How to treat my 50-year old aunt's stage IV breast cancer?

Question

Hello doctor,

My aunt is diagnosed with stage 4 ductal carcinoma in her right breast. She is in her late 50s. The doctors have done certain genetic testing and identified a BRCA mutation in her. What is her survival possibility?

What is this BRCA mutation, and how does it contribute to her disease condition? Whether surgical removal of the affected breast be beneficial? Her receptor test reports were ER positive, PR negative, and HER2 positive. What is the best treatment for her condition?

She also has Parkinsonism and diabetes. How is this going to affect her cancer treatment? Can surgical removal of the affected breast help? We are worried about her and do not know how to help her feel better. She is becoming weaker day by day, and what is the best food that will help her deal with this deadly disease?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understand your concern.

The treatment plan usually depends on the receptor status of the tumor. Stage IV breast cancer is treated with a combination of hormone therapy, chemotherapy, targeted therapy, and immunotherapy depending on receptor positivity and BRCA (breast cancer gene) status.

BRCA mutation is suggestive of hereditary breast cancer, and there are drugs like PARP inhibitors (poly ADP ribose polymerase) (Olaparib), especially for those with variants in the BRCA gene. Genetic screening of the family, specifically sisters and daughters, should be conducted.

Since the tumor is ER-positive (estrogen receptor) it would respond to anti-estrogen or aromatase inhibitor therapy. Trastuzumab with a Taxane is beneficial as HER2 (human epidermal growth factor receptor 2) receptors are also positive. The use of antiestrogenic treatment and Taxane may be associated with the worsening of Parkinsonism which necessitates close monitoring.

Surgery is usually reserved to control symptoms and palliation. Palliative radiation may be used in controlling bulky primary disease and metastases to the brain, bone, and lungs.

Consult an oncosurgeon and a medical oncologist; a multidisciplinary team, including an endocrinologist and a neurologist, would be best to create a tailored treatment plan.

I hope I have answered your questions.

Let me know if I can assist you further.

Regards.