Advances in Metastatic Breast Cancer

What is a metastatic disease?

It basically refers to the stage of cancer that has spread over the body away from the primary site of cancer. Breast cancer has to be an increasing cause of mortality among all other types of cancers in women. In regard to Breast Cancer awareness month, this blog will inform about advances in metastatic breast cancer.

Metastatic breast cancer is a condition where the primary breast cancer has spread to the adjacent regions of breast or to a distinct part of the body, such as bone, lung, ovaries, etc. It is also considered as a Stage IV breast cancer.

How is breast cancer diagnosed?

A breast cancer diagnosis is done through screening of the breast through a mammogram or ultrasound. Sometimes breast cancer is initially diagnosed in a metastatic condition; such stage 4 breast cancer is known as de novo breast cancer.

The metastatic tumor that forms in the other parts of the body is from the cells of the breast cancer, which is spread through lymph nodes, blood vessels.

What are the treatment options?

According to the American Cancer Society, the treatment option available for Metastatic Breast cancer are, Hormonal Therapy, Chemotherapy, Targeted drugs, and only in specific cases surgery and/or radiation therapy is helpful. These treatments aim to shrink the tumors (or slow their growth), improve symptoms of stage 4 breast cancer, and also aid women’s survival rate.

Many times it is said that this cancer is incurable, but according to ESMO guidelines, it is suggested that many studies have indicated an improvement in the overall survival. Due to the advances in the human epidermal growth factor receptors 2 (HER2)- positive metastatic breast cancer.

ESMO guidelines on Advanced Breast Cancer: 

• The management of  this form of breast cancer is complex, and hence advisable that involvement of all appropriate specialties in a multidisciplinary team (including but not restricted to medical, radiation, surgical oncologists, imaging experts, pathologists, gynecologists, Psycho-oncologists, social workers, nurses, and palliative care specialties), is crucial.
• From the time of diagnosis, patients should be offered appropriate psycho-social care, supportive care, and symptom-related interventions as a routine part of their care. The approach should be personalized to meet the needs of the individual patient.
• The patient should be aware of all available treatment options, should be addressed that these conditions is incurable but can be treated, should be offered comprehensive, culturally sensitive, up to date and easy to understand information about their disease and its management.
• Many cancer clinical trial studies strongly suggest the use of BIOSIMILARS for both treatments of breast cancer (i.e. Trastuzumab) and supportive care (i.e. Growth factors).

Although initial diagnosis and pre-treatment measures that are considered to be essential for breast cancer and metastatic breast cancer are; ER/PR status of the tumor, Her2 status of the tumor. As many hormonal therapies, targeted therapies, and many clinical trials approved drugs are available for an option of ER/PR positive/negative, Her2 positive/negative breast cancer.

Many a time metastatic breast cancer is misled with lung or bone cancer, where the diagnosis of the primary site is essential which can be classified as knowing the type of cells causing cancer.

Though the metastatic breast cancer is incurable but can be treated and the survival life span of an individual can be improved by regular screening and precision medicine-based disease management plans.

References:

• https://www.cancer.org/cancer/breast-cancer/treatment/treatment-of-breast-cancer-by-stage/treatment-of-stage-iv-advanced-breast-cancer.html
• https://www.esmo.org/Guidelines/Breast-Cancer/4th-ESO-ESMO-International-Consensus-Guidelines-for-Advanced-Breast-Cancer-ABC-4
• Sundquist, M., Brudin, L. and Tejler, G., 2017. Improved survival in metastatic breast cancer 1985–2016. The Breast, 31, pp.46-50.
• Kobayashi, K., Ito, Y., Matsuura, M., Fukada, I., Horii, R., Takahashi, S., Akiyama, F., Iwase, T., Hozumi, Y., Yasuda, Y. and Hatake, K., 2016. Impact of immunohistological subtypes on the long-term prognosis of patients with metastatic breast cancer. Surgery today, 46(7), pp.821-826.
• Fietz, T., Tesch, H., Rauh, J., Boller, E., Kruggel, L., Jänicke, M. and Marschner, N., 2017. Palliative systemic therapy and overall survival of 1,395 patients with advanced breast cancer–Results from the prospective German TMK cohort study. The Breast, 34, pp.122-130.

-By DIVYA JINDAM