system to seek out breast cancer cells and destroy them.
- Palbociclib (Ibrance) is a targeted treatment that works by stopping breast cancer cells from dividing and growing. Palbociclib can be used in combination with letrozole or fulvestrant for the treatment of locally advanced or metastatic ER-positive, HER2-negative breast cancer.
- Ribociclib (Kisqali) a cyclin-dependent kinase 4/6 inhibitor, was approved by the FDA in March 2017 as an initial therapy, in combination with an aromatase inhibitor, for the treatment of postmenopausal women with HR-positive/HER2-negative advanced (metastatic) breast cancer.
Chemotherapy is 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.
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.