“Metastatic breast cancer used to be considered a death sentence; that’s absolutely not true anymore.”
Metastatic breast cancer—the most advanced stage of breast cancer, in which the cancer has spread to other parts of the body—isn’t considered a death sentence anymore, thanks to breakthrough discoveries in metastatic breast cancer treatment.
In a study conducted by the National Cancer Institute, researchers found that between 1992-1994 and 2005-2012, five-year relative survival among women initially diagnosed with metastatic breast cancer at ages 15-49 years doubled from 18% to 36%.
“More and more we’re seeing complete responses to therapy. That’s something that was previously unheard of for metastatic breast cancer,” says Amy Tiersten, MD, a hematologist and oncologist at the Mount Sinai Hospital in New York City. “That’s not true in every single case, but many patients with metastatic breast cancer can live good quantity and quality of lives—we have great treatment for it.”
How Metastatic Breast Cancer Treatments Have Improved
While metastatic breast cancer can’t be cured (the way many early-stage breast cancers can be) and is more difficult to treat than early-stage breast cancer, there are many treatment options for metastatic breast cancer available, such as chemotherapy, hormonal therapy, and targeted therapy.
“Amazing changes have happened in options for treatment for metastatic disease,” says Dr. Tiersten. “More and more we’re seeing complete responses to therapy. That’s something that was previously unheard of for metastatic breast cancer.”
Researchers have discovered certain characteristics that help cancer cells (or other cells near them) grow and thrive. This has led to the development of drugs that “target” these differences from normal cells, a class known as targeted therapy.
Targeted therapies are generally less likely than chemotherapy to harm normal, healthy cells. “Chemotherapy was the old gold standard we had to treat these patients with,” says Dr. Tiersten. “Chemotherapy is pretty course. You’re killing cancer cells, but you’re also killing normal cells.”
Targeted therapies are different, because they go after the cancer cells’ inner workings—what makes them different from normal, healthy cells—while leaving most healthy cells alone. These drugs tend to have side effects different from standard chemo drugs. Depending on the type of breast cancer, however, doctors may use targeted therapies along with chemotherapy for maximum effectiveness.
“The age of targeted therapies is really about understanding what pathways make a cancer cell proliferate more than a normal cell,” says Dr. Tiersten. “The medications that have been developed to target those specific pathways [are] absolutely incredible.”
Dr. Tiersten is a professor of medicine, hematology, and medical oncology at the Icahn School of Medicine at Mount Sinai. She sees patients at the Dubin Breast Center.
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Metastatic breast cancer used to be
considered the death sentence and
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that's absolutely not true anymore.
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We think of it more as a chronic disease.
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That's not true in every single case but
many patients with metastatic breast
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cancer can live good quantity and
quality of lives.
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We have great treatment for it.
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I think it's really important to educate
people about how metastatic breast cancer
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in general requires some sort of
treatment and definitely the way for
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example diabetes or
high blood pressure requires medication.
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And definitely sometimes, we need to
do something to keep the disease under
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control, but amazing changes
have happened in options for
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treatment for metastatic diseases compared
to from when I was in training 20 years
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ago to ten years ago to now, there's so
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much incredible research that's been done
mostly in the area of targeted therapies.
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So if you think about chemotherapy which
was the old gold standard which we had to
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treat these patients with,
chemotherapy is pretty coarse.
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You kill rapidly dividing cells.
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You're killing cancer cells, but
you're also killing some normal cells that
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rapidly divide, like hair, or
the stomach lining or nails.
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The age of targeted
therapies is really about so
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much science that has gone on
understanding what pathways make a cancer
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cell proliferate more than a normal cell
and medications that have been developed
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to target those specific pathways
is absolutely incredible.
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The goal of treatment for
metastatic breast cancer is to
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optimize the person's quality of life
by controlling any symptoms that they
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have from metastatic disease as well as
possible and to extend their life as well.
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More and more, we are seeing
complete responses to therapy.
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That's something that was previously
unheard of for metastatic breast cancer.
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And so I don't think you want to be
unrealistically positive if someone
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doesn't have a great prognosis or
a lot of good treatments options.
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But in those patients who do, I think
it's important to reiterate that time and
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time again so that they really can own and
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accept that they can live
well with this disease.
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Study estimates number of U.S. women living with metastatic breast cancer. National Cancer Institute. (Accessed on April 30, 2018 at https://www.cancer.gov/news-events/press-releases/2017/metastatic-breast-cancer-survival-rates)
Systemic treatment for metastatic breast cancer: General principles. UpToDate. (Accessed on April 30, 2018 at https://www.uptodate.com/contents/systemic-treatment-for-metastatic-breast-cancer-general-principles)
Breast Cancer Treatment (PDQ®)–Patient Version. National Cancer Institute, 2018. (Accessed on April 30, 2018 at https://www.cancer.gov/types/breast/patient/breast-treatment-pdq#section/_148)