How do I manage both breast and ductal cancer at 56?

Question

Hi doctor,

I am a 56-year-old woman diagnosed with metastatic breast cancer that has spread to my bones and liver. I was originally treated for stage II invasive ductal carcinoma five years ago with a mastectomy, chemotherapy, and hormonal therapy (Letrozole), but the disease recurred last year.

My recent PET-CT scans showed multiple lytic lesions in the spine and pelvis, along with liver metastases measuring up to 2.5 cm. My CA 15-3 level is 145 U/mL, and alkaline phosphatase is 320 IU/L, both significantly elevated.

I experience severe bone pain, especially in my lower back and hips, which makes it difficult to walk or sleep. I am currently taking Palbociclib with Fulvestrant, along with Zoledronic acid every four weeks for bone protection, but fatigue, nausea, and hair thinning have been challenging. My hemoglobin is 9.6 g/dL, and I often feel weak and dizzy.

Emotional distress and anxiety about the future are also affecting my sleep and appetite. My oncologist mentioned newer targeted therapies and immunotherapy options for HR-positive, HER2-negative metastatic disease, but I am unsure which might be suitable for me. Are there any recent advances or clinical trials that offer better control of metastases and improved quality of life for someone in my condition?

Please help.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

I am really sad that your disease has metastasized to your liver and bones, but I want to reassure you that we can still control the disease, prevent further spread, and reduce its impact on your daily life. We also have effective second-line targeted hormonal therapies, such as Alpelisib or Everolimus, that you may be able to take. I would like to know whether your tumor was HER2-positive (human epidermal growth factor receptor 2) or negative to help choose the most appropriate immunotherapy for you.

It is very good that you are receiving monthly Zoledronic acid, as it helps protect your bones. Please remember to take vitamin D and calcium supplements, along with iron and multivitamins, to support your overall health. Try to eat small, frequent meals and stay well-hydrated.

For localized bone pain, I strongly recommend palliative radiotherapy, which can significantly reduce discomfort. You should also take painkillers according to your pain scale so that your pain is adequately controlled.

Please do not lose hope; there are still many treatment options available for you. You may also benefit from joining a support group to help you cope during this difficult stage. Participating in clinical trials is another valuable option, as it can give you access to new forms of immunotherapy at no cost.

I hope this has helped you.

Please feel free to reach out to me again for further queries.

Thank you.