> Living with metastatic breast cancer (January 2014)
What is metastatic breast cancer?
Metastatic breast cancer (also called advanced or stage IV breast cancer) is breast cancer that has spread beyond the breast and axillary lymph nodes (the lymph nodes in the underarm area) to other parts of the body.
In the U.S., few women have metastatic disease when they are first diagnosed with breast cancer (less than five percent of diagnoses).1 More commonly, metastatic breast cancer arises months or years after a woman has completed treatment for early or locally advanced (stage I, II or III) breast cancer. The risk of breast cancer returning and metastasizing varies from person to person.
People diagnosed with metastatic disease face very different challenges than people diagnosed with early breast cancer. Here, we discuss treatment, prognosis and some of the emotional and practical aspects of living with metastatic breast cancer.
Can metastatic breast cancer be treated?
Although metastatic breast cancer is not currently considered curable, it may be able to be treated. Some people may live many years with metastatic breast cancer as a long-term chronic condition. And, as treatment for both early-stage and metastatic breast cancer continues to improve, so does survival.
If breast cancer metastasizes, it most often spreads to the bones, liver, lungs or brain. When breast cancer spreads to another part of the body, it’s still breast cancer and treated with breast cancer therapies. For example, breast cancer that has spread to the lungs is still breast cancer (not lung cancer) and is treated with breast cancer drugs, rather than drugs for a cancer that began in the lungs.
What are the goals of treatment?
The goals of treating metastatic breast cancer are to control tumor growth and prolong life while also maintaining quality of life.
Treatment is highly personalized and depends upon the characteristics of breast cancer and the side effects a person is willing to accept or able to tolerate. Not only does one person’s cancer differ from another’s, but personal choices also guide treatment more than with early-stage breast cancers. Some treatments have side effects that impact quality of life, and the potential benefits of these treatments may be greater for some people than others. Together with her/his oncologist, a person with metastatic breast cancer can find the balance of treatment and quality of life that is right for her/him.
Learn more about quality of life issues for people with metastatic breast cancer.
How is metastatic breast cancer treated?
Treatment plans are guided by many factors, including:
The most common treatments for metastatic breast cancer include:
For people who have metastatic breast cancer that has spread to the bones, there are drugs that can be added to help improve bone strength and prevent fractures.
Radiation therapy is less commonly used, but can be used to treat some areas in the body where the cancer has spread and causes symptoms or pain. This depends on the location of the metastases and whether the metastases cause any symptoms. For example, radiation therapy may be used to ease the pain of cancer that has spread to the bone.
Surgery is not commonly used for metastatic breast cancer since it has not been shown to improve survival.
Are there new treatments for metastatic breast cancer?
People with metastatic breast cancer are often the first to benefit from new breast cancer drugs. Cancer drugs are generally approved for the metastatic setting before they are used to treat early stage cancers. Several new drugs for metastatic breast cancer have been FDA-approved over the past two years. For any person with metastatic breast cancer, the best treatment choices for her/him will be guided by characteristics of the cancer cells (such as estrogen receptor status and HER2/neu status).
In July 2012, the FDA approved the use of the drug everolimus in combination with exemestane for the treatment of ER+, HER2/neu-negative metastatic breast cancers. Everolimus is typically used to treat cancers in postmenopausal women who have already been treated with another aromatase inhibitor (letrozole or anastrozole).
Everolimus is an mTOR (mammalian target of rapamycin) inhibitor, a class of targeted therapy drugs that may make hormone therapy more effective. Exemestane is an aromatase inhibitor hormone therapy drug.
Randomized controlled trials have shown that the combination of everolimus and exemestane can slow the growth of such cancers better than exemestane alone.2-3
Trastuzumab emtansine (T-DM1, Kadcyla)
In February 2013, the FDA approved the use of trastuzumab emtansine (T-DM1) for the treatment of HER2+ metastatic breast cancers that have progressed on trastuzumab and a taxane-based chemotherapy.
T-DM1 is a new type of targeted therapy for HER2+ metastatic breast cancer. T-DM1 is a single drug that consists of trastuzumab (which targets HER2+ cancer cells) attached to a chemotherapy called DM1. This drug is unique because it allows the targeted delivery of chemotherapy to HER2+ cancer cells, with less effect on other cells in the body.
A randomized controlled trial showed T-DM1 increased survival better than lapatinib and chemotherapy for women with HER2+ metastatic breast cancers.4
In June 2012, the FDA approved the use of pertuzumab, in combination with trastuzumab and a taxane chemotherapy, for the treatment of HER2+ metastatic breast cancers that have not been treated with chemotherapy, trastuzumab or lapatinib.
Pertuzumab is an antibody that targets HER2+ cancer cells in a different way than trastuzumab. A randomized controlled trial showed that pertuzumab in combination with trastuzumab and chemotherapy slowed the growth of HER2+ metastatic breast cancer and increased survival better than trastuzumab and chemotherapy alone.5-6
What affects prognosis?
Survival for metastatic breast cancer differs greatly from person to person. Although the average length of survival for women with metastatic breast cancer is about two years, this is an average and does not predict how long any one person may live. Many people will live much longer. About 15 percent of women with metastatic breast cancer live five or more years after diagnosis, and some women live 10 or 20 years beyond diagnosis.8
Keep in mind that survival estimates are based on women diagnosed before some of the newer treatments for breast cancer were available. Modern treatments for both early stage and metastatic breast cancer mean improved survival for women diagnosed today. Some treatments available today can change the natural course of the cancer and improve survival. For example, the drug trastuzumab (Herceptin) specifically targets HER2+ cancer cells, and has improved survival for women with HER2+ breast cancer. With continued advances in treatment, survival for women with metastatic breast cancer should continue to improve.
While certain characteristics of a person’s cancer and medical history can affect the chance of long-term survival, our ability to make exact predictions remains limited. At best, prognosis for any person is an estimate. We do know that some people will go on to live for many years with metastatic disease. And, as we learn more and breast cancer treatments improve, the number of these people should grow.
Is joining a clinical trial right for me?
Clinical trials offer the chance to try new treatments and possibly benefit from them. For people with metastatic breast cancer, the time to consider joining a clinical trial is before starting a new treatment. Clinical trials are designed for specific groups of people, so it’s important to find a trial that fits a person’s unique situation (including which metastatic breast cancer treatments a person has already had). People with metastatic breast cancer should talk with their oncologists about a clinical trial when a current treatment stops working and the oncologist recommends changing treatment (at each treatment juncture).
Karen (featured at left), a woman currently living with metastatic breast cancer says, "I joined a clinical trial, not as a last resort, but for the chance to try a new drug that has the potential to become a standard therapy."
Where a person lives may be a factor in choosing to join a clinical trial. Some clinical trials are done only in one (or a few) medical centers, while others are done in many locations across the country. The costs of getting treatment through a clinical trial should not be different from usual treatment costs.
BreastCancerTrials.org in collaboration with Susan G. Komen® offers a custom matching service that can help find clinical trials for people with metastatic breast cancer. Learn more about clinical trials and find a list of resources to help find a clinical trial.
Are there resources to help with financial issues?
Financial issues can be a bigger concern for people with metastatic breast cancer than for other breast cancer survivors. While a person with early breast cancer has a set time period of treatment, a person with metastatic breast cancer does not have a time limit for treatment. Treatment may continue over years rather than months. There are many financial assistance programs that can help. For example, people who are (or have recently been) employed may qualify for Social Security benefits and people with low income or who are unemployed may qualify for Medicaid.
Learn more about insurance and financial issues.
Addressing emotional needs
Taking care of emotional needs is an important part of living with metastatic breast cancer. Social support can reduce anxiety, stress and depression.9-11 Whether it’s informal support (such as from family, friends and religious organizations) or more formal support (such as from counseling in a one-on-one or group setting), social support can improve the emotional well-being and quality of life for people with metastatic breast cancer.
Learn more about social support.
Reducing pain and any other symptoms caused by treatment or the cancer itself (called palliative care) is important to preserve quality of life during all phases of breast cancer treatment. However, it is especially important throughout treatment for metastatic breast cancer.
Learn more about palliative care.
Learn more about quality of life.
At some point, active cancer treatment for metastatic breast cancer may be stopped. This can happen when treatment stops helping or when it greatly affects quality of life. Once cancer treatment is stopped, palliative care becomes the main focus rather than just a part of treatment.
Counseling or a support group can help address and manage the feelings and emotions that come with this stage of metastatic breast cancer care. With a patient’s personal guidance, hospice can make the later stage of cancer care as comfortable as possible for the patient and her/his family.
Learn more about hospice.
Hope for the future
For those living with metastatic breast cancer, treatment and other aspects of breast cancer care are highly personalized. According to Dr. Lisa Carey, MD, medical director of the University of North Carolina (UNC) Breast Center and associate director for clinical science at UNC Lineberger Comprehensive Cancer Center, “Researchers are helping define the important biologic sunsets within metastatic breast cancer, which is how we will develop targeted strategies for the future." For women and men diagnosed with metastatic disease today, there are many new treatment options. These treatments offer the hope of improved survival and as researchers continue to develop new treatments, this hope continues.
What is Komen doing to address the needs of metastatic breast cancer patients?
Komen research grants and programs
Since 2006, Komen has invested more than $91 million in nearly 200 research grants that focus on understanding why metastasis occurs and how to treat it. Projects include:
- Identifying the genes and processes that cause breast cancer cells to metastasize
- Developing and testing new therapies to prevent and treat metastatic breast cancer
- Discovering new methods for predicting or detecting metastasis using urine or blood tests or body scans
To learn more about Komen’s research on metastatic breast cancer, please read the Research Fast Facts.
In addition to research, Komen convened a Metastatic Breast Cancer Roundtable in 2012 to identify and prioritize unmet needs in the metastatic breast cancer community. The Roundtable participants included 10 representatives from Komen Affiliates and Advocates in Science across the country who are living with metastatic breast cancer.
Relevant, evidence-based information about metastatic breast cancer, psychosocial support, access to quality care and treatment options, and more research into the causes of and treatments for metastatic breast cancer were identified as the top four unmet needs by the participants. Susan G. Komen continues to address these needs throughout our mission work.
Metastatic Breast Cancer Alliance
In October 2013, Komen joined forces with 14 other breast cancer charities to form the Metastatic Breast Cancer Alliance. The Metastatic Breast Cancer Alliance aims to:
- Increase awareness and education on metastatic breast cancer
- Advance research and policy issues that have the potential to extend life, enhance quality of life and ultimately find a cure for metastatic breast cancer
In 2014, the Metastatic Breast Cancer Alliance will release a report to raise awareness about current promising awareness, education, research and policy efforts.
- American Cancer Society. Breast Cancer Facts & Figures 2013-2014, 2013.
- Baselga J, Campone M, Piccart M, et al. Everolimus in postmenopausal hormone receptor-positive advanced breast cancer. N Engl J Med. 366(6):520-9, 2012.
- Bachelot T, Bourgier C, Cropet C, et al. Randomized phase II trial of everolimus in combination with tamoxifen in patients with hormone receptor-positive, human epidermal growth factor receptor 2-negative metastatic breast cancer with prior exposure to aromatase inhibitors: a GINECO study. J Clin Oncol. 30(22):2718-24, 2012.
- Verma S, Miles D, Gianni L, et al. for the EMILIA Study Group. Trastuzumab emtansine for HER2-positive advanced breast cancer. N Engl J Med. 367(19):1783-91, 2012.
- Baselga J, Cortés J, Kim S, et al. for the CLEOPATRA Study Group. Pertuzumab plus trastuzumab plus docetaxel for metastatic breast cancer. N Engl J Med. 366(2):109-19, 2012.
- Swain SM, Kim SB, Cortés J, et al. Pertuzumab, trastuzumab, and docetaxel for HER2-positive metastatic breast cancer (CLEOPATRA study): overall survival results from a randomised, double-blind, placebo-controlled, phase 3 study. Lancet Oncol. 14(6):461-71, 2013.
- National Cancer Institute. Stage IIIB, inoperable IIIC, IV, recurrent, and metastatic breast cancer. http://www.cancer.gov/cancertopics/pdq/treatment/breast/healthprofessional/page7, 2013.
- National Cancer Data Base, American Cancer Society. Detailed guide: Breast cancer. American College of Surgeons and American Cancer Society, 2005.
- Goodwin PJ, Leszcz M, Ennis M, et al. The effect of group psychosocial support on survival in metastatic breast cancer. N Engl J Med. 345: 1719-26, 2001.
- Institute of Medicine. Meeting psychosocial needs of women with breast cancer. Washington, D.C., National Academies Press, 2004.
- Björneklett HG, Lindemalm C, Rosenblad A, et al. A randomised controlled trial of support group intervention after breast cancer treatment: results on anxiety and depression. Acta Oncol. 51(2):198-207, 2012.
Posted January 29,2014