Oligometastatic Breast Cancer - right line of treatment?

Daniel86

Hey everybody!

As I mentioned in a couple of other posts, my wife was just diagnosed with Stage IV de novo BC. They found what it looks like a single met limited to the upper edge of her left femur.

Now, granted I might be reading too much into it as I have been trying to gain some control over this effing demon by increasing my knowledge over it, but I was going through Anne's guide to MBC and it came to my attention the tendency to think of oligometastatic BC patients as kind of borderline into stage IV. My wife was just given a first line treatment with Femara and Inbrace followed by radiotherapy as she is HR+/Her-2 Neg. Is that the same experience others have had with this? I am just debating whether the no-chemo approach is the correct one given the so far contained presence of mets.

Don't know if this is making any sense. I am spent

Daniel

Husband11

Would a circulating tumor cell test make any sense here? Just throwing that out there.

Daniel86

What is that? I mean, I get what the name implies but I am not familiar with it at all.

Moderators

Hi Daniel,

For some more information, you can read about circulating tumor cell tests and other blood marker tests on the main Breastcancer.org site's page on Blood Marker Tests.

We hope this helps!

--The Mods

exbrnxgrl

Hi Daniel,

I also have a single bone met to my upper left femur. Ibrance had not been approved when I was dx'ed almost 7 years ago. I had radiation to the femur met to render it necrotic (no pain or other symptoms, they just wanted to kill it). I was on Arimidex for 2 years and have been on Femara for almost 5 years. I also had two years of monthly infusions of a bone strengthener (pamidronate, an older drug which is not used much anymore). I have been NEAD since the radiation and lead a mostly, normal life. My mo thought this was the best course of action, but thought chemo would not be unreasonable and my second opinion mo concurred. I felt that chemo would always be there and since my tumor was not aggressive (grade 1), I went with the least life disrupting tx first. Here I am, almost 7 years later and pleased with my tx. I should add, that no one can predict in advance, if a tx will work or not and I will do chemo when and if necessary. There are quite a few members who have limited mets and went the AI (aromatase inhibitor) route, never had chemo and are doing well. This is in no way predictive of how your wife might do if she chooses a similar course, but it has been very effective for some. Have you had a second opinion? Take care.

Goodie16

Hi Daniel,

I had a single met to my brain that was HR+/Her2-. My only treatment, aside from surgery, has been the hormonals. First I tried tamoxifen and after struggling with side effects I switched to Arimidex. I have been on it since August 2016 with no problems. My onc is of the belief to leave "tools in the toolbox until you need them." That being said, I'm monitored every 2 months via tumor marker blood tests. My brain is scanned every 6 months and my entire body every year. I should also note I had GammaKnife radiation to the tumor bed after my craniotomy to remove the met.

I have been NED in my body since 2015. My brain may also be NED, but a questionable spot showed at my last scan. My neuro onc isn't 100% sure if its a new growth in the tumor bed or scar tissue, so he moved my next scan from 6 months to 4 months. Fingers crossed that it's just scar tissue. I

The hormonals are powerful drugs and fight the HR+ cancers very well.

Best of luck to your wife.

Daniel86

Thanks everyone for the quick replies!

exbrnxgrl - I remember reading about your diagnosis and thinking my wife's sounded similar to your case (she is also G1), so that gave me a lot of encouragement. I have been thinking about getting a second opinion but I feel like it needs to come from my wife as I don't want to impose on her and at the moment she seems okay with the decision (she got chemo for a lymphoma 12 years ago, so she is not keen on the idea to beging with and she felt relieved when she was offered Hormonal treatment instead). I will definitely try to bring it up as I think it's best to act upon when you still might have the upper hand (yeah, I know, that is never necessarily true with MBC).

Goodie16 - thank you for sharing your experience. I am really sorry about the ambiguity of the latest results. You sound like a pro but I know it sucks to have to wait. Please, keep us posted and best of luck to you too.

Husband11

My thoughts stem from the desire to know if there is anything out there that you haven't been able to detect so far. Elevated tumor markers or circulating tumor cells would suggest some residual disease that needs monitoring, and possibly a higher level of treatment such as chemo.

Has the oncologist suggested chemo might be appropriate? Or is that entirely something you are pondering based on reading Anne's guide?

ABeautifulSunset

I had one single met to my acitabulum at time of diagnosis. I was 47 and went full bore bilateral mast and pretty hard core chemo. Still had a recurrence 4 years later, so in retrospect...probably didn’t need to be so aggressive. If I had to do it over, I like exbrnxgrl’s route. Then again, we are all different. A second opinion is ALwAYS a good idea.

Even tho I’ve had some progression, I’m still oligo, and it’s been almost 7 years. Hang in there.

Sunset

exbrnxgrl

husband11,

Oh that we could detect all that might be out there! CTC and/or tumor markers are not accurate for many, which is why some mo's choose not to do them. If they do use them, and numbers are climbing, then the next step is usually a PET scan. My mo just does regular PET scans (initially every 3 months, then every 6 months and we are about to go to once a year). I know we all want to be as proactive as possible, but we don't yet have the medical knowledge to "catch" mets at at a very early stage. Nor does finding it early seem to increase ones chances of survival. Terribly frustrating when we want to be actively doing something to improve our chances and increase our lifespans, but the ugly reality of this disease.

Sunset,

Glad to hear that you are doing well now. You know, as per medical advice, I could have gone either way. I did what I felt was right at the time (i tend to be a "less is more type of person."). But I had no guarantees about the ultimate efficacy of either tx. I consider myself just plain lucky since I have probably done less, via medical intervention, lifestyle etc.) to fight bc. I should add that I have led and continue to lead a fairly healthy lifestyle, but am not compulsive about things. I just try to be happy as much as I can.