Mother Diagnosed with metastatic breast cancer to bones (spinal vertebrae)

[checddd]

Hi,

My Mother had breast cancer (Stage 3, er+ve, with lymph node involvement) in June 2011. She had lumpectomy, Chemotheraphy, and Harmone Theraphy (Letrozele).

She was Cancer free for 3 and half years and has been currenlty diagonsed with metastatic breast cancer to bone (spinal vertebrae).

She is now taking Hormone Theraphy (tamoxfin) and Everolimus (Affinator) for controlling the tumor growth. She underwent 10 rounds of initial radiation theraphy to relieve pain.

I just want to know if the treatment plan is ok?

Also, I want to connect with people who have similar diagnosis so that we could talk

Thanks

Dude

[Hidden]

Sorry to hear. Wait for docs' advice.

[checddd]

Thanks I wanted Dr submits opinion abt the treatment plan

[checddd in reply to checddd]

Also she is taking biophosponates

[manish_vkg TeamBCI]

Dear please lets know the current diagnosis in detail and your mother age then dr. Can provide best suggestion...

[checddd]

My mom is 60 yrs old. The current status is metastasic breast cancer (stage 4). The cancer has spread to her spinal vertebrae. She is taking tamoxfin and everolimus. And once a month biophosponate(intravenous)

[kontak TeamBCI]

Really sorry to hear about your mother. Lets wait for Doctors to advice

[roxboxfox RadiationOncologist]

Sorry to hear about this Dude (checddd)

First of all has a Her2 neu receptor status been done.

Its good that early radiatio m tp the spine has been given and Bisphosphonates have been initiated to prevent any future Skeletal related events.

I am presuming that a CT scan has been performed and there are only Spine (bone) mets and no evidence of Visceral (lung / liver) metastasis here. If not done it needs to be done

For spine (bone) only mets, my preference is to initiate pts on Exemestane 25 mg Po od +Everolimus based on the robust data from BOLERO-2 Trial.

The idea being to overcome the aromatase inhibitor resistance by allosyeric mTOR inhibition thru Everolimus.

Though I muat admit there is data from TAMRAD study as well which is a phase 2 study has also shown similar benefit where Tamoxigen was added to Everolimus.

With Best wishes

Dr Rohit Malde

[checddd in reply to roxboxfox]

Thanks for the response doctor. Good to know that the treatment is heading in right direction.

Yes CT Scan was done and only bone metastis was detected and no visceral metasis was found.

The Her2 neu receptor was done for the original tumor which was detected on her left breast three and half years ago. The Her2 neu receptor status was negative then. The BCRA1 status wa negative and it was only er+ve. She had a recurrence now in December 2014. Should we do a biopsy again, is it possible to do bone biopsy?

Thanks

Dude.

[roxboxfox RadiationOncologist in reply to checddd]

Change in her2 status is seen in 2-5% as quoted in clinical papers.

Though I have not personally seen this.

As mentioned previously in one of Sumeets post on Her 2 testing on this forum, if its done in a reliable good reputation pathology lab with decent volume and experience of handling Her 2 samples, then its reliable but if not at times ppl do repeat the Her 2 status.

In your moms scenario there is no point in recommending bone biopsy at this point in time as

1) Bone biopsy is always difficult

2) Biopsy from spine is not without serious rrisks

3) she has already received Palliative RT.

You re on right track, be content and let u r mom have a good pain free quality of life.

These are the best days. Take her on pilgrimage or holidays this summer. Keep her happy as long as possible.

You understand this is now incurable but certainly controllable for quite few years to come.

All the best

Dr Rohit Malde

[napra]

Dear Friend,

I can understand what you and your dear ones must be going through on account of your mother's condition. The only thing i can tell you is, make her feel loved. express how important she is for you. The rest she will manage.

At this point i remember a beautiful poem written by an indian poet by name Nizzim Ezekiel, in which the mother feels glad that a scorpion had stung her and spared her children. She doesn't mind the pain at all.

This is how your mom will also think. She will make it a point to comfort you all.

The gift of love is all that she needs.

meena prasad

[sumeet_shah Administrator]

Sorry for my delayed reply

I perfectly agree with roxboxfox above.

There are times when the disease may not be curable, so our aim remains to keep her disease under control and ensure a good quality of life.

One thing I must tell you is, if the disease is limited only to bones and has not spread to organs or nodes, then outcome is better than those where disease has spread to liver / lungs / brain / nodal systems. I know quite a few patients who have ER positive disease and later developed only bone metastases and are pulling on quite well for last few years. Of course, every patient is different, but considering other types of metastases, statistics are in favour of your mom.

Bisphosphonates aer being given to strengthen the bones and also for their 'immuno modulator' effect. You can google that and read it up.

[checddd]

Thanks for the response doctor