What is the goal of metastatic breast cancer treatment?
The first thing to know is that treatment for MBC can look different than treatment of earlier-stage breast cancer, which often starts with a lumpectomy or mastectomy. “Generally speaking, we don’t recommend surgery as part of metastatic breast cancer treatment, because now that the cancer has spread, removing it from the breast isn’t going to have a long-term impact on the outcome,” Dr. Teplinsky explains. “Instead, the goal is to treat the cancer that’s now spreading throughout the body with medications that [also] spread throughout the body.”
Known as systemic therapies, these medications can shrink tumors or slow their growth, prevent cancer spread, and improve symptoms. This category does include traditional chemotherapy, but it doesn’t end there. Newer, targeted medications can fight cancer without doing as much damage to healthy tissue as traditional chemo, helping minimize serious side effects. That’s especially important for metastatic breast cancer, since treatment has no end date. “We obviously want to treat the cancer, and get rid of it as much as we can, but we also want people to live well with metastatic breast cancer,” Dr. Teplinsky says. “That’s really important. All of our treatment plans are designed to both improve outcomes and improve someone’s quality of life.”
What factors impact the type of treatment that’s recommended?
The exact type of metastatic breast cancer treatment doctors recommend varies based on the type of breast cancer someone has. To determine the type, a sample of breast tissue from a biopsy is sent to a lab, where pathologists examine cancer cells for certain biomarkers. They’ll look for things like whether the cancer cells have receptors for the hormones estrogen and/or progesterone, and if they have receptors for HER2 (human epidermal growth factor receptor 2), a protein that can cause breast cells to grow and divide too rapidly. “The combination of receptors that someone has guides their treatment,” Dr. Teplinsky says. Breast cancer that lacks receptors for both hormones as well as the HER2 protein is known as triple-negative breast cancer.
Other factors doctors consider include where in the body the breast cancer has spread—like the bones, lungs, liver, and brain—and specific genetic mutations. “Seeing a doctor who specializes in treating breast cancer is especially important when it comes to metastatic breast cancer, because there are so many treatment options,” Dr. Teplinsky says. “It can get complicated, and I always recommend getting a second opinion, as it’s becoming more nuanced than it used to be.”
What are the main kinds of treatments available?
Having your own knowledge of the treatment options can help you feel more confident discussing your path forward with your doctor. Here’s a general overview of types of metastatic breast cancer treatments, and what treatment may look like depending on the specific type of breast cancer someone has.
