Would immunotherapy help in metastatic breast cancer?

Question

Hello doctor,

My 54-year-old sister was diagnosed with metastatic breast cancer eight months ago, and I feel completely lost about what to do next. She was originally diagnosed with stage II breast cancer four years ago and underwent chemotherapy and radiation. We all thought she was cured, but now the cancer has spread to her bones, spine, ribs, and pelvis, and there are also spots in her liver on the CT scan.

Her oncologist started her on letrozole and palbociclib, but the bone pain has become unbearable, even with oxycodone 15 mg every four hours. Her tumor marker (CA 15-3) increased from 45 to 178 in just two months, which her doctor says indicates the cancer is progressing.

She is also going through menopause due to the cancer treatments, which makes everything worse, with hot flashes and mood swings. Radiation to her spine provided some relief, but now she has developed a compression fracture in the T7 vertebra. Her hemoglobin level has dropped to 8.9, and her platelet count is 89,000, likely due to the chemotherapy.

She has three children under 16 and keeps asking how much time she has left, but the doctors will not give a clear answer. Are there any other treatment options for metastatic breast cancer that might work better? I’m also worried about her liver function since her ALT is now 67.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I am truly sorry for what your sister and your family are going through. Metastatic breast cancer can feel overwhelming, especially after fighting the disease once before and hoping it was behind her. When cancer spreads to the bones and liver, and a treatment such as letrozole with palbociclib is no longer holding it back, it is understandable to feel frightened and desperate for options. The rise in tumor markers and worsening bone pain suggest that the current regimen is losing effectiveness, but there are still other treatments that oncologists may consider in this situation.

Many patients who progress on the first line of hormonal therapy with a CDK4/6 ( cyclin-dependent kinase) inhibitor are switched to a different targeted approach, such as Fulvestrant combined with another CDK inhibitor, or medications that target the PI3K pathway if her tumor has that mutation. If her cancer is HER2-positive or triple-negative, there are newer therapies, such as antibody–drug conjugates, that can work even after chemotherapy.

When the liver is involved, the oncology team carefully monitors liver enzymes and may adjust medications or change treatment strategies to avoid further liver injury. Her hemoglobin and platelet counts are low, which can occur due to chemotherapy or bone marrow involvement. In these situations, transfusions or medications to support blood counts may help.

Her bone pain is a very heavy burden and should never be ignored. In addition to strong pain medications, drugs such as denosumab or zoledronic acid can strengthen the bones, reduce pain, and lower the risk of fractures. Radiation to painful bone areas can be repeated in selected spots, and some patients benefit from procedures like vertebroplasty to stabilize compression fractures.

Palliative care is not only for end-of-life situations but is a specialty focused on controlling pain, nausea, fatigue, and anxiety while cancer treatment continues. Many patients feel better and stronger with this kind of support.

I hope this helps.

Please follow up if you have any further concerns.

Thank you.