At 55, can bone-targeted therapy cure my mom’s back pain?

Question

Hello doctor,

My mom is 55 years old and has metastatic breast cancer. It is an estrogen receptor-positive / human epidermal growth factor receptor 2-negative (ER+/HER2-) breast cancer. Her PET scan shows spread to the bones. Her cancer antigen (CA 15-3) is high at 62 units per millilitre. She is on hormone therapy and a cyclin-dependent kinases 4 and 6 (CDK4/6) inhibitor, but has severe fatigue and low white blood cell counts. She’s worried about the quality of life and her treatment burden. Please tell,

What is her realistic long-term outlook for women in this stage?
Can bone-targeted therapy help with her back pain?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

I am very sorry that your mother has reached the stage of metastatic breast cancer. But of course, this is not the end of life. With metastatic breast cancer, we have more than one line of treatment, especially since you mentioned that your mother is estrogen receptor-positive (ER) and progesterone receptor-positive (PR). This gives us the opportunity to rely on targeted hormonal therapy and also to rely on immunotherapy and make good use of it.

Regarding cyclin-dependent kinase 4 and 6 (CDK) inhibitors, they are very good medications, and the doctors can give medicines like Everolimus, Fulvestrant, Palbociclib, and Ribociclib. We have many drugs we can use at this stage. As for the cancer itself, these treatments help limit and delay the spread, reduce the spread, and also improve her quality of life. At this stage, it is also very important that we rely on Denosumab.

Denosumab (a bone antiresorptive medication) is taken monthly, and we need to take calcium and vitamin D with it as supplements. It reduces the spread of the tumor to the bone, decreases bone pain, and also improves bone strength. At this stage, if the pain is severe, the doctors can give her localized radiotherapy to the area where the pain is.

Doctors can use non-steroidal anti-inflammatory drugs to control her pain. For a healthy life she can follow the steps mentioned below.

For proper nutrition, she must have small, frequent meals.
She needs to stay hydrated all the time.

Since you mentioned that she is ER-positive or PR-positive, I suggest that she undergo a genetic test or a BRCA test. In case she turns out to have the breast cancer gene (BRCA-positive), then the doctors will consider PARP (Poly (ADP-ribose) Polymerase) inhibitors for her and also recommend doing a BRCA test for her daughter if she is more than 25 years old. In such cases, doctors can use an appropriate preventive strategy for everyone in your family.

I hope this information helps you.

Feel free to ask further queries.

Thank you.