Hi! My name is Dr. Erin Ellis, and I have taken care of patients with metastatic breast cancer (MBC) for nearly 30 years beginning in my fellowship at the University of Chicago. In those days, the focus was on complicated chemotherapy regimens, with some selected patients receiving high-dose chemotherapy with stem cell reinfusions. Unfortunately, this avenue did not prove to increase the survival of patients with MBC and was a risky, challenging undertaking. Since then, our approach has evolved dramatically with more targeted options – particularly for those with estrogen receptor positive tumors and for those with HER 2 overexpression. We now see not only improved survival but far fewer side effects and an improved quality of life for most. Those patients with triple negative breast cancer need more options, but perhaps new approaches in immunotherapy with pay off for this group. I worry the most about them!
I have learned a tremendous amount over the years from my patients with breast cancer, especially those living with MBC. It is not an easy feat to live well despite the uncertainty that looms with this diagnosis, and yet so many of you do. This is truly a disease where I can enjoy growing old with my patients – seeing their children grow up, graduate, get married. It is a wonderful intimacy that many other oncologists don’t necessarily experience! Some cancers still carry a dreadful prognosis.
How do patients with MBC do it? I asked a couple of my patients to share their thoughts on “living well.” Andrea is an eight-year survivor of HER 2 positive MBC. Her initial treatment caused me to sprout many new gray hairs as she developed severe allergic pneumonitis after receiving two doses of Herceptin. Luckily, we had other tools in the “tool box,” and she has not only thrived but has written a book to help others. She is active on the national scene, drumming up more support for MBC research. Andrea? “When I first heard the word ‘metastatic,’ I was floored. We are so used to hearing about early detection; it never occurred to me that as a young woman I could actually be diagnosed with metastatic breast cancer. Like most women who hear those words, I was terrified. Almost eight years later, I now know that there are many treatment options and more being developed all the time. I’ve tried to take the fear out of those words by turning my voice to advocacy and spreading the word that there’s definitely hope.”
Lorraine was a new mom nursing her young daughter. Unfortunately, her breast lump – thought to be a blocked milk duct – proved to be breast cancer. She had a particularly nasty case of HER 2 positive breast cancer with weight loss, breathing difficulties and bone pain when we started her treatment. She has benefited not only from standard treatment for this type of MBC but is now on a clinical trial using Tucatinib with Xeloda and Herceptin. Responding beautifully, I should add. At the end of her first chemotherapy regimen, she hired a band and had a dance party in our lobby. Unbridled joy in this photo! Lorraine? “ I attribute my success to the incredible chemotherapies available, along with healthy living and eating and naturopathic remedies to keep the body strong. Equally important though, I have a huge community that assisted and relentlessly supported me during and after chemotherapy. It is important to have people in your corner--if anything, to help organize child care!!”
Mimi has had MBC of the liver for more than 18 years. She relapsed only a year or two after her initial chemotherapy – usually a worrisome sign. But she responded to hormonal therapy for nearly a decade and had continued to respond to many different chemotherapy regimens both on and off clinical trials. Hormone responsive MBC can have a very protracted natural history, and her long response to hormone therapy is more and more common. Mimi is a costumer for Greg Thompson Productions, overseeing the Snowflake Lane at Bellevue Square each holiday season. She and her therapy dog Krista are basically celebrities around the SCI! Mimi? “With a diagnosis of metastatic disease, all I wanted was to know how much time I had left. If you had told me at age 38 that I would still be happy and working at 56, I would have laughed, but a metastatic diagnosis is not what it used to be. Not that it’s always easy, and after over a dozen types of chemotherapy, I am still presented with options. I bring Krista not for me but for everyone at the SCI to bring joy. You can never give up.”
So, over the years, the prognosis of patients with MBC has improved, but we need to do much more to improve their quality of life. One trial that we are starting in the fall will study patients receiving adjuvant chemotherapy who often experience fatigue, memory changes, joint pains, neuropathy and altered dietary habits. The tests will look at changes in the body to see if we can determine why these symptoms occur. If we can understand the pathophysiology of these problems in the adjuvant population, perhaps we can find ways to intervene both in this group and the MBC patient population. Let’s hope so!
Lastly, how you take care of yourself matters. We know that obesity worsens survival in MBC, and adopting a low-fat diet if you have ER-negative disease can lessen the risk of progression. So, diet matters. At the American Society of Clinical Oncology conference this year, we learned that two servings of tree nuts per week could lessen the risk of relapse in colorectal cancer patients. Our friends in nutrition, rehabilitation medicine, naturopathy, and psychiatry not only contribute to a better sense of well-being but may help patients with MBC live longer.
This September, the Swedish Cancer Institute is proud to co-sponsor the second annual Northwest Metastatic Breast Cancer Conference. This fall offers an expanded agenda with both regional and national speakers on topics ranging from nutrition and acupuncture to novel therapies and how you can get involved in the push to further breast cancer research. Very few conferences in the nation are devoted to metastatic breast cancer alone with the special issues facing patients with this disease. We are also delighted to have Amazon Web Services this year lending their thoughts on how big data can help improve the lives of those with MBC.
I hope you will attend this excellent conference in September! The conference will be an opportunity for MBC patients, families and caregivers to get the most current information on treatments, research trials, patient support and national issues for metastatic/stage IV breast cancer (MBC). See you there!
To register or learn more about the event, please visit http://komenpugetsound.org/nwmbcc/.