From the Guidelines
Metastatic breast cancer symptoms vary based on where the cancer has spread but commonly include bone pain, headaches, seizures, breathing difficulties, jaundice, swelling, fatigue, weight loss, and poor appetite. Treatment typically involves systemic therapies including hormone therapy (such as tamoxifen, aromatase inhibitors, or fulvestrant), targeted therapies (like trastuzumab, pertuzumab, or CDK4/6 inhibitors), and chemotherapy (including taxanes, anthracyclines, capecitabine, or eribulin) 1.
Key Considerations
- Treatment selection depends on cancer subtype, previous treatments, and specific metastasis locations.
- Local treatments such as surgery or radiation may address specific symptoms or complications.
- Supportive care is essential and includes pain management, bone-strengthening medications (bisphosphonates or denosumab), and addressing side effects.
- Treatment goals focus on extending survival while maintaining quality of life rather than cure.
- Regular monitoring through imaging and blood tests helps assess treatment effectiveness, with adjustments made as needed.
- The approach is individualized based on the patient's specific cancer characteristics, overall health, and personal preferences 1.
Systemic Therapies
- Hormone therapy: tamoxifen, aromatase inhibitors, or fulvestrant
- Targeted therapies: trastuzumab, pertuzumab, or CDK4/6 inhibitors
- Chemotherapy: taxanes, anthracyclines, capecitabine, or eribulin
Supportive Care
- Pain management
- Bone-strengthening medications: bisphosphonates or denosumab
- Addressing side effects
Monitoring and Adjustments
- Regular imaging and blood tests to assess treatment effectiveness
- Adjustments made as needed to maintain quality of life and extend survival 1.
From the FDA Drug Label
Patients who experienced neurotoxicity in clinical trials and for whom follow-up information on the complete resolution of the event was available had spontaneous reversal of symptoms with a median of 9 weeks from onset (range: 0 to 106 weeks). Severe peripheral motor neuropathy mainly manifested as distal extremity weakness occurred in 4.4% (42/965). Severe asthenia has been reported in 14.9% (144/965) of metastatic breast cancer patients but has led to treatment discontinuation in only 1.8%. Symptoms of fatigue and weakness may last a few days up to several weeks and may be associated with deterioration of performance status in patients with progressive disease.
The symptoms of metastatic breast cancer are not directly addressed in the provided drug label. However, the label does mention symptoms experienced by metastatic breast cancer patients treated with docetaxel, including:
- Neurotoxicity: paresthesia, dysesthesia, pain
- Severe peripheral motor neuropathy: distal extremity weakness
- Severe asthenia: fatigue and weakness Treatment options are also not directly addressed in the label, but it does provide information on the management of symptoms and side effects associated with docetaxel treatment, such as adjusting the dosage or discontinuing treatment in cases of severe toxicity 2.
From the Research
Symptoms of Metastatic Breast Cancer
- Metastatic breast cancer can cause a range of symptoms, including pain, fatigue, depression, insomnia, and pathologic fractures 3
- Bone metastasis is a common site of metastasis, and can cause severe morbidity, including spinal cord and nerve compression syndromes, and life-threatening hypercalcemia 4
- The symptoms of metastatic breast cancer can vary depending on the site of metastasis, with bone being the most frequent site 3
Treatment Options for Metastatic Breast Cancer
- The primary goals of treatment for metastatic breast cancer include prevention and palliation of symptoms, maintenance or improvement of quality of life, and prolongation of survival 5
- Treatment options for metastatic breast cancer include endocrine therapy, chemotherapy, targeted therapy, and radionuclides 4, 5, 6
- Chemotherapy options include anthracyclines, taxanes, capecitabine, gemcitabine, and vinorelbine 5
- Targeted therapies include CDK4/6 inhibitors, PI3K inhibitors, PARP inhibitors, and anti-PDL1 immunotherapy, depending on the tumor type and molecular profile 6
- Patient-reported outcomes (PROs) are important for treatment decision making and outcome, and can support shared treatment decision making and management of symptoms 7
Management of Symptoms
- Symptom management is an important aspect of treatment for metastatic breast cancer, and includes the use of bisphosphonates, denosumab, and radionuclides to manage bone pain and prevent skeletal-related events 4
- The use of PROs can help to identify and manage symptoms, and improve quality of life for patients with metastatic breast cancer 7