When breast cancer is considered to be in Stage IV, it means that it has “metastasized” or spread beyond the breast and lymph nodes to other parts of the body.
While surgery and radiation therapy may be part of the treatment regimen when breast cancer is diagnosed at Stage IV, more aggressive therapy will likely take place immediately, which may consist of a combination of hormone therapy, chemotherapy and/or targeted therapy.
In Stage IV or metastatic breast cancer, it is not uncommon for the cancer to spread to the bone, causing pain and discomfort. In these cases, radiation therapy may be recommended to help relieve the bone pain. Additionally, other therapies called bisphosphonates will be given to strengthen the bone affected by the spread of the breast cancer.
Following are more specifics about each of these types of treatments:
If the tumor is found to be hormone receptor-positive, hormone therapies such as tamoxifen (Nolvadex) or aromatase inhibitors (exemestane/Aromasin, anastrozole/Arimidex, or letrozole/Femara) will be used in combination with chemotherapy and/or targeted therapy immediately following diagnosis.
Used for more than 30 years to treat breast cancer, tamoxifen is given as a pill and works by blocking the activity of estrogen. Aromatase inhibitors are typically given to women who have already gone through menopause, and work by preventing the body from making estradiol, a form of estrogen.
There are many different types of chemotherapy agents and combinations of chemotherapy agents that are used to treat metastatic breast cancer. Some of the commonly used combinations include:
AC: Doxorubicin (Adriamycin) and Cyclophosphamide
A à CMF: Doxorubicin (Adriamycin) followed by CMF: cyclophosphamide (Cytoxan), methotrexate (Amethopterin, Mexate, Folex), and 5-fluorouracil (Fluorouracil, 5-FU, Adrucil)
AC à T: Doxorubicin (Adriamycin) and cyclophosphamide followed by paclitaxel (Taxol) or docetaxel (Taxotere). During this regimen, the targeted monoclonal antibody therapy trastuzumab (Herceptin) may be given if the tumor is HER2-positive tumor.
CAF (FAC) :Cyclophosphamide, doxorubicin (Adriamycin), and 5-fluorouracil (Fluorouracil, 5-FU, Adrucil)
CEF (FEC) :Cyclophosphamide, epirubicin, and 5-fluorouracil (Fluorouracil, 5-FU, Adrucil). This regimen also may be followed by docetaxel (Taxotere).
CMF:Cyclophosphamide (Cytoxan), methotrexate (Amethopterin, Mexate, Folex), and 5-fluorouracil (Fluorouracil, 5-FU, Adrucil)
EC: Epirubicin (Ellence) and cyclophosphamide
TAC: Docetaxel (Taxotere), doxorubicin (Adriamycin), and cyclophosphamide
TC:mDocetaxel (Taxotere) and cyclophosphamide
TCH: Docetaxel (Taxotere), carboplatin, and trastuzumab (Herceptin) for HER2-positive tumors
Besides these commonly used treatment regimens, other chemotherapy agents also are used to treat metastatic breast cancer. These include: albumin-bound paclitaxel (Abraxane), capecitabine (Xeloda), cisplatin (Platinol), gemcitibine (Gemzar), ixabepilone (Ixempra), mitoxantrone (Novantrone), pegylated liposomal doxorubicin (Doxil) and vinorelbine (Navelbine).
If the tumor is found to be HER2-positive, meaning the tumor is a more aggressive form of breast cancer, the use of the targeted monoclonal antibody trastuzumab (Herceptin) will likely be given in combination with the specific chemotherapy regimens listed above.
Additionally, another targeted therapy called bevacizumab (Avastin) also may be given. This particular therapy works to cut off the blood vessels that supply the tumor with blood necessary to grow.
In metastatic breast cancer, it is not unusual for the cancer to spread to the bones.
Therapies called bisphosphonates (pamidronate/Aredia or zoledronic acid/Zometa) along with calcium and Vitamin D typically are given to help strengthen the bone affected by the spread of the breast cancer.
Surgery and Radiation Therapy
While the mainstay of treatment for earlier stages of breast cancer, surgery and/or radiation therapy is typically reserved to help relieve pain and discomfort or to treat the breast cancer that has spread to a specific area of the body.
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