Metastatic Breast Cancer

What are the available treatment options for breast cancer?

Going through the treatment plan could be tough. But, it is important that you complete it.

There has been a considerable progress in the variety of treatment options available for breast cancer. This has in turn led to improved outcomes. With a combination of effective breast cancer management measures, it is possible to improve survival rates too.

The treatment regimen that the physician chooses will depend on many factors that includes: tumour sub-type, stage of cancer, patient’s age, general health and presence of mutations, among others. A combination of treatment modalities is most likely chosen to achieve the best possible results. Available treatment options include:

I. Surgery

Depending on the spread of cancer, doctor may recommend a Lumpectomy (partial removal) or a Mastectomy (complete removal of breast). Surgery is often accompanied by radiation therapy. Thereafter, some women prefer going for a breast reconstruction surgery.

II. Radiation therapy

Surgery is often accompanied by radiation therapy (or, Radiotherapy) with an intent to kill any residual cancer cells and to prevent recurrence. During this, targeted, high-energy radiations (e.g. X-rays) are used to kill the cells in the area where cancer cells are present. However, radiation kills the normal cells also, resulting in side-effects. Some of this can be overcome with modern technologies though.

III. Systemic therapy

In contrast to localized treatment (as in the case of surgery and radiotherapy), systemic therapy refers to administration of the drug throughout the body (like for example, through the bloodstream). Systemic therapy can be recommended either before surgery (neoadjuvant therapy) or after surgery (adjuvant therapy). In case of large-sized tumours, neoadjuvant therapy may help shrink the tumour. Whatever the case, the aim is to control the growth and spread of the cancer cells, which are otherwise not accessible by localized treatment.

Systemic therapy can be of different types: Chemotherapy, Hormone therapy or Targeted therapy. The choice is made based on factors that include size of the tumour, number of lymph nodes involved and the presence or absence of tumour-specific markers.

i. Chemotherapy

Chemotherapy is one of the most commonly advised treatment modalities. Chemotherapeutic drugs could be taken orally in a pill form or, can be injected into the vein (IV). Often, more than one such drug is used over a period of 3 to 6 months, with ample break time in between so as to allow the body to recover. Example: Doxorubicin, Carboplatin, Cyclophosphamide, Paclitaxel, Docetaxel

ii. Hormonal therapy

For breast cancers that are hormone receptor positive, most of the cells have receptors for oestrogen or progesterone. Cancers can be ER positive, PR positive or HER2 positive. In ER positive cancers, there is an increased receptor expression for oestrogen on the cells, while in PR positive, progesterone receptor expression is high. In a yet another third category of breast cancer type, there is an overall increased receptor expression of HER2 (human epidermal growth factor receptor 2). This sub-type is a favorable one for targeted breast cancer therapy. Hormonal therapy is often recommended in this case. Hormonal therapy usually recommended is tamoxifen alone or in combination with aromatase inhibitor. (For e.g., Anastrozole, Exemestane)

iii. Targeted therapy

In targeted therapy, the drug selectively binds to soluble proteins or molecular markers on target cells. This binding directly or indirectly affects the growth of cancer cells – by either directing the cells to die or by restricting growth. This thus results in little harm to surrounding healthy cells.

Bevacizumab, an anti-angiogenesis drug, is one such targeted therapeutic that acts by binding to VEGF (Vascular endothelial growth factor), and blocking VEGF activity. Bevacizumab in combination with chemotherapy drugs is indicated for treatment of patients with metastatic breast cancer in whom treatment with other chemotherapy options does not work. Other examples of targeted drugs include trastuzumab, pertuzumab and trastuzumab emtansine.

What measures can one take to cope with the disease?

Coping with the disease

• Breast cancer can be effectively managed if detected early. Cancer survival rates are high if detected early.
• Increased awareness, routine examination, adopting a healthy lifestyle, completing the treatment regimen, rehabilitation and palliative care are key elements towards breast cancer care and control.
• Be patient while you wait for your test results. It is always good to get a second opinion for a more accurate diagnosis.
• Going through the treatment plan may be hard. But, it is important that you complete it.
• Follow your treatment plan strictly. The following pointers can help in this:

1. Maintain a record of the plan
2. Join along a family member or friend to remind you on the treatment regimen
3. Set an alarm on your mobile
4. Download a related app
5. Stay strong – the pain will fade with time
6. Do not hesitate to reach out for support at any time