Managing Persistent Breast Cancer: Treatment Challenges and Options

Recurrent during treatment?

In late 1994, I discovered I had a tumor, and the doctor said it was stage III, so I started chemotherapy.
The first four cycles included cranberry extract, 5-FU, and possibly platinum-based drugs.
However, the tumor did not shrink, and my CA 15-3 levels rose to over 260.
Then, I switched to European Taxol (and another drug I forgot) and after two cycles, the doctor said the tumor had shrunk, so I underwent surgery.
During the surgery, they removed 29 lymph nodes, all of which were infected, but in reality, the tumor had not shrunk.
The doctor mentioned I would need 6-8 more cycles of chemotherapy.
However, when it was time for the second cycle post-surgery, I had a severe cold, yet I still went through with the chemotherapy, which nearly killed me.
I consulted a pulmonologist for over two months with no improvement and had to treat it as tuberculosis, during which time I received no treatment for the cold.
After recovering from the cold, the doctor stopped chemotherapy and switched me to oral medication to control the tumor.
I then started taking Gefitinib, but unexpectedly, after my first dose last year, I found out the cancer had metastasized to the other side of my neck, and I underwent radiation therapy.
At the end of last year, after finishing Gefitinib, I discovered a small lump had reappeared in the breast where I had surgery in early January.
Recently, I found another lump in the opposite breast.
Doctor, I have several questions:
1.
Is surgery necessary? If I do not undergo surgery, would it be worth trying the new medication to see if it is effective?
2.
Will the effectiveness of oral chemotherapy drugs be reduced?
3.
I am still undergoing treatment, but the tumor continues to grow.
Does this mean that the previous medications were ineffective?
4.
Is it because I have no effective medication that the doctor decided to switch to oral drugs to maintain my quality of life instead of continuing chemotherapy?
5.
I feel like I have tried all available medications.
Should I consider paying out of pocket for treatment to find something that works?
6.
If I do not pay out of pocket, what suggestions does Dr.
Wu have?
7.
If I choose to pay out of pocket, what are the doctor's recommendations regarding Lapatinib and Sutent, or any other suggestions?
8.
What conditions must be met to participate in a clinical trial?
9.
Has the doctor encountered cases like mine, where there is continuous metastasis but no noticeable symptoms?
I apologize for the numerous questions, and I greatly appreciate your answers to help clarify my doubts.
Thank you very much.

len, 40~49 year old female. Ask Date: 2008/03/12

Dr. Wu Jingtang reply Breast and Thyroid

Dear Miss Len,
First of all, I would like to express my highest respect for your fighting spirit! Of course, I also want to give you my greatest encouragement! The recurrence of cancer during treatment indicates that the previous medications may have been insufficient, which is certainly related to the nature of this cancer! Currently, a tumor has developed in the opposite breast, and I still recommend surgical excision followed by treatment based on the characteristics of this newly developed tumor, as the characteristics of the new tumor may not necessarily be the same as those previously encountered.

Since you have already undergone various treatments, the effectiveness of oral chemotherapy agents is not guaranteed to be diminished, as different drugs have varying mechanisms of action.
I hope this approach can help identify suitable medications for you.
Furthermore, these oral chemotherapy agents have been validated through clinical trials and should be available for use!
Regarding the Lapatinib and Sutent you mentioned, each has its own advantages and disadvantages.
Currently, in Taiwan, they are considered to be in the clinical trial phase (with preliminary results available abroad).
Of course, to participate in a clinical trial, you must meet the criteria set for each medication! You can consult your attending physician or a nearby medical center to get involved! There are certain risks associated with this, but you can discuss and make a decision with the physician leading the trial!
Cases like yours, which involve continuous metastasis, are indeed very challenging! I greatly admire your perseverance and also commend the dedication of your attending physician! Finally, once again, I cheer you on! Open and honest discussions with your physician and cooperation should be the best strategy! Wishing you all the best!
Sincerely,
Dr.
Wu Ching-Tang
Attending Surgeon, Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2008/03/12

More Info

Managing persistent breast cancer, especially in advanced stages, poses significant challenges for both patients and healthcare providers. Your situation, characterized by recurrent tumors and multiple treatment regimens, is complex and requires a nuanced understanding of cancer biology, treatment options, and patient quality of life.

1. Surgical Intervention: The decision to undergo surgery after multiple treatments should be carefully considered. If the tumor is localized and operable, surgery may provide a chance to remove the cancerous tissue. However, if the cancer has metastasized or if there are significant health risks associated with surgery, it may be more beneficial to explore systemic therapies first. Discussing the potential benefits and risks of surgery with your oncologist is crucial. They can provide insights based on the tumor's characteristics and your overall health.

2. Oral Chemotherapy Effectiveness: Oral chemotherapy can be effective, but its efficacy may vary based on the specific drugs used and the individual’s response. If you have been on oral medications and the tumors continue to grow, it may indicate that the current regimen is not effective. It’s essential to have open discussions with your healthcare provider about the effectiveness of your treatment plan and whether adjustments are necessary.

3. Indications of Treatment Efficacy: Persistent tumor growth despite treatment can be disheartening and may suggest that previous therapies were not effective. However, cancer treatment is not always linear, and some patients may experience periods of stability or response after initial resistance. Continuous monitoring and imaging are essential to assess the effectiveness of any treatment.

4. Quality of Life Considerations: Your healthcare team may prioritize your quality of life when considering treatment options. If aggressive chemotherapy poses significant risks to your health, they may opt for less intensive treatments that manage symptoms and maintain quality of life rather than pursuing aggressive regimens that may not yield substantial benefits.

5. Cost of Treatment: The decision to switch to self-funded treatments can be challenging. While some newer therapies may not be covered by insurance, they might offer additional options that could be more effective. Discussing the potential benefits and risks of these treatments with your oncologist is essential. They can help you weigh the costs against the potential benefits.

6. Targeted Therapies: Lapatinib and Sutent are examples of targeted therapies that may be considered based on the specific characteristics of your cancer. Lapatinib is often used in HER2-positive breast cancer, while Sutent is typically used for renal cell carcinoma and gastrointestinal stromal tumors. Your oncologist can provide guidance on whether these options are appropriate for your situation.

7. Clinical Trials: Participating in clinical trials can provide access to cutting-edge therapies that are not yet widely available. Eligibility for trials often depends on specific criteria, including the type of cancer, previous treatments, and overall health. Your oncologist can help identify suitable trials and guide you through the application process.

8. Similar Cases: Many patients experience persistent disease despite treatment, and it is not uncommon for oncologists to encounter such cases. Each patient's journey is unique, and while some may have stable disease for extended periods, others may experience rapid progression. Your healthcare team can provide support and resources to help you navigate this challenging journey.

In summary, managing persistent breast cancer requires a collaborative approach involving your oncologist, surgical team, and possibly other specialists. Open communication about your concerns, treatment preferences, and quality of life is essential in making informed decisions about your care.

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