Are there newer treatments for metastatic breast cancer?

Question

Hello doctor,

I am 52 years old and was diagnosed with metastatic breast cancer eight months ago after finding a lump that turned out to be stage 4 with spread to my liver and bones. The oncologist put me on Letrozole and Palbociclib, but my liver enzymes keep going up.

My ALT is 156, and AST is 134, which is far higher than normal. The bone mets in my spine are causing severe pain, and I am on Oxycodone every four hours, but still cannot sleep at night. I had six cycles of chemotherapy before starting the targeted therapy and lost all my hair, which has not grown back yet.

My CA 15-3 tumor marker was 89 last month, which the doctor said is stable but not going down. The metastatic breast cancer has also caused fluid buildup around my lungs, and I have had it drained twice already.

I am also in menopause now from all the treatments, and having severe hot flashes that wake me up soaking wet.

Are there any new treatments for metastatic breast cancer that might work better?
How long can I expect these medications to keep working before the cancer becomes resistant?
How do I explain prognosis to my teenage daughter?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

I hope you are doing okay. I am very sorry to hear about your diagnosis of metastatic breast cancer. I know how difficult and stressful this can be. It causes a lot of fear and worry for you and your family, especially since you have a teenager at home. Teenagers understand everything that is going on, and that makes it even harder.

I suggest that your daughter join a family cancer support group. It will help her understand your condition better and learn how to cope with it. You can reassure her that today there are many treatment options for breast cancer. Cancer is not like it used to be.

There are many new medicines and ongoing clinical trials. Every day, new treatments appear that give hope, help control the cancer, and allow patients to live longer and better lives.

Regarding your case, as I mentioned, you have already had hormone therapy with Palbociclib, but the disease has progressed. That is not the end. There are still many other medications that can be used, such as Exemestane, Fulvestrant, PARP (poly ADP ribose polymerase) inhibitors, and several others.

The choice depends on your genetic test results (genetic panel). Once we know your genetic results, we can adjust your treatment plan and choose the most effective medicine for you.

These newer drugs can work very well and keep the disease under control for many years, sometimes four to seven years or more. It depends on the patient’s strength, will to continue treatment, and desire to live and keep fighting.

I truly believe in your strength, and I am confident that you can keep going, for yourself and for your children. You have the power to change the way you face this illness. I would like you to think of it as something manageable, something that has treatment options and several ways to control it.

Regarding the side effects you are experiencing now, hair loss typically improves once chemotherapy is discontinued. It takes some time, but it does grow back. In the meantime, you can try wearing a wig that makes you feel comfortable and gives hope to both you and your family. It helps everyone feel that things are okay.

As for the severe hot flashes, there are medications like Gabapentin that can help control them well. They are expected at your age and because of the hormonal treatments you are receiving, but they can be managed to make you more comfortable.

Regarding the pain that keeps you awake at night, we usually advise taking your pain medication, such as Codeine, a little before bedtime to help you sleep better. Another good option is using pain control patches, which work through the night and help keep the pain under control.

Regarding the bone pain, localized radiotherapy can be used if we can clearly identify the exact area that is hurting. This type of focused radiation usually helps relieve the pain effectively. At the same time, we give Zoledronic acid to help strengthen the bones. And of course, we should never forget to take vitamins, especially multivitamins, calcium, and vitamin D.

It is also very important to pay attention to nutrition, eat plenty of vegetables and fruits, and stay well hydrated every day. These small things make a difference in your overall health and energy. I truly hope you can start seeing things with more hope and positivity than before.

I hope that this answers your query.

Kindly follow up if you have more doubts.

Thank you.