How to treat metastatic breast cancer at age 46?

Question

Hello doctor,

I am writing on behalf of my 46-year-old sister, who has been battling breast cancer for the past three years. Unfortunately, her recent PET scan showed metastasis to her bones and liver. She is currently on Letrozole and Denosumab injections.

Lately, she has been experiencing extreme fatigue, hot flashes, irregular bleeding, and bone pain. We are worried that these symptoms may mean her treatment is not working anymore. She is also anxious about menopause being induced by her therapy.

Is there any way to manage her hormonal imbalance without interfering with her cancer treatment?
The oncologist mentioned switching to a CDK4 or 6 inhibitor, so I want to know what side effects we should expect and whether it will affect her chances of living longer. Also, her calcium levels have been fluctuating. Could that be related to Denosumab?

Please advise if we should consider a second-line hormonal or targeted therapy now.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

I completely understand the fear you feel for your sister and the worry you have about her. This situation can be scary and stressful for the family, but I want to reassure you that she still has many treatment options and opportunities.

We have several hormonal and targeted therapy options, such as Fulvestrant or Exemestane. She could also receive CDK4 (cyclin-dependent kinase 4) or 6 inhibitors, which are another good option. Medications like Palbociclib and Ribociclib generally have few side effects, mainly mild fatigue and some gastrointestinal discomfort.

For the bone issues, she can take Denosumab monthly, which is a very suitable option and usually does not cause major problems with calcium levels. She may also benefit from localized therapy for areas affected by the cancer.

She will need good nutritional support and should take small, frequent meals, along with strong emotional support from you. It is important to stand by her and help her get through this phase. Please encourage her to stay well hydrated, maintain balanced nutrition, and surround herself with emotional comfort.

Regarding treatment options, new therapies and clinical trials are continually emerging. Cancer spread does not mean it is uncontrollable; it simply means her treatment plan needs adjustment. With the proper care, she can continue to fight effectively and remain stable.

Please do not hesitate to ask any questions at any time.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.