Metastatic breast cancer is breast cancer that has spread from the breast to distant parts of the body. It is also called stage IV breast cancer. Common areas where breast cancer can spread include the bones, lungs, liver, and brain.
Treatment for metastatic breast cancer depends on several factors, including the type of breast cancer, hormone receptor status, HER2 status, genetic or molecular characteristics, where the cancer has spread, previous treatments, and overall health.
This guide explains common metastatic breast cancer treatment options, factors that influence treatment decisions and costs, and the role of supportive care and clinical trials.
What Is Metastatic Breast Cancer?
Metastatic breast cancer occurs when cancer cells travel from the original breast tumor through the blood or lymphatic system and form tumors in other parts of the body. Even when the cancer spreads to another organ, it remains breast cancer. For example, breast cancer that spreads to the lungs is still considered metastatic breast cancer rather than lung cancer.
Some people develop metastatic disease after previously being treated for early-stage breast cancer, while others are diagnosed with metastatic breast cancer when they are first diagnosed.
How Doctors Determine Treatment
There is no single treatment plan for everyone with metastatic breast cancer. Doctors typically consider several characteristics before recommending therapy.
Important factors may include:
- Hormone receptor status
- HER2 status
- Genetic or molecular changes
- Location and extent of metastases
- Previous cancer treatments
- Symptoms and complications
- Overall health and treatment preferences
These factors can influence whether hormone therapy, targeted therapy, chemotherapy, immunotherapy, radiation, surgery, or combinations of treatments are considered.
Main Metastatic Breast Cancer Treatment Options
Hormone Therapy
Hormone therapy may be used when metastatic breast cancer is hormone receptor-positive. These treatments work by interfering with hormones that can contribute to the growth of certain breast cancer cells.
Examples include tamoxifen, aromatase inhibitors, and fulvestrant. In some cases, hormone therapy is combined with targeted medicines. The specific treatment depends on the cancer's characteristics and previous treatment.
Targeted Therapy
Targeted therapies are designed to act on particular proteins, receptors, or genetic changes associated with cancer cells.
For example, HER2-targeted treatments may be used when testing shows HER2-positive disease. Other targeted medicines may be considered when specific mutations or biomarkers are identified.
Because treatment options depend on tumor characteristics, biomarker and genetic testing can be an important part of treatment planning.
Chemotherapy
Chemotherapy uses medicines that travel throughout the body to destroy or slow the growth of cancer cells. It may be used for metastatic breast cancer depending on factors such as cancer subtype, previous treatment, symptoms, and how quickly the disease is progressing.
For some hormone receptor-negative cancers and certain situations involving symptomatic or rapidly progressing disease, chemotherapy can be an important treatment option.
Immunotherapy
Immunotherapy uses medicines that help the immune system recognize and attack cancer cells. It may be appropriate for certain patients with metastatic triple-negative breast cancer, depending on characteristics of the tumor.
The suitability of immunotherapy depends on individual test results and the patient's overall treatment plan.
Radiation Therapy and Surgery
Although systemic medicines are often the primary treatment for metastatic breast cancer, local treatments can sometimes be used for specific tumors or symptoms.
Radiation therapy may help control pain or other problems caused by cancer that has spread to areas such as the bones or brain. Surgery may also be considered in selected situations, including certain symptomatic tumors or complications.
The purpose of local treatment should be discussed with the cancer care team because it may be intended to control a specific problem rather than treat cancer throughout the body.
Supportive and Palliative Care
Supportive care is an important part of metastatic breast cancer treatment. It focuses on managing symptoms, treatment side effects, and other challenges associated with advanced cancer.
Palliative care can be provided alongside cancer treatment and may address:
- Pain
- Fatigue
- Nausea
- Emotional concerns
- Sleep problems
- Nutrition
- Other quality-of-life issues
The NCI notes that palliative care can be provided at any stage of cancer and can be used alongside cancer treatment.
Understanding Metastatic Breast Cancer Treatment Costs
Treatment costs in the United States can vary considerably. Expenses may depend on the type of therapy, treatment frequency, hospital or clinic, insurance coverage, medications, laboratory testing, imaging, and other medical services.
Patients may want to ask their healthcare provider or insurance company about:
- Expected treatment costs
- Insurance coverage
- Deductibles and coinsurance
- Prescription coverage
- Out-of-pocket maximums
- Financial assistance programs
Comparing costs should not mean choosing treatment based only on price. Medical suitability and the recommendations of the cancer care team are important considerations.
Clinical Trials
Clinical trials can provide access to new treatments or combinations that researchers are studying. Trials may examine new medicines, treatment strategies, or approaches to managing symptoms and quality of life.
Eligibility varies according to factors such as cancer subtype, previous treatments, overall health, and other medical characteristics. Patients can ask their oncologist whether a clinical trial may be appropriate.
When Treatment Needs to Change
Metastatic breast cancer treatment may change when the cancer progresses or when side effects make a particular therapy difficult to continue. Doctors may then consider another treatment, depending on the cancer's current characteristics and previous therapies.
Because metastatic breast cancer can change over time, ongoing monitoring and communication with the healthcare team are important.
Final Thoughts
Metastatic breast cancer treatment can involve hormone therapy, targeted therapy, chemotherapy, immunotherapy, radiation therapy, surgery, supportive care, and clinical trials. The appropriate combination depends on the specific characteristics of the cancer and the individual patient's health and treatment goals.
When comparing treatment options and costs, patients should consider medical suitability, potential benefits and side effects, insurance coverage, and overall quality of life. A qualified oncologist can explain which options may be appropriate for a particular diagnosis.
This article is intended for general educational purposes and should not replace personalized medical advice from a qualified healthcare professional.