Treatments for Stage 4 Breast Cancer

 

Treatments for Stage 4 Breast Cancer

  • Treatment is considered palliative in this situation with cure unlikely.
  • Goal of treatment is prolongation of life and improvement in clinical symptoms with the least amount of side effects.
  • Hormonal therapy such as letrozole, anastrozole, exemestane, fulvestrant and tamoxifen may be used to control estrogen/progesterone (ER/PR) receptor positive cancer as the side effects of these drugs are much less than chemotherapy. Patients can remain on these drugs (as long as they work) much longer than chemotherapy as there are less side effects.
  • The difference between hormonal therapy and chemotherapy is not how well they work but the time it takes to work and shrink/control the cancer. Chemotherapy works much faster than hormonal therapy. If a patient has extensive cancer or symptoms and therefore needs a response quickly, chemotherapy is likely to be used first. The patient can then be changed to hormonal therapy if ER/PR positive.
  • Patients whose cancer is ER/PR negative do not respond to hormonal therapy and therefore can only be treated with chemotherapy.
  • Single agent chemotherapy in her2 negative patients is preferred. Combination chemotherapy may give a quicker treatment response but does not give any survival benefit. It is also associated with more side effects.
  • Clinical trials also remain an important option for all patients and should always be considered when possible.

Single Agent Chemotherapy Drugs for Her2 Negative Cancer

  • Doxorubicin (Adriamyacin)
  • Paclitaxel (Taxol)
  • Capecitabine (Xeloda)
  • Vinorelbine (Navelbine)
  • Nab-paclitaxel (Abraxane)
  • Gemcitabine (Gemzar)
  • Docetaxel (Taxotere)
  • Eribulin (Halaven) – for 3rd line or later use
  • Ixabepilone (Ixempra)

Combination Chemotherapy in Her2 Negative Cancer

  • Paclitaxel and Gemcitabine
  • Docetaxel and Capecitabine
  • Gemcitabine and Carboplatinum
  • Paclitaxel and Bevacizumab (Avastin) – 1st line use only and a controversial treatment at this time
  • Everolimus (Afinitor) and Exemestane (Aromasin) – for ER and/or PR positive after progression on anastrazole (Arimidex) or letrozole (Femara)
  • CMF (Cyclophosphamide, Methotrexate, and Fluorouracil)
  • TAC (Docetaxel, Doxorubicin, and Cyclophosphamide) – not used much in Stage 4 disease as it is a tough

Treatment in Her2 Positive Cancer

  • Pertuzumab (Perjeta), Traztuzumab (Herceptin) and Docetaxel (Taxotere) – 1st line treatment only
  • Traztuzumab and Paclitaxel +/- Carboplatin
  • Traztuzumab and Vinorelbine
  • Traztuzumab and Docetaxel
  • Traztuzumab and Lapatinib (Tykerb)
  • Traztuzumab and Anastrazole (if ER/PR positive)
  • Lapatinib and Capecitabine (if prior Traztuzumab use)
  • Lapatinib and Letrozole (if ER/PR positive and 1st line use)
  • Ado-trastuzumab emtansine (Kadcyla) – (use in patients who have previously received Traztuzumab and a Taxane)
  • Any of the her2 negative drugs can also be used after progression of the cancer or contraindication to the above treatments.

Side Effects:

  • Hair loss
  • Low white blood cells
  • Infection
  • Nausea and vomiting
  • Constipation
  • Diarrhea
  • Joint and muscle pains
  • Flu symptoms
  • Mouth sores
  • Edema or fluid retention
  • Changes in appetite or taste
  • Infertility
  • Eye changes
  • Nail and skin changes
  • Anemia or thrombocyptopenia
  • Neuropathy
  • Congestive heart failure
  • Lung damage
  • Leukemia
  • Mental tiredness
  • Fatigue
  • Allergic reactions
  • Blood clot
  • Bleeding
  • Wound healing
Dr. Chris Charlton

Dr. Chris Charlton

Dr. Chris was born in Europe but has lived in the US for many years. He attended college both in Europe and the US and completed medical school at the University of Texas. Residency and fellowship in oncology was completed at Baylor. Read More...
Dr. Chris Charlton

Dr. Chris Charlton

Dr. Chris Charlton

Dr. Chris Charlton

Dr. Chris Charlton

Dr. Chris Charlton

Dr. Chris Charlton

Dr. Chris Charlton