options after 5-year battle with breast cancer - 1262720

andreea
Posts:4

Hi,
My name is Andreea and my mother was diagnosed with metastatic breast
cancer 5 years ago. We are in Romania, and we wonder what would be the
treatment options for a patient in US with similar condition.

I apologize for the long message, I didn't know which data is most relevant.
**
- diagnosed 5 years ago, my mother is now 67. Found bone mets to some
neck vertebras and two small tumors (< 1cm) in the breast.

Current status
- very low blood pressure (80/40)
- complete lack of teeth, jaw necrosis - infection, almost
- continuously on antibiotics.
- bad liver tests, some > 100 times the normal values.
- markers for breast cancer: 4000, never went below 200. I understand they must be 30.
- a spot (possible met) in lung, she's been complaining for a few days
of painful breathing.
- severe constipation, continuous use of laxatives
- bone mets on all segments of the spine, pelvic bones, ribs, shoulders, skull
- very hard to walk, pain in the ribs and chest
- most of the time bedridden, pain when moving, general weakness
**
Current treatment
- for pain: fentanyl patches, diclofenac, sevredol (morphine sulfate)
- for constipation: duphalac.
- some drugs for heart and cholesterol
- for vomiting: metroclopramid
**
Earlier treatment:
- at first radiation (about 6 cycles) for neck vertebras and recently
about 3 months for pelvic bones.
- zometa
- femara
- taxotere + farmorubicin (6 cycles)
- myocet until two months ago, stopped because of side effects.
- almost continuous chemo since diagnosis
**
So, I'd like to know which options would you have for a patient in a
similar situation. Also, if you could point me something to read, that
would be very helpful!

Thanks a lot!

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Reply # - March 12, 2014, 08:36 AM

catdander
Posts:

Hello Andreea, We had a very similar question just the other day and was answered by Jim, "As with lung cancer, after five years there may not be a clear cut “standard of care”, but if your friend posts she will likely get a discussion of options.
If she reads Dr. Cianfrocca’s Breast Cancer 101 post at http://cancergrace.org/breast-cancer/2011/09/06/breast-cancer-101/ she will see the types of information she should provide. As Dr. Cianfrocca stated:

“The best treatment for an individual patient depends on multiple things including:
The stage and type of the breast cancer
Certain characteristics of the breast cancer cells, including the presence of estrogen and progesterone receptors and whether or not HER2 is overexpressed.
Whether the woman has gone through menopause
The woman’s overall health including other medical conditions” "
In addition, it would be helpful to know BRCA mutation status.http://cancergrace.org/topic/breast-cancer-recommendations#post-1262642

I hope this gives you a good reference to ask a more specific question. Here too is a link to other blog posts in our library, http://cancergrace.org/breast-cancer/

All best,
Janine

Reply # - March 12, 2014, 01:15 PM

andreea
Posts: 4

Thank you, Janine,

I wil add the result of the biopsy (for breast tumours).

invasive ductal breast carcinoma, well differentiated (grade 1)
ER positive 40-50% in cancer cells
PGR positive 40-50% in cancer cells.
C-erbB-2 weak positive discontinuous membrane in dispersed cancer
cells (-/+). Not sure how to translate this.
Ki67 positive ~10% in cancer cells.

Reply # - March 12, 2014, 03:13 PM

Dr West
Posts: 4735

I'm sorry that we really can't provide a recommendation of how specifically to proceed. Our goal is to provide a framework of the rnage of options and the general principles we'd use to select an appropriate treatment, but we aren't in a position to make an individualized treatment recomemendation to someone who isn't our patient. Instead, the general information should provide guidance that you can use to apply to your specific scenario.

Good luck.

-Dr. West

Reply # - March 16, 2014, 12:36 PM

andreea
Posts: 4

Thank you for your answer! Yes, I understand that we cannot get medical advice here. My goal is to learn the guiding general principles you use for patients in roughly the same situation, so that, together with the doctor of my mother, we can take the best decisions.

I'd have some general questions, maybe you can comment on them.

1. What intervention is best for the almost continuous vomiting she experiences (like 4-5 times in 12 hours)?

2. Her doctor suggested Faslodex. From your experience, what are the common side effects in weak patients? Is it true that the potential benefits of this drug outweigh its side effects?

3. In such a situation, when the patient is weak and without apetite, is it helpful to strengthen the body with IV perfusions with glucose and other nutrients (like vitamins)?

Thanks for your help!

Reply # - March 16, 2014, 04:00 PM

catdander
Posts:

1. This links to 3 posts on the subject of nausea and vomiting. http://cancergrace.org/cancer-treatments/tag/emend/

If your mom is having IV treatments the drug emend is often given at the same time and has a tremendous benefit for many people. There are a couple of other drugs that can be prescribed, one that is taken in anticipation of nausea and one taken after onset. All of these drugs were very helpful for my husband while in treatment. Some can be taken as a suppository if a pill can't stay down.

2. Given as FDA approved the drug has shown that the benefits outweigh the harm in a significant number of people. From the Mayo Clinic website, "Fulvestrant injection is used to treat metastatic breast cancer (cancer that has spread) that is hormone-receptor positive in women who have already stopped menstruating (postmenopausal). It is used for women who have breast cancer that has not improved after using other cancer medicines.

Many of the breast cancer tumors will grow when estrogen is available in the body. This medicine blocks the effects of the estrogen hormone in the body. As a result, the amount of estrogen that the tumor is exposed to is reduced, which will limit the growth of the tumor." http://www.mayoclinic.org/drugs-supplements/fulvestrant-intramuscular-r… The side effects of faslodex can be found in the Mayo link above and click on "side effects" in the left column.

3. Dr. West has written on the subject weight lose, http://cancergrace.org/cancer-treatments/2009/02/16/acs-mgmt/ Unless a person is expected to make a substantial recovery a feeding tube can easily cause more damage than benefit so should to discussed with the doc.

I hope this helps,
Janine

Reply # - March 16, 2014, 04:32 PM

JimC
Posts: 2753

Hi andreea,

(Janine hit the "submit" button much faster than I did, but I'll let my replies stand in case they contain additional information or an alternate perspective that is helpful to you).

There are various agents that can be used to combat vomiting, and sometimes they just have to be tried sequentially to see which works best for a particular patient. You can read Dr. Harman's post on this here: http://cancergrace.org/cancer-treatments/2009/05/19/cinv/ and this presentation on the related subject of nausea (for which many of the same medications are used): http://cancergrace.org/cancer-treatments/2012/08/03/dr-stephanie-harman…

Usually the doctor will make an initial determination on whether a patient has the strength to tolerate a particular treatment, but each patient reacts to a treatment in a different way, so it's usually not possible to anticipate which of the most common side effects will cause one particular patient the most trouble.

As far as dealing with lack of appetite and weight loss, Dr. West has written a post on this subject of anorexia-cachexia syndrome” (ACS) here: http://cancergrace.org/cancer-treatments/2009/02/16/acs-mgmt/ As he says:

"ACS is actually divided into a primary form, which is weight loss caused by a metabolic syndrome directly by the cancer, and a secondary form that is weight loss caused by barriers like nausea, mouth sores, esophagitis, taste changes related to chemotherapy, and other indirect causes of decreased food intake."

[continued in the following post]

Reply # - March 16, 2014, 04:35 PM

JimC
Posts: 2753

[continued from previous post]

He went on to say:

"How is it treated? Historically, people have tried to push food into people, but studies have actually shown that in patients with primary ACS, nutritional support doesn’t translate to improvement in body mass. This is because the body still continues to break down proteins in the face of higher caloric intake. But nutritional support, whether in the form of concentrated high calorie and high nutrition food like Boost or Ensure, or tube feedings directly into the stomach, or even IV nutrition, can be helpful for patients with secondary ACS. This is because secondary ACS isn’t accompanied by the metabolic spiral that nullifies the benefits of nutritional support."

So the bottom line is that if the lack of appetite is caused by the cancer itself, trying to push nutrients into a patient's body tends not to be effective; instead, an effort may be made to stimulate appetite.

JimC
Forum moderator

Reply # - March 16, 2014, 08:02 PM

Dr West
Posts: 4735

I would say that the most effective intervention when people are very sick as a potential symptom of the underlying cancer is to treat the cancer as effectively as possible. Fortunately, hormone therapies for patients with a hormone receptor (estrogen and/or progesterone receptor)-positive breast cancer typically have an extremely favorable "therapeutic index", the balance of efficacy vs. side effects. Efficacy can be very great, and the side effect profile is typically relatively mild, with muscle/joint aches often being the leading issue. If the treatment works to combat the cancer effectively, as is often the case, the balance is overwhelmingly favorable for hormone therapy.

I would say that, in contrast, doing glucose-laden fluid infusions and vitamins is not remotely likely to be an effective strategy if the underlying cancer is not being treated optimally.

Good luck.

-Dr. West

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