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My treatment

My treatment

Choosing a treatment can be daunting, and there are a lot of questions to ask your oncologist about your available options. You want to choose a treatment that is effective, but it is also important to understand the possible side effects and consider how a treatment may affect your lifestyle. It’s important to talk to your oncologist about which treatment may be right for you.

What are the types of treatment for metastatic breast cancer?

The treatment you will receive for your metastatic breast cancer will largely depend on the type and location of your cancer. You may be given a combination of therapies or you may receive only one therapy at a time.

The three main types of drug therapy that you can be offered to control your cancer are chemotherapy, anti-hormonal therapy (also called endocrine therapy) and targeted therapy1,2. Radiotherapy, and rarely surgery, may also be used when necessary for disease or symptom control.

In addition, you may be given treatments to help relieve the symptoms of the cancer or the metastases in your body for example, bone stabilizing agents such as bisphosphonates which will help strengthen your bones, particularly if you have bone metastases3,4.

Click on different treatment type to find out more information

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  • Chemotherapy
  • Radiotherapy
  • Anti-hormonal therapy
  • Targeted therapies
  • Bone stabilising agents
  • Surgery
  • Chemotherapy

    Chemotherapy drugs given orally or intravenously, kill cancer cells. However, they can harm normal cells too and this can cause side effects. There are potential side effects of chemotherapy, discuss with your oncologist so that you can manage the side effects better2.

  • Radiotherapy

    Radiotherapy is the use of high-energy radiation that kills cancer cells. Radiotherapy may be given to control your cancer and also used to relieve bone pain. It is common to radiate metastases in the bone that are causing pain2.
    Radiotherapy for metastatic breast cancer is usually given as a single dose or as a short course over a few days. You may experience skin irritation, tiredness, aches and swelling on the treatment areas.

  • Anti-hormonal drug therapy

    Estrogen and progesterone are hormones that cause some breast cancer cells to make more cancer cells. Estrogen is mostly made by ovaries and made in small amounts by the adrenal glands, liver and body fat. Progesterone is mostly made by the ovaries. Blocking these hormones from working or lowering hormones levels may help stop breast cancer cells from growing2.
    There are two classes of hormonal therapy which are Antiestrogen and Aromatase inhibitor.

    Hormonal therapy Generic drugs name
    Antiestrogen Tamoxifen
    Fulvestrant
    Aromatase inhibitor Anastrozole
    Letrozole
    Exemestane


    Hormone therapy may cause menopause-like symptoms. Menopausal symptoms include hot flashes, vaginal discharge or dryness, sleep problems, weight gain, thinning of hair, fatigue and changes in mood6.

  • Targeted drug therapy

    Targeted therapies work on specific types of breast cancer by blocking specific pathways that breast cancer cells use to multiply. To determine if any targeted therapies are right for you, your oncologist will have to determine what type of cancer you have2.
    There are therapies which are used in the treatment of HR-positive breast cancer that specifically target the signaling pathways that are activated by hormones, such as estrogen2.
    There are also several therapies that target HER2 receptors2. These drugs work in people with high levels of HER2 in the cancer cells, but they do not work in cancers that do not have this protein.

    Subtype7  Generic drugs name7
    HER 2+ Trastuzumab
    Lapatinib
    Pertuzumab
    Ado-trastuzumab emtansine
    HER 2- Bevacizumab
    HR+ / HER2- Everolimus
    Palbociclib
    Ribociclib
  • Bone stabilizing agents

    These are drugs that are often used when there are metastases in the bone. They work by helping to strengthen your bones and help reduce bone loss.
    They can help relieve bone pain and reduce the long-term risk of bone breaks3. They are taken as pills or injections.

  • Surgery

    Surgery is rarely used in metastatic breast cancer2. When it is used, it is because removing tumor tissue will help to improve your body function or relieve pain.
    If you have surgery, you may receive drug therapy and/or radiotherapy.


What are the specific treatment options for metastatic breast cancer subtypes?

Treatment options can vary depending on the type of metastatic breast cancer you have1,7. For example, your oncologist may recommend a combination of an anti-hormonal treatment and a targeted therapy if your cancer is HR-positive, or a HER2-targeted therapy for HER2-positive cancer. Consult with your oncologist to understand which treatment is best for you.

What treatment is best for me?

HOW DO I KNOW IF MY TREATMENT IS WORKING?

People react differently to different cancer treatments, so it is difficult to predict if your cancer will respond to a treatment or not. Your oncologist will conduct a variety of tests over time to find out if your treatment is working9. These may include looking at:

The size of your tumor/metastases

Your oncologist may use imaging procedures to see if your tumor or metastases are growing, shrinking or staying the same size. These may include computed tomography (CT)10 or magnetic resonance imaging (MRI) scans11.

The level of tumor markers

Tumor markers are proteins found in the blood when tumors are active in the body. The presence of high levels of tumor markers often indicates active disease. The levels of tumor markers over time can be used by your oncologist to monitor the efficacy of your treatment8.

The level of circulating tumor cells

Circulating tumor cells (CTCs) are cancer cells that have detached from the primary tumor and are circulating in the bloodstream.

CTCs can act as ‘seeds’ for new tumors (metastases) at other sites in the body. Your oncologist may monitor the level of CTCs in your blood to see how well you are responding to treatment8.

Development of new metastases

Your oncologist will want to make sure that cancer cells have not spread to other parts of the body. For this, imaging procedures such as computed tomography (CT) or magnetic resonance imaging (MRI) scans can be used.

How long do i need to stay on treatment?

Treatment for metastatic breast cancer is long term. This is because ongoing treatment is needed to control your cancer and prevent it from getting worse, and to help control symptoms of metastases1. Your treatment may change over time and you may be given the same treatment several times, alternated with other treatments.

There is no single best way to treat metastatic breast cancer and each person’s situation is different.

You may be tempted to stop treatment once you feel better or if it makes you feel sick. However, as much as possible, it is critical to keep taking your treatment for as long as it is prescribed. Talk to your oncologist if you are thinking about stopping your treatment. There are things that can be done to help reduce side effects.

WHAT TREATMENT SIDE
EFFECTS CAN I EXPECT?

The side effects you experience will depend on the type of treatment you are receiving2. Also, everyone reacts differently to treatment. The side effects you have may be very different to those of another person on the same treatment.

If you are receiving an intravenous chemotherapy treatment, the side effects will usually be worse the first few days after treatment. It is a good idea to plan for this until you know how you will feel.

Not everyone experiences side effects with treatment. If you do not experience any side effects, it does not mean that your cancer treatment is not working.

Always tell your oncologist or nurse about any side effects you experience. There are supplemental treatments that can help with the side effects or in some cases your cancer treatment may be adjusted. Also, what feels like a side effect could be a sign of the cancer growing.

Common side effects and how to manage them

Some of the most common side effects of breast cancer treatment include fatigue, pain, nausea and vomiting, diarrhea, hair loss, low white blood cell count, and weight gain or weight loss.

Pain

If you are having pain it is important to let your oncologist or nurse know. They can prescribe medications to help manage your pain and recommend pain relief methods3.

It might help to keep a record of the frequency and the severity of your pain – does the pain get worse at night, or when doing specific things? Relieving your pain effectively will have a large impact on the way you feel – it can help reduce fatigue, anxiety and depression, and improve your sleep and overall well-being.

Cancer pain is usually treated with medicine and complementary therapies2. Therapies such as acupuncture, massage therapy and relaxation techniques can help you to control your pain. Exercise can also help.

Fatigue

Fatigue is so much more than feeling tired: it is complete exhaustion. It may be related to the physical effect of the cancer itself or be a side effect of treatment. It could also be related to changes in your sleeping patterns and added stress and anxiety3.

Tips for dealing with fatigue2,3:

  • Eat regularly and eat healthy foods
  • Do regular gentle exercise
  • Plan your day and only do what is most important to you
  • Ask for help from friends and family
  • Take short breaks or naps
  • Tell your oncologist or nurse – they may be able to prescribe medicine to help with fatigue
Nausea and vomiting

Untreated nausea and vomiting can make you feel very tired and can also lead to more serious problems. Tell your oncologist or nurse if you experience nausea or vomiting – there are medicines available to help you control them.

Tips to reduce nausea and vomiting2,3:

  • Gentle exercise and fresh air
  • Avoid spicy, greasy or very sweet foods – try bland and easy-to-digest foods
  • Ginger and lemon can reduce nausea
  • Eat regular small meals
Sleeping problems and insomnia

A number of things can prevent you from having a good night’s sleep, including pain, stress, side effects of the treatment, anxiety and depression. You may feel like you can’t sleep, wake up frequently in the night, or wake up very early.

This can affect your ability to function day-to-day. Tell your oncologist if you experience sleeping problems – there are medicines that may help.

Tips to help you sleep2,3:

  • Try to maintain your usual sleeping pattern
  • Reduce noise and light in your room
  • Try relaxation techniques, meditation or mindfulness
  • Have a warm drink before bedtime (but avoid caffeine)
  • Keep a diary by the bed to record thoughts or worries that are keeping you awake
Lack of concentration and cognitive changes

These can be caused by physical or emotional changes that may or may not be related to your treatment3. It is important you report any problems with concentration to your oncologist or nurse.

Hair loss

If you are receiving chemotherapy as a treatment you may experience thinning or drying-out of your hair, or hair-loss3. Even anti-hormonal therapies can sometimes lead to hair thinning.

For some, but not all chemotherapies, scalp cooling may be an effective way to prevent hair loss. Ask your oncologist whether this may help for your particular treatment and whether scalp cooling is offered at your clinic.

Having your hair fall out can be very upsetting, and it might be a good idea to cut your hair short if you know you are going to lose it2. This can help you regain some control of the situation, rather than waiting for your hair to fall out. Do what feels right for you.

References
  1. National Breast Cancer Foundation Australia (2020). Stage 4 (Advanced or Metastatic) Breast Cancer. Retrieved from https://nbcf.org.au/about-breast-cancer/diagnosis/stage-4-advanced-or-metastatic-breast-cancer/. Accessed 18 August 2020.
  2. Australian Government Cancer Australia (August 2020) Metastatic Breast Cancer. Retrieved from https://breast-cancer.canceraustralia.gov.au/affected-cancer/cancer-types/breast-cancer/types/metastatic-breast-cancer. Accessed 18 August 2020.
  3. National Cancer Institute (2020). Breast Cancer Treatment Adult -Patient Version. Retrieved from https://www.cancer.gov/types/breast/patient/breast-treatment-pdq. Accessed 18 August 2020.
  4. National Cancer Institute (2020). NCI Dictionary of Cancer Terms. Retrieved from https://www.cancer.gov/publications/dictionaries/cancer-terms. Accessed 18 August 2020.
  5. National Cancer Institute (2020). Chemotherapy to Treat Cancer. Retrieved from https://www.cancer.gov/about-cancer/treatment/types/chemotherapy. Accessed 18 August 2020.
  6. National Cancer Institute (2020). Hormone Therapy for Breast Cancer. Retrieved from https://www.cancer.gov/types/breast/breast-hormone-therapy-fact-sheet. Accessed 18 August 2020
  7. NCCN Guidelines for Patients Metastatic Breast Cancer 2020. Retrieved from https://www.nccn.org/patients/guidelines/content/PDF/stage_iv_breast-patient.pdf. Accessed 18 August 2020
  8. Breastcancer.org (2020) Blood Marker Tests. Retrieved from https://www.breastcancer.org/symptoms/testing/types/blood_marker. Accessed 18 August 2020.
  9. Breastcancer.org (2020) Breast Cancer Tests: Screening, Diagnosis, and Monitoring. Retrieved from https://www.breastcancer.org/symptoms/testing/types. Accessed 18 August 2020.
  10. Breastcancer.org (2020) CT (CAT) Scans (Computerized Tomography). Retrieved from https://www.breastcancer.org/symptoms/testing/types/cat_scans. Accessed 18 August 2020.
  11. Breastcancer.org (2020) Breast MRI (Magnetic Resonance Imaging). Retrieved from https://www.breastcancer.org/symptoms/testing/types/mri. Accessed 18 August 2020.