Living well with metastatic breast cancer

Finding out your breast cancer has spread is devastating. However, since BCNA began, there have been new treatment discoveries and scientific advances. Medical oncologist Professor Fran Boyle AM speaks to The Beacon about how developments over the past 20 years have led to women and men living well for longer.

People diagnosed with metastatic breast cancer often want to understand why their cancer spread, especially if they have previously had treatment for early breast cancer.

‘Breast cancer is spread in two ways – through the body’s lymphatic system and through the bloodstream,’ Professor Boyle says.

‘That is why we remove one or some of the lymph nodes during surgery and test them to see if the cancer has started to spread into them. The results help us decide the best treatment options.’

Unfortunately there is not yet any way to determine early on if there are cancer cells in the bloodstream.

Professor Boyle says we are also still some way off understanding why some cancers metastasise and some do not.

‘Metastatic breast cancer can present early, sometimes as the first diagnosis of breast cancer or not until later, after treatment for early breast cancer has finished,’ she explains.

‘Hormone receptor positive breast cancer can sometimes come back many years after initial treatment and, for this reason, hormone blocking treatments such as tamoxifen or the aromatase inhibitors are sometimes now extended out to 10 years.’

The good news is that metastatic breast cancer is today considered very treatable, as many people respond well to drug treatment and radiotherapy.

‘There have even been exceptional survivors, who have lived for many years after their metastatic breast cancer diagnosis,’ Professor Boyle says.

According to Professor Boyle, more and more people diagnosed with metastatic breast cancer are going to survive longer over the coming decades.

‘It’s true that sometimes people die quickly from metastatic breast cancer, but that generally reflects the severity of the cancer, when it has affected multiple organs, or that the patient is too unwell from other conditions to tolerate treatment,’ she explains.

‘These days, a rapid death from metastatic breast cancer is unusual.’

Professor Boyle says it is very difficult to generalise on survival times, because every case is different.

‘On average we expect about four to five years, although it could range from six months to more than 10 years. Occasionally, some patients are alive 15 or 20 years later,’ she says.

‘Today, there is a greater choice of treatments, and there is research that supports the theory that better supportive care (including diet, exercise and stress management) and communication with the treatment team helps people survive longer and better.’

Treatments have improved metastatic breast cancer outcomes so much that, for some people, it can be managed like a chronic disease, with extended periods of wellness and strategies to minimise episodes of being unwell.

The newest development in treatment for metastatic breast cancer is the CDK inhibitors, a new class of drugs to treat hormone receptor positive, HER2-negative metastatic breast cancer.

These tablet-based treatments are given with hormone blocking therapies and make them work harder, helping to stop cancer cells becoming resistant to treatment.

‘This means on average a longer period of disease control,’ says Professor Boyle.

‘BCNA has been working with oncologists to try to secure PBS funding for these drugs.

‘When approved, subsidised treatment will initially only be available for women with newly diagnosed metastatic disease (so called “first-line” treatment), as this is where their greatest impact is expected.

‘Other treatments in trial at present include other strategies for overcoming resistance. Some of these will use cancer DNA mutations detected in the blood to select patients most likely to respond,’ she says.

For women with genetic breast cancer (BRCA1 and 2 mutations) new drugs called PARP inhibitors will be available soon, as will more widespread gene testing.
‘I’ve been looking after people with metastatic breast cancer for 20 years now and in that time I’ve seen the most amazing changes – for HER2-positive disease particularly,’ says Professor Boyle.

‘And yet the frustration is that we’re not there yet.

‘I think we are going to see people cured of this disease – hopefully in my working lifetime. In the meantime, we’ve transformed a rapidly fatal disease into a disease where mostly people can live well.’

If you have recently been diagnosed with metastatic breast cancer, order BCNA’s free Hope & Hurdles pack by calling 1800 500 258 or visiting bcna.org.au.

What is metastatic breast cancer?

Metastatic breast cancer (also called stage IV, secondary or advanced breast cancer) is breast cancer that has spread beyond the breast to other organs in the body, most often the bones, liver, lungs or, less commonly, brain. Although metastatic breast cancer has spread to another part of the body, it is considered and treated as breast cancer. For example, breast cancer that has spread to the bones is still breast cancer (not bone cancer) and is treated with breast cancer drugs, rather than treatments for a cancer that began in the bones.

Professor Fran Boyle AM

Professor Fran Boyle AM

Issue 82
Autumn 2018