What Are the Signs of Metastatic Breast Cancer?

Is metastatic breast cancer curable?

Metastatic breast cancer is not curable, but can be treated to slow the growth of cancer, provide symptomatic relief, prolong life and improve quality of life. Treatment for metastatic cancer is lifelong, however, some patients do opt to forego treatment, except for palliative care.

What is the treatment for metastatic breast cancer?

The primary treatments for metastatic breast cancers are systemic therapies with medications. Medications may vary depending on the type of breast cancer and where it has spread. Medications may be administered as oral tablets, injections or infusions.

Breast cancer patients also have the option of registering for clinical trials for new treatments. Surgery and/or radiation therapy have limited use in treating metastatic breast cancer. Radiation therapy is the use of high energy rays or particles directed at the cancer cells to destroy them.

Surgery and/or radiation therapy may be used in metastatic breast cancer to:

• Remove the primary tumor in the breast if it is causing an open wound
• Treat small areas of the brain in case of brain metastasis
• Relieve pressure on the spinal cord in case of metastasis to the spine
• Prevent fractures in bone metastasis
• Treat blockage in the liver
• Provide relief from pain and other symptoms from metastatic cancer

Systemic therapies for metastatic cancer typically consist of a combination of two or more of the following therapies:

Chemotherapy

Chemotherapy is the primary treatment for metastatic breast cancer. Chemotherapy drugs kill all cells that are in the growth and division phases, including healthy ones. Chemotherapy is particularly toxic to cancer cells because they are always growing and dividing.

Hormone therapy

Hormone therapy may be used in addition to chemotherapy, to shrink tumors or slow down growth in metastatic cancers that are hormone receptor (HR) positive. Hormone therapy may be given as long as it proves useful to the patient without unacceptable side effects.

Targeted therapy

Targeted therapy medications target specific proteins and cell signaling enzymes which promote growth and division in cancer cells. Targeted therapy medications do not directly destroy cancer cells but alter the way they function and slow down tumor growth.

Several different targeted therapy medications are used to treat metastatic breast cancer depending on HR and HER2 status, and gene mutations which play a role in cell growth and division. Types of metastatic breast cancers that are treated with targeted therapy include:

• HER2 positive cancers
• HER2 negative cancers with BRCA or PIK3CA gene mutations
• Triple negative cancers

Immunotherapy

Immunotherapy drugs enhance the ability of immune cells (T-cells) to identify and kill cancer cells. Immunotherapy drugs block the activity of a protein known as PD-1 in T-cells which normally prevents the T-cells from attacking the body’s own cells.

Immunotherapy also works by blocking PD-L1, a protein present in some cancers, which interact with PD-1 in T-cells to escape being killed. Immunotherapy is used to treat triple negative cancers that are positive for PD-L1 protein.