What is the treatment for my metastatic breast cancer?

Question

Hello doctor,

I was diagnosed with stage II breast cancer four years ago. I underwent a mastectomy and chemotherapy and was told I was cancer-free. Recently, however, scans have shown that the cancer has returned and spread to my bones (spine, ribs, pelvis), liver, and lungs. Over the past few months, I have been experiencing severe bone pain, persistent shortness of breath, extreme fatigue (I can barely leave bed), unintentional weight loss of about 30 pounds, and occasional confusion and headaches.

My oncologist informed me that this is now stage IV metastatic breast cancer, which is no longer curable but treatable, and this news has been devastating for my family and me. My pathology report shows ER-positive, PR-positive, and HER2-positive disease, with a tumor marker CA 27 to 29 of 310 U/mL (normal less than 38).

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

I want to reassure you that your condition can still be managed and controlled with the right treatment plan. At this stage, we can consider single-agent chemotherapy if your general health allows it. If chemotherapy is not suitable, we can move to targeted therapy, which is often better tolerated and has fewer side effects. Nowadays, there are several drugs that fall under the targeted therapy category. These medications are more precise in their action, cause fewer side effects than chemotherapy, and can significantly improve the patient’s condition by keeping the disease under control and preventing further spread.

Since your cancer is hormone receptor–positive, we can use hormone-targeted therapies such as:

Fulvestrant.
Ribociclib.
Palbociclib.
Anastrozole.

These drugs are effective in slowing disease progression and maintaining a good quality of life, with far fewer side effects than traditional chemotherapy.

When it comes to bone pain caused by bone metastases, we can use Denosumab (a monoclonal antibody that strengthens bones and minimizes complications related to bone metastases). Along with this, we will provide vitamin D and calcium supplements to support bone health.

For localized pain, radiotherapy can be applied to specific areas to provide relief. In addition, pain management will include medications such as nonsteroidal anti-inflammatory drugs (NSAIDs). If the pain persists, we may escalate to weak opioids, and if necessary, strong opioids, under the guidance of the palliative care team, who will customize pain management according to your needs.

Nutritional support and adequate hydration are also very important parts of your care plan. Maintaining good nutrition will help your body cope better with treatment and recovery. Once we start the hormonal targeted therapy, most symptoms are expected to improve, breathing becomes easier, bone pain decreases, and overall physical function gets better.

I truly hope this message provides you with reassurance and positivity.

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

Thank you.