How to manage my sister's metastatic breast cancer?

Question

Hello doctor,

My 44-year-old sister was diagnosed with metastatic breast cancer eight months ago, and the treatments do not seem to be working anymore. She initially had stage 2 breast cancer three years ago and underwent a mastectomy, chemotherapy, and radiation. Everything looked good until a routine CT scan showed spots in her liver and bones. Her tumor markers, CEA and CA 27 to 29, keep going up despite being on Letrozole and Ribociclib.

The oncologist just added Fulvestrant injections, but she is having terrible hot flashes and joint pain that make it hard to take care of her 12-year-old twin daughters. Her latest scan shows new lesions in the spine and pelvis. The bone pain is so bad that she needs Oxycodone just to get through the day, but it makes her drowsy and constipated. She is also losing weight without trying, down 20 pounds in two months.

Worried about how much time she has left and what to tell her daughters.
Are there clinical trials she should consider?

Her cancer is ER-positive, PR positive, and HER2-negative.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I completely understand your fear and the anxiety you are living with now after the recent diagnosis. But I want to tell you that we never lose hope. Every day, there is a new medication, and there are so many drugs that your sister can use, which can help her, improve her condition, and make a big difference for her.

Currently, she is on Fulvestrant. Fulvestrant is an effective medication; it reduces bone metastasis and metastases in general. If she does not feel comfortable on it, she can take Exemestane or Olaparib. It is also essential and very possible for us to enroll her in a clinical trial. This will make a big difference for her.

She will receive the medications with Fulvestrant and use them, and the treatment will be free for her and suitable for her, God willing. The second point is that emotional support must be maintained well. Emotional support is very important at this stage. There is no such thing as being terminal, and there is no such thing as the end of life. Every time there is a new medication, and there are new things that give us new hope, and we can live with them and cope with all the symptoms, because everything has a treatment.

For bone pain, she has to take localized radiotherapy to relieve the pain and monthly Denosumab with calcium and vitamin D to strengthen the bone and decrease metastasis, along with proper nutrition, fruit and vegetables in small, frequent meals, and keep herself well hydrated.

The treatment plan includes palliative radiotherapy, Denosumab monthly, and targeted hormonal therapy. Regarding follow-up, it is seven days.

Preventive measures include BRCA 1 and 2 (breast cancer gene 1 and breast cancer gene 2) for sisters and daughters after the age of 25.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.