Systemic Treatment for Stage 4 Breast Cancer
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Dealing with Stage 4 breast cancer can be an extremely challenging and devastating experience for anyone. Treatment for stage 4 breast cancer is complex and typically involves a combination of different therapies aimed at controlling the growth of the cancer, managing symptoms, and improving the patient's quality of life.
At this stage of the disease, management is key to prolonging one’s life by months and sometimes even years. Despite the gravity of the situation, it is important to try to keep some optimism and positivity to help conquer this difficult phase.
The specific approach to treatment will depend on the type of cancer, its location, the patient's overall health, and other individual factors. The patient's emotional and mental well-being is also an important aspect of care that should be prioritized. With the right treatment and support, patients can manage their symptoms and improve their quality of life, while also prolonging their time with loved ones. It is important to work closely with healthcare professionals to develop a personalized treatment plan that meets the unique needs and goals of each patient.
Systemic treatment
In stage 4 breast cancer, the breast cancer cells have spread to other parts of the body, such as the brain, bones, lungs and liver. As such, systemic treatment, which provides treatment throughout the whole body, is often the main form of treatment for stage 4 breast cancer. Rather than eliminating all cancer cells in the body, systemic treatment for stage 4 cancer aims to suppress and slow down cancer growth to reduce pain and improve quality of life.
Here are the common treatment options for systemic treatment:
Chemotherapy refers to the administration of drugs with cell-killing properties.
Hormone therapy, or endocrine therapy, is a type of cancer treatment used for certain types of breast cancer, specifically hormone receptor-positive breast cancer.
Targeted drug therapy is a type of cancer treatment that uses drugs to specifically target and attack cancer cells while minimizing damage to healthy cells.
Immunotherapy is a type of cancer treatment that uses the body’s immune system to fight cancer cells. Antibody drug conjugates such as Sacituzumab may be used. These make use of antibodies created in a laboratory and chemotherapeutics to target cancer cells.
Factors that determine the systemic treatment for you
The type of systemic treatment used will depend on certain factors.
Hormone receptor status
The hormone receptor status shows if the breast cancer cells have excess hormone receptors on them or not. For hormone receptor-positive cancers, the presence of hormones promotes the uncontrolled growth of cancer cells. The hormone receptor status also determines if hormone therapy can be used.
- Hormone receptor (HR)-positive cancers
For cancers that are HR-positive, hormone therapy is often used as the main treatment method to hinder the growth of cancer cells. SERMs such as tamoxifen, SERDs such as fulvestrant, and aromatase inhibitors such as anastrozole and exemestane are different types of hormone therapy that may be used to treat HR-positive breast cancer.
Sometimes, targeted drugs such as PI3K/mTOR inhibitors or CDK4/6 inhibitors may also be used in combination with these drugs to overcome endocrine resistance.
In some rare cases, chemotherapy may be considered as the main treatment method instead of hormone therapy. This is only if the disease progression is acutely life-threatening or if the cancer is recurrent and endocrine-resistant. Otherwise, hormone therapy will be used as the main treatment method for HR-positive cancers.
- Hormone receptor-negative cancers
For HR-negative breast cancers, the treatment options would have to depend on other factors, such as the HER2 status of the cancer as well as the presence of gene mutations. The progression of the disease would have to be considered as well.
HER2 status
Breast cancers that are HER2-positive may be treated with a combination of chemotherapy and HER2-targeted drugs such as trastuzumab and pertuzumab. If the cancer is HR-positive, hormone therapy might also be given.
Breast cancers that are both HER2-negative and HR-negative are known as triple-negative breast cancers (TNBCs). For TNBCs, chemotherapy is often the first treatment used. However, for TNBCs that have protein or gene changes, a combination of chemotherapy and immunotherapy may be used. Hormone therapy and targeted therapy are usually ineffective and are rarely options for treating TNBCs.
Learn more: Targeted Drug Therapy for HER2-Positive Breast Cancer
It's important to note that the treatment plan for stage 4 breast cancer is highly individualized. Oncologists consider factors such as the patient's overall health, the extent of metastasis, previous treatments, and potential side effects when designing a treatment approach. In many cases, a combination of different systemic treatments is used to target the cancer from various angles and improve the patient's quality of life. Regular communication with the healthcare team and staying informed about treatment options are crucial for making informed decisions.
