Medications for extensive breast cancer spread

[blms]

Metastatic Breast cancer survivors

Liver and Bone mets.

[Bestbird]

Treatments depend upon the subtype. Whether the cancer is hormone receptor negative or positive, and whether it is HER2 positive or negative.

Either way, bone-directed therapies such as Xgeva or Zometa are recommended for bone mets.

[kduck in reply to Bestbird]

Could you tell me what treatments are for liver mets if you are ER+HR+HER2-. My doctor is talking about IV Chemo and I feel as if there are more hormonal treatments I could try first? Thanks

[Bestbird in reply to kduck]

Below from my book (which is also available as a complimentary .pdf) called "The Insider's Guide to Metastatic Breast Cancer" is an excerpt about approved non-chemo treatments. For detailed information about treatments, side effect mitigation, cutting edge research and more, please visit insidersguidembc.com

First Line Hormonal and Targeted Treatment Options for Postemopausla HR+, HER2- Patients:

• The combination of a CDK4/6 inhibitor such as Ibrance (Palbociclib), Kisqali (Ribociclib) or Verzenio (Abemaciclib) with either an Aromatase Inhibitor (Letrozole [Femara], Arimidex [Anastrozole], or Aromasin [Exemestane]) or with Faslodex (Fulvestrant) is the current standard-of-care as initial treatment.

• An Aromatase Inhibitor alone.

• Faslodex (Fulvestrant) with either Letrozole or Arimidex.

• Faslodex alone.

• Tamoxifen (Nolvadex) or Fareston (Toremifene) alone (rarely used as a first-line therapy).

Second Line Hormonal and Targeted Treatment Options depend upon what endocrine therapy you have previously taken:

• Possibly any of the above therapies.

• Piqray (Alpelisib) in combination with Faslodex if your cancer has a PI3K mutation (more about this below).

• Talzenna (Talazoparib) or Lynparza (Olaparib) if you have a germline (inherited) BRCA1 or BRCA2 mutation (more about this below).

• Afinitor (Everolimus) with either Aromasin, Faslodex, or Tamoxifen.

Third and Fourth Line Hormonal and Targeted Treatment Options depend upon what endocrine therapy you have previously taken:

• Possibly any of the above therapies (although not all options are widely used in a third- or later-line setting).

• Verzenio alone (after disease progression on endocrine therapy and prior chemotherapy for MBC).

• Either Ethinyl Estradiol, Megace (Megestrol Acetate), or Halotestin (Fluoxymesterone).

Chemotherapy is usually prescribed after 2 to 3 lines of endocrine-based therapies (and/or the targeted therapies above) have stopped working. A clinical trial may also be a consideration. Once the cancer has regressed or stabilized, it may be possible to go back on a previous therapy if sufficient time has elapsed and if the initial response to the therapy had been favorable.

DID YOU KNOW?

If you have bone metastases, you should receive a bone-directed therapy such as Xgeva (Denosumab) or Zometa (Zoledronic acid) in addition to your other therapy.

If your cancer has progressed on first-line hormonal therapy and has a PI3K mutation, then you are eligible to take Piqray (Alpelisib) tablets along with Faslodex. Piqray is a PI3K inhibitor that has shown a clinically meaningful benefit in treating patients with this type of breast cancer. A diagnostic test called “Therascreen PI3KCA RGQ PCR Kit,” has been FDA-approved to detect the mutation in a tissue and/or a liquid biopsy.

If you have a germline BRCA mutation, you may want to speak with your doctor about taking a PARP inhibitor such as Talzenna (Talazoparib) or Lynparza (Olaparib), which are FDA-approved for HER2 negative MBC patients with a BRCA mutation. Talzenna or Lynparza is generally prescribed for hormone receptor positive, HER2 negative MBC patients with a BRCA mutation after first- or second-line therapy has failed.

Although very rare, if your cancer has microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) characteristics, or is Tumor Mutational Burden-High (TMB-H), and if you’ve progressed on prior therapy and have no satisfactory treatment options, then the PD-1 inhibitor Keytruda (Pembrolizumab) is an FDA-approved option.

If your cancer has a Neurotrophic Receptor Tyrosine Kinase (NTRK) gene fusion without a known acquired resistance mutation, and if you’ve progressed on prior therapy and have no satisfactory treatment options, Vitrakvi (Larotrectinib) and Rozlytrek (Entrectinib) – oral tyrosine kinase inhibitors that act as an "on" or "off" switch in many cellular functions – are FDA-approved options. NTRK fusions are extremely rare, occurring in only about 0.5–1% of common cancers.

[Marieleb]

Hello. Responded to you on another post for liver mets but with regards to treatment there are quite a few... Will list the ones I had in case helpful. My MBC (ER+ HER2 - )was de novo to Bones and lymph nodes ( May 18) with further spread to liver in Dec 19.

1. Ibrance/Letrozole

2. Everolimus/ Afinitor

3. Faslodex

4.Xeloda

5. Taxol

6. New clinical trial drug - Sacituzumab Govitecan ( if I had not made it onto the trial I would have proceeded with Eribulin)

And you are also likely to get Zometa infusion to strengthen the bones- in the UK we get 9 months 4 weekly infusion and every 3 months after that.

Take care

[Hidden]

Hi blms -

You've received some good responses here, so let me just add that you might want to buy or download Bestbird's amazing book, The Insider's Guide to MBC.

You can go to the site: insidersguidembc.com/

Then go to the order tab. If you'd like to purchase a hard copy, you can click through, but Bestbird (aka Anne Loeser) generously allows for a free pdf download, which you can get via a link at the bottom of the "order" page...

This book very clearly lays out the current treatment options -- and lots more!

Best,

Lynn

[kduck]

What treatments are you currently on? Like you I have bone and liver mets. My doc want to do IV Chemo taxotere and I just want to do anything besides IV Chemo

[blms in reply to kduck]

I stopped Ibrance about 9 days ago so that will be out of my system before I start IV chemo.

[blms]

yes, I hate thinking about IV chemo again but I am trying hard to adjust. I start 3/22 at 7:30 AM at MedstarLombardi Georgetown. Just not sure why taxotere instead of taxol??

[kduck in reply to blms]

I don’t know! What are the differences? I hope all go well Monday. I’ll private message you one day next week, just to see how you are doing