Insight on metastatic breast cancer treatment

When breast cancer spreads beyond the breast and the lymph nodes, it’s known as metastatic breast cancer. Most commonly, breast cancer spreads to the brain, bones, lung and liver. Wherever it spreads, metastatic breast cancer brings a unique set of physical and mental challenges.

To better understand metastatic breast cancer, including the best ways to cope with a diagnosis and treatment, we spoke with Jennifer Litton, M.D. Here’s what she had to say.

Who is most at risk for metastatic breast cancer?

Breast cancer survivors who had large, aggressive tumors, those whose tumor spread to multiple lymph nodes under the arm, and those whose disease didn’t respond well to therapy given prior to surgery are more likely to develop metastatic breast cancer. Also, if breast cancer goes undiagnosed and untreated for a long time, a patient is more likely to eventually be diagnosed with metastatic disease.

How is metastatic breast cancer typically treated?

Because breast cancer isn’t a single disease, treatment can be complex. There isn’t a standard step A, B, C, then D. Treatment depends on the subtype of breast cancer, so we’ll look at the patient’s biology, the location of the tumor as well as the patient’s current symptoms.

Because there isn’t a clear treatment path, patients can get frustrated. It can be hard not always having a clear plan of what’s next, but that’s why we recommend patients talk openly with their care team about their concerns and potential next steps should their current treatment stop working. This is also why we encourage patients to seek other types of support, such as supportive care and integrative medicine approaches, such as yoga, meditation and acupuncture.

What supportive care options are available to metastatic breast cancer patients?

There are a lot of misconceptions surrounding supportive care. People think it means only hospice, but studies actually show that when you involve supportive care early on patients do better. Supportive care can help with pain, appetite and fatigue. For example, at MD Anderson, our Supportive Care Center has highly skilled care teams to help manage these and many other symptoms. In addition, the Integrative Medicine team may use other approaches, including acupuncture to help with hot flashes, peripheral neuropathy and nausea, It’s a nice option for someone wanting to try something in addition to standard medications. There’s also good data supporting yoga and mindfulness for stress relief.

We also often find patients need psychological support. At MD Anderson, we offer support groups and a great psychiatry team. Counselors can help with depression and provide counseling for the patient and the family.

What are some side effects of metastatic breast cancer treatment?

Treatment is different for each patient, but one of the biggest things I see people struggle with is hair loss. Not because of vanity, but because it’s the outward sign that a patient is going through treatment.

Some people get skin rashes, nail changes, numbness and tingling that can really affect comfort and function. Other challenges include fatigue, nausea and vomiting, but all can be managed so patients shouldn’t hesitate to discuss their concerns with their doctor.

What advice do you have for patients with metastatic breast cancer?

It’s OK to get a second opinion. Any doctor that discourages that is questionable.

Also, bring someone else to your appointments because there’s a lot of information at these visits. Having another set of ears to listen and take notes can be really helpful.

Lastly, get a copy of any imaging you have – such as CT scans, mammograms and MRIs -- on CDs. That way, wherever you get treatment, they can have the films to compare to future films.

Tell us about new metastatic breast cancer research.

MD Anderson has a robust clinical trial catalogue for metastatic breast cancer patients, and we’re working every day to explore more treatment options such as precision medicine and immunotherapy for metastatic breast cancer. By molecularly profiling these tumors, gene mutations that were once considered just abnormalities become keys to successful personalized treatments. And although we haven’t had significant success with treating breast cancer with immunotherapy yet, some studies have shown that a small number of patients with triple-negative breast cancer have had improvement that was long lasting.

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