Stage IV Breast Cancer
Patients diagnosed with Stage IV or metastatic breast cancers have disease that has spread from the affected breast to one or more distant sites in the body. Historically, metastatic breast cancer has been considered incurable; the goal of treatment has been to provide relief from symptoms and prolong the duration and quality of life. However, there have been some important advances resulting in the addition of many more treatment options for managing this disease. These include the now widespread use of taxane chemotherapy, the development of targeted therapies, and the development of more active hormonal therapy drugs.
By 1997, these patients had been observed over 10 years and the original 14% remain alive without a relapse of their cancer and appear cured of their disease. It is important to understand that because over 50% of patients with stage IV breast cancer relapse, it is not useful to compare the response rate to chemotherapy, the average duration of survival or time to relapse. When evaluating treatment strategies in stage IV breast cancer, patients should compare the percent of patients alive with or without relapse 3-5 years from treatment to determine whether a treatment is truly superior.
In general, women who have advanced breast cancer at the time of diagnosis live approximately 18 months after diagnosis (median survival rate). Those who are still alive five years after their diagnosis of advanced breast cancer can live an additional 3.5 years (median survival rate) according to the American Cancer Society.
This study suggested that there were no differences in survival between the standard-dose and high-dose chemotherapy regimens in women with metastatic breast cancer who had a complete or partial response to initial standard-dose therapy. However, the number of women treated in this trial does not allow the identification of any subsets of women that might benefit more than the overall group from the high-dose regimen.
High-dose chemotherapy and autologous stem cell transplant treatment for previously untreated stage IV breast cancer appears safe; however, the benefit of this treatment approach is currently unknown. It is known that many factors may influence an individual patient’s potential outcome if treated with high-dose chemotherapy. Patients without prior treatment, those with small amounts of cancer, and those whose cancer responds to conventional chemotherapy all do better.
Early detection procedures must include monthly self-examinations done at the same time each month. From age 20-40, healthy women should have clinical breast exams performed by their health care providers every three years. After age 40, the breast exams should be annually and should include a mammogram or similar procedure.
Monoclonal antibodies are a treatment that can locate cancer cells and kill them directly without harming normal cells. Herceptin (trastuzumab) is the first monoclonal antibody approved by the Food and Drug Administration for the treatment of breast cancer. Herceptin recognizes a protein on the cancer cell surface of 1 in 3 patients with breast cancer. In order to be treated with Herceptin your doctor must test the breast cancer cells for the protein that Herceptin recognizes. This protein is called Her 2-neu. Herceptin or other monoclonal antibodies are not substitutes for other cancer treatments but have the advantage of being administered during or after high-dose chemotherapy and killing cancer cells by a different method than chemotherapy with the goal of improving the total treatment. Clinical trials are currently being performed to determine whether monoclonal antibodies administered during or after high-dose chemotherapy can improve survival or cure rates.