Stage IV De Novo Breast Cancer - Bone Mets

bydand

Hi, I'm new to these forum! My mom was recently diagnosed with de novo stage IV breast cancer with bone mets (<5 on her ribs and pelvis). She's 65 and got a mammogram after finding a lump in her breast. Mammogram showed multifocal tumor (5 foci, largest one ~3cm). Later she had a PET that showed the mets. She was asymptomatic other than mild Hypercalcaemia.

They were initially planning to do a mastectomy but upon the PET results, they decided to proceed with chemotherapy. She will be getting AC followed by Paclitaxel every week. Tumor is ER+, PR+, HER2-.

Has anyone had a similar experience? What can I we expect in terms of prognosis?

Cure-ious

Bydand, I don't know the details of multifocal tumors, but I would get a second opinion with a specialist in breast cancer at a major center before doing anything. This sounds potentially oligometastatic, and you might get very different recommendation to move ahead with surgery and radiation followed by targeted drugs and treat this with curable intent. Others will weigh in soon...

bydand

She is being treated with a curative intent for now since she is oligometastatic. Her oncologist said that based upon how she responds to chemo, the next steps may be surgery and radiation.

Cure-ious

awesome! do be aware the new recommendations are to definitely get that primary tumour out...

PS presuming any is left after chemo!

Heidihill

Hoping all tumors get their comeuppance and more. In my (oligometastatic) case the tumors disappeared with chemo but I still had surgery and radiation to "clean up." I'll never know I suppose if these were necessary but I'm still here 11 years later without a recurrence.

Cure-ious

Wow Heidihill, that is amazing, especially as you are ER-positive, its more often the case to hear these stories for the HER2-positive cancers. Maybe they will get the blood test/biopsys to the point where they can determine if you are cured..

Bestbird

For low-burden hormone receptor positive disease, endocrine therapy (not chemotherapy) is the standard of care. And for bone metastasis, a bone-directed therapy such as Xgeva or Zometa is used in tandem with systemic therapy.

I would highly recommend a second opinion, as the use of chemotherapy in the first-line setting for her particular circumstances is questionable.

Below is an excerpt about this from my book, "The Insider's Guide to Metastatic Breast Cancer," which is available in eBook or paperback formats at Guide on Amazon It is also available upon request, free of charge in .pdf format by emailing bestbird@hotmail.com

"In many cases, patients with hormone receptor positive breast cancer respond well to hormonal therapies. The concept behind hormonal ("endocrine") therapy is to starve the cancer cells of the estrogen hormone they need in order to thrive. Except for highly symptomatic disease, hormonal therapies (with or without CDK4/6 inhibitors) are normally the first-line therapy for both premenopausal and postmenopausal patients, even when there is visceral disease (i.e. disease in the soft internal organs such as the lung or liver).In general, if first-line therapy is endocrine therapy instead of chemotherapy, patients will have a better quality of life (QOL). Although randomized studies have been few and far between, the ones that have been done suggest that survival is the same, and some data show that survival is better. From a QOL standpoint, it is felt that endocrine therapy is the best initial treatment for most patients."

pajim

Bydand, I'd put in another plug for a second opinion. She has a bunch of mets so calling it oligometastatic is possible but questionable. For women who have ER+ cancer hormonal therapy does much more good than chemotherapy. Not to mention that ACT is a tough one. [Good for lower stage women whom they CAN cure]

bydand

Thank you all so much for your replies! I voiced my concerns to her MO. He told me that they are approaching her with a curative intent since she is oligometastatic with only bone mets and think that her cancer is slow growing. After course of chemo they will repeat the PET scan and based on the results decide on surgery +/- radiation. It sounds like hormonal therapy will come after chemo

bydand

Thanks for all the support! Just wanted to share the wonderful news that my mom is NED after completing AC + T!!! According to the PET scan there is (almost) complete response of both the primary tumor and the bone mets. Now the doctors are considering mastectomy...

Moderators

bydand, thank you for sharing such fantastic news! It's always inspiring to see that treatment helps!

Best wishes, and please keep us posted!

The Mods

OnTarget

That's great!!